政府投入兼顾医疗服务供方和需方的可操作性研究

政府对卫生费用投入的有限性,决定了其对供需双方补给的局限性.文章通过分析政府投入只补给供方或只补给需方产生的主要问题,试图探索政府投入兼顾医疗服务供方和需方的可操作性方式,使其更好地抑制医疗费用,服务群众.     

对“供需兼补”有关问题的思考

针对政府对医疗卫生事业的投入问题，通过对补供方、补需方的必要性和补助标准的分析，认为：补需方的基本依据是为了满足国民的基本医疗需求．补供方的基本标准是为了适应满足国民的基本医疗需求。而使二者相互协调、平衡发展则应是政府要坚持的基本原则。     

换个思路看补偿之争

卫生部部长陈竺在向全国人大常委会提交的“关于城乡医疗卫生体制改革和加强食品药品安全监管情况的报告”中，就人们关心的新医改方案中政府补偿问题，明确提出了“政府投入兼顾医疗服务供方和需方”。在许多人看来，“补需方”的提出者和推动者反对“补供方”，意味着政府财政一分钱都不能投入供方。实际上，“补需方”的提出者和推动者真正反对的是一种特殊的补供方方式，     

试论医院的发展方向

医疗市场的运作和发展要受到多种因素的影响 ,其中宏观卫生政策和医疗卫生需求是重要的两个方面。国家经济的发展、卫生政策的变化、人们对健康需求的提高 ,给医疗市场的发展提供了新的契机。医疗机构如何抓住机遇、迎接挑战、调整方向、健康发展值得思考和探索。从经济学的角度来看 ,在医疗市场中医院是供方 ,病人是需方 ,医院和病人的关系是供需双方的关系 ,需方的需求是供方进行自我调节的方向 ,而供方的发展方向又引导着需方的进一步需求 ,两者相辅相成 ,互为制约 ,互为重要。国家八部委《关于城镇医药卫生体制改革的指导意见》的出台和…     

经济学视角下的新型农村合作医疗制度

从经济学视角分析新型农村合作医疗的制度设计：政府直接投资需方间接帮助了供方，有利于缓解有效需求不足造成农村卫生服务供过于求的假象；医疗救助是新型农村合作医疗基金不出险的保证；“保大不保小”易引致过度医疗行为，不利于“预防为主”卫生方针的落实；报销手续繁琐增加了管理成本。     

卫生筹资政策对公平性的影响

供方筹资政策和需方筹资政策是当今世界各国采取的主要卫生筹资政策,而这些政策或多或少都没有把公平性有机融合进去,由此产生了以下几方面的影响：健康不公平性明显,卫生公布不公平影响了卫生服务的可及性和可得性,医疗费用上涨造成新的不公平性等。为完善卫生筹资政策,增加社会公平性,应重视基本医疗服务和预防保健服务的提供;卫生筹资政策应更多地倾向于穷人和低收入者等脆弱人群,积极推行各种形式的预付制等。     

基本医疗补需方也要补供方

经常听到人们争论卫生筹资体制应该补需方还是补供方的问题，双方各执一词，各有道理。但是在现实生活中，这并不是一个真问题。因为虽然理论上可以进行抽象争论，而现实生活总是丰富多彩的，解决问题的办法也是综合的，世界上多数国家往往是既补需方也补供方。     

对公立医院改革要有实质性措施

解决看病难和看病贵问题,必须是医疗服务的购买能力和供给能力同步发展,协调平衡。针对当前许多人缺乏医疗保障（购买能力不足）以及部分地区医疗机构服务能力低下（供给不足）的情况,作为主导医疗卫生事业发展的政府,无论是补需方,还是补供方都是有道理可言。补供方和补需方,并不是非此即彼的关系。     

试析支付方式对卫生服务供给的影响

卫生费用支付方式是患者(需方)或医疗保险机构对医疗服务提供者(供方)支付医疗服务费用的方式。医疗费用的支付方式是医疗保险制度改革的重要环节，也是影响医疗目标实现的重要因素之一，对医疗机构的医疗服务行为具有一定的影响。如何有效地改革和完善医疗费用支付方式，在供方、需方、医疗保险机构之间形成有效的利益约束机制，使基本医疗服务费用保持在当地适当水平，从而有效地使用有限的卫生资源，确保满足需方的基本医疗需求、     

德宏州中缅跨境婚姻人群HIV感染及卫生服务利用现况和影响因素的定性研究——基于供需双方视角

目的 探讨德宏傣族景颇族自治州(德宏州)中缅跨境婚姻人群HIV感染及卫生服务利用的现况和影响因素。方法 以Andersen卫生服务利用行为模型为理论框架,对德宏州卫生服务机构工作人员(供方)进行焦点小组访谈,对中缅跨境婚姻人群(需方)开展一对一访谈,对访谈文本进行主题分析。结果 共招募40人,其中供方7人,需方33人;需方受访者中女性13人,平均年龄(38.61±5.74)岁,男性20人,平均年龄(39.30±5.90)岁。德宏州跨境婚姻人群对中国的医疗保险政策满意,获得的社会支持较好、健康信念水平较高,对其卫生服务利用产生了影响。同时,影响该人群HIV感染的因素有AIDS知识欠佳、追踪溯源、检测工作不足等。结论 德宏州对跨境婚姻人群的管理工作取得了一定成效,在当地获得卫生服务的公平性较高,但仍应加强多部门合作,多维度解决身份识别、婚检、溯源等管理工作上的困难,加强对该人群的卫生服务保障。     

Selected myths guiding the Reagan Administration's health policies

This article analyzes four major assumptions that guide the Reagan Administration's health policies: 1) the Administration received an overwhelming popular mandate to reduce the federal role in the U.S. health sector; 2) the size and growth of federal social (including health) expenditures are contributing to the current economic recession; 3) the costs to business of federally imposed health and safety regulations have contributed to making the U.S. economy less competitive; and 4) market intervention is intrinsically more efficient than government intervention in regulating the costs and distribution of health resources. Based on these assumptions, the main characteristics of the Reagan Administration's health policies have been 1) a reduction of federal health expenditures and, very much in particular, expenditures to the poor, handicapped, and elderly; 2) a weakening of federal health and safety regulations to protect workers, consumers, and the environment; and 3) the further privatization and commodification of medical services. This article shows that there is no evidence to support the assumptions on which these policies are based. Quite to the contrary, all available evidence shows the opposite: 1) the majority of Americans want an expansion of federal health expenditures and a strengthening of federal health regulation; 2) U.S. government expenditures and regulations are much more limited than those of other countries whose economies are performing more satisfactorily; and 3) those countries with larger government interventions have more efficient health care systems than the American one, where the "free market" forces are primarily responsible for the allocation of resources. Thus, major Reagan Administration health policies are based on myth rather than reality.     

Behavioural Economics and Human Decision Making: Instances from the Health Care System

Over the last two decades behavioural economics has gained much momentum among scholars because of its innovative and controversial ways of explaining processes and mechanisms underpinning individuals’ judgements and decision making. Thanks to these features, behavioural economics has been applied to diversified domains, namely finance, public choice and marketing. Although the intrinsic characteristics of the health care sector, ranging from incomplete and asymmetrical information to high frequency of critical choices, make the sector a fertile ground for behavioural economics applications, research on the influences of behavioural economics on health care and clinical decision making are still rather fragmented. Therefore, through an interdisciplinary literature review integrating behavioural economics research with medical and behavioural decision-making studies, this article contributes to behavioural decision-making literature by providing a wide overview of how behavioural economics strategies may impact, and be implemented in, diverse health care circumstances. Examples of behavioural economics applications to health care circumstances include: organ donation and transplantation; habitual choices; individuals’ loss aversion and trust; present-biased preference; decision fatigue and excessive choice. Hence, this article aims to promote the effective behaviour of both consumers and providers in health care.     

How consumers evaluate health care quality: Part II

This article is the second in a series which examines the way in which consumers assess information regarding the quality of health care services. In the previous article it was demonstrated that, in the view of health care consumers, three major perceptions held by health care consumers, are: (1) substantial differences in quality exist among health care providers, (2) little information is available that allows for the comparison of health care providers on issues related to quality, and (3) when such information is available it is found to be useful and often serves as the basis for decision regarding the choice of health care providers. We further discussed the short coming of marketing strategies based on complex quality indicators and the difficulties of image advertising in an age of institutional mistrust. The reader is reminded that these findings relate to the subjective assessments of consumers, not to objective facts concerning health care delivery.     

基于经济伦理学角度对我国卫生制度的考察与建议

该文从经济伦理学角度提出经济伦理学对卫生制度的指导原则,并通过剖析我国卫生制度公平与效率的困境与矛盾,具体提出加大政府对公共卫生的投入、卫生供给主体多元化、构建合理的卫生服务体系和保障体系、建立有效的医疗服务信息机制、提高政府对贫困人口和弱势群体的转移支付等五项建议,以改善卫生资源配置公平性并提高卫生服务效率和质量.     

Enhancing health programme efficiency: a Cambodian case study

In 1995, the Cambodian Urban Health Care Association (CUHCA) was set up as facilitator between private health care providers and patients, guaranteeing good quality health care and fair pricing to patients and providing training and logistic support to providers. Providers were engaged on a fee-for-service basis and competition encouraged. CUHCA's objectives followed the same line of thought as the 1993 World Development Report, aiming at influencing the unregulated private health care market through competition mechanisms. But soon after the start of the project the basic problem was recognized to be not the absence of effective government regulation but rather that consumers lack the requisite knowledge to make good choices in the market for health services. CUHCA had not adequately addressed the demand for health services. The original supply-side strategy of improving health services by increasing competition was a failure. In order to improve CUHCA's health programme efficiency the association's objectives were subsequently redefined and its functioning reorganized. CUHCA now tries to educate consumers and provides good quality services so that consumers will be able to act on the basis of their newly acquired knowledge. CUHCA's health centres serve as model clinics for first-line health care. Community educators organize information, education and communication (IEC) activities. Staff help school teachers to improve formal health education in schools and CUHCA assists local leaders in sanitation development. Only full-time personnel are employed, encouraging team spirit and communication with the target population. Salaries are based on team performance. The CUHCA programme demonstrates that, depending on the market situation, health programme models need to address both the supply and the demand for services in order to be efficient. Where consumers lack essential knowledge to make appropriate choices in the health service market, interventions should focus on health education and social marketing and provide models of quality care catering to informed consumer choice.     

Economics and ethics in mental health care: traditions and trade-offs

BACKGROUND: Both economic and ethical perspectives are exerting increasing influence at all levels of mental health policy and practice; yet there is little consensus on how these two different perspectives are to be reconciled or explicitly incorporated into decision-making. AIM: This review article is directed towards a fuller understanding of the complex trade-offs and compromises that are or may be made by clinicians, managers and policy-makers alike in the context of mental health care planning and delivery. METHOD: We briefly outline a number of key principles of health care economics and ethics, and then focus on the particular incentives and trade-offs that are raised by these principles at three levels of the mental health system: government and society; purchasers and providers; and users and carers. RESULTS: At the level of government and society, we find (economically influenced) attempts to reform mental health care offset by concerns revolving around access to care: whether society is prepared to forgo economic benefits in exchange for improved equity depends to a considerable extent on the prevailing ethical paradigm. The implementation of these reforms at the level of purchasers and providers has helped to focus attention on evaluation and prioritization, but has also introduced "perverse incentives" such as cost-shifting and cream-skimming, which can impede access to or continuity of appropriate care for mentally ill people. Finally, we detect opportunities for moral hazard and other forms of strategic behaviour that are thrown up by the nature of the carer:user relationship in mental health care. CONCLUSION: We conclude by highlighting the need to move towards a more open, accountable and evidence-based mental health care system. Acknowledgement of and progress towards these three requirements will not deliver ideal levels of efficiency or equity, but will foster a greater understanding of the relevance of ethical considerations to mental health policies and strategies that are often influenced strongly or solely by economic arguments, whilst also demonstrating that equity must come at a price.     

Policy issues relevant to evaluation of interactive health communication applications

This article provides an analysis of policy-related issues associated with the evaluation of interactive health communication (IHC) applications. These include an assessment of the current health and technology policy environment pertinent to public (government, education, public health) and private (medical care providers, purchasers, consumers, IHC developers) IHC stakeholders and discussion of issues likely to merit additional consideration by these stakeholders in the future.     

An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care

Advocates of health reform continue to pursue policies and tools that will make information about comparative costs and resource use available to consumers. Reformers expect that consumers will use the data to choose high-value providers-those who offer higher quality and lower prices-and thus contribute to the broader goal of controlling national health care spending. However, communicating this information effectively is more challenging than it might first appear. For example, consumers are more interested in the quality of health care than in its cost, and many perceive a low-cost provider to be substandard. In this study of 1,421 employees, we examined how different presentations of information affect the likelihood that consumers will make high-value choices. We found that a substantial minority of the respondents shied away from low-cost providers, and even consumers who pay a larger share of their health care costs themselves were likely to equate high cost with high quality. At the same time, we found that presenting cost data alongside easy-to-interpret quality information and highlighting high-value options improved the likelihood that consumers would choose those options. Reporting strategies that follow such a format will help consumers understand that a doctor who provides higher-quality care than other doctors does not necessarily cost more.     

Improving transfer of mental health care for rural and remote consumers in South Australia

In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care.