奥巴马医疗改革浅析

美国国内的众多因素促使奥巴马进行医疗改革,建立全民医保。奥氏改革方案通过了众议院的投票,开始进入众议院辩论阶段。该法案主要是建立高质量的、可支付的、所有人都参加的医疗保险。尽管已经获得通过,但是两党关系、利益集团、民众以及资金都制约着奥氏改革,改革的前景扑朔迷离。     

希腊卫生筹资机制改革的主要影响因素分析

以希腊1983年NHS建立为界点,分两个时期描述影响健康保健制度筹资机制改革的政治、经济等各种相关因素.通过分析发现:政治因素居于主导地位,各政党的改革理念和管理能力,利益集团的配合程度对希腊健康保健制度筹资机制的形成起到了关键作用.     

卫生防疫机构人事制度改革的措施

为加快防疫站各项事业的发展 ,适应当前人事制度改革形势 ,加强单位内部科学管理 ,最大限度地调动和发挥防疫站职工的主观能动性 ,以便公开、公正、公平地培养和选拔中层干部 ,积极贯彻落实中组部《深化干部人事制度改革纲要》和中组部、人事部、卫生部《关于深化卫生事业单位人事制度改革的实施意见》,我们在中层干部任用和职工用人制度上进行了改革 ,取得了初步成就。1　制订改革方案1.1　调查摸底由于人事制度改革涉及到每位职工 ,因此了解每位职工对改革的心态十分重要。在改革方案出台前 ,我们在各种会议场合作宣传 ,向中层干部、职工…     

在治理整顿中完善医院承包责任制

在治理整顿中如何完善医院经营承包责任制,是深化医院改革必须解决的一个问题。笔者想借助沈阳地区医院实行承包责任制的情况,推而广之地谈点不成熟看法。一、承包经营责任制是深化医院改革的优化选择纵观9年来沈阳卫生改革的历程,各种不同的医院改革方案先后出台,通过实     

对突破医院改革路径依赖的思考

随着市场经济体制建立以及国际竞争的导入,医院改革的步伐越来越快,触及程度越来越深入,面临的矛盾也越来越尖锐,医院改革过程中产生的路径依赖问题是当前医院改革面临困境的重要原因.该文认为特殊利益集团的反对、传统保守的观念以及初期选择的路径是产生医院改革路径依赖的关键,并针对路径依赖产生的原因提出了思考和建议.     

政府手里有三种工具

<正>目前,全国很多地区都在探索建立分级诊疗制度,但改革的出发点有所不同,改革的成效和难点也会不一样。有些地方改革出发点是为了缓解老百姓看病难,让老百姓在家门口就能看病。这种从患者的角度推行分级诊疗的改革,要避免两种可能发生情形:由于医疗机构规划和设置等问题导致分级诊疗后患者看病更加不方便,或是尽管患者留在家门口看病,但基层的医疗能力不足,不能让患者看好病。如果出现这两种情况,那么改革方案就需要相应的调整和细化。     

丹阳市卫生防疫机构人事分配制度的改革

１９９９年,我市卫生系统全面实行了人事分配制度改革,我站根据卫生系统人事分配制度改革意见,结合卫生防疫工作的特点,制定了改革方案。于２０００年元月全面实施了这项改革。１改革方案的制定人事分配制度改革涉及每个职工的切身利益,其能否顺利实施,关键在于制定的改革方案是否切合本单位的实际,是否具备较高的合理性、可行性与可操作性。我们的做法如下。１．１民主组织改革方案起草小组在全站卫生、防病、检验、行政、后勤五个系列中由群众分别推荐一名懂业务、善管理、群众信得过的人员组成改革方案起草小组。１．２草拟改革方…     

推进分配制度改革促进医院科学发展

文章从改革思路、改革方案、实施办法、实践效果、体会和打算五方面阐述医院进行绩效工资多维度考核的必要性和重要性.     

医改是创新，不是另起炉灶

作为试点城市,我们认为,公立医院改革要创新和发展,但不是另起炉灶;要积极引入竞争机制发挥公立医院的主体作用,但不是行业垄断;要充分体现公立医院的公益性,调动医务人员积极性,但不是吃大锅饭。基于上述这些认识,我们认真把握改革原则和方向,精心制定改革方案,总体目标就是要让资源得到优化,群众得到实惠,政府得民心,     

医院后勤服务改革模式的探讨

随着社会主义市场体制的不断完善和深入发展,后勤服务化改革思路逐渐明晰,有不少医院出台了改革方案或提出了结合医院实际的改革举措,也取得了不同程度的社会效益和经济效益.     

双赢理论与公立医院的公益性建设分析

"双赢"的本义就是指对博弈双方都有利的行为和结果,"双赢"观念的建立,为现代竞争带来了新的策略和思路。在市场经济的大背景下,公立医院的公益性与经营性的矛盾冲突在所难免,如何在公立医院公益性建设中运用双赢理论缓解其矛盾并创造出新的利益对于深化公立医院改革具有十分重要的意义。     

Weighted win loss approach for analyzing prioritized outcomes

To analyze prioritized outcomes, Buyse (2010) and Pocock et al. (2012) proposed the win loss approach. In this paper, we first study the relationship between the win loss approach and the traditional survival analysis on the time to the first event. We then propose the weighted win loss statistics to improve the efficiency of the unweighted methods. A closed‐form variance estimator of the weighted win loss statistics is derived to facilitate hypothesis testing and study design. We also calculated the contribution index to better interpret the results of the weighted win loss approach. Simulation studies and real data analysis demonstrated the characteristics of the proposed statistics. Copyright © 2017 John Wiley & Sons, Ltd.     

Labor rekindles reform

The health care crisis is back. There is intensifying sentiment across the country that universal coverage is our only way out. The labor movement has used historically such opportunities for change to win health benefits at the bargaining table and strengthen the social safety net. Eighty years of incremental victories and many failed attempts at major health reform have taught labor a crucial lesson: we must build a powerful grassroots movement to drive our effort to achieve universal coverage, or it is doomed to be corrupted by those wedded to the status quo. Now is the right time for reform.     

Health care reform and social movements in the United States

Because of the importance of grassroots social movements, or "change from below," in the history of US reform, the relationship between social movements and demands for universal health care is a critical one. National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself. However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage.     

The Mexican Social Security counterreform: pensions for profit.

The social security counterreform, initiated in 1997, forms part of the neoliberal reorganization of Mexican society. The reform implies a profound change in the guiding principles of social security, as the public model based on integrality, solidarity, and redistribution is replaced by a model based on private administration of funds and services, individualization of entitlement, and reduction of rights. Its economic purpose is to move social services and benefits into the direct sphere of private capital accumulation. Although these changes will involve the whole social security system--old-age and disability pensions, health care, child care, and workers' compensation--they are most immediately evident in the pension scheme. The pay-as-you-go scheme is being replaced by privately managed individual retirement accounts which especially favor the big financial groups. These groups are gaining control over huge amounts of capital, are authorized to charge a high commission, and run no financial risks. The privatization of the system requires decisive state intervention with a legal change and a sizable state subsidy (1 to 1.5 percent of GNP) over five decades. The supposed positive impact on economic growth and employment is uncertain. A review of the new law and of the estimates of future annuities reveals shrinking pension coverage and inadequate incomes from pensions.     

新型农村合作医疗的制度创新探析

新型农村合作医疗制度不是传统农村合作医疗的简单恢复，而是在新的历史条件下结合现代社会保险理论和技术，对传统农村合作医疗进行改革、完善和创新。新型农村合作医疗具有传统的农村合作医疗制度无可比拟的优势，初具社会保障制度的雏形，成为中国农村社会医疗保障体系的重要组成部分。     

National health care reform and the 103rd Congress: the activities and influence of public health advocates.

OBJECTIVES: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.     

The Self Help Alliance--an experiment with 18 self help support projects in different parts of England

This paper highlights some of the interesting findings fromthe Self Help Alliance (SHA) scheme. The SHA is an experimentalthree-year programme examining the value of providing localgeneralized support to self help groups concerned with healthand social care. The method used in this paper to focus upon findings is two-fold.Firstly the views of six experienced self help support developmentofficers are reported within a framework set by Dr Evers forthe Vienna Dialogue III. Secondly, the National DevelopmentOfficer of the SHA raises other issues of interest that havearisen during the scheme and supplements his analysis with referenceto research reports produced by the Tavistock Institute of HumanRelations. A broad range of issues are covered with a view to giving thereader a ‘flavour’ of the debate that has takenplace and is continuing.     

中国公费医疗与劳保医疗的改革

本文系统地阐述了我城镇社会医疗保险的改革与发展,以及其变革的原因.同时,介绍了即将在全国实施的城镇职工基本医疗保险的筹资和运作方式.     

我国医药卫生与医疗保障和社会经济协调发展战略研究

描述了目前国内任何地区的区域卫生规划研制和实施时面对的中短期（2－5年内）工作重点－我国医药卫生、医疗保障和社会经济协调发展战略。我们认为要形成卫生事业与社会之间的协调发展状况,必须在短期内克服和解决四方面逻辑相关的问题：如社会和卫生两方关注的表现问题得不到有效解决;医保改革将缺乏有效运作条件;两者也导致医院内部改革缺乏动力,卫生事业发展 突破性进展;区域卫生规划在上述基础上极有可能流于形式。另外,医疗卫生机构在体制和产权制度方面的改革滞后于宏观神经经济改革的进程,也给上述问题的解释和解决披上了模糊的色彩,文章依据研究结果,分步阐述了短中期规划中的工作重点。