我国医药产业政策回顾与分析

医药产业政策是指国家或者地区为了实现一定的经济目的,以医药产业为对象所实施的能够影响产业发展进程的一整套政策的总称,它已成为政府宏观调控国家医药产业的重要手段。本文通过追溯我国建国以后医药产业的相关政策,并对其进行梳理分析,发现我国医药产业政策发展趋势与存在的一些问题,并据此提出了一系列解决这些问题的建议。     

Emerging policy contradictions between the United Nations drug control system and the core values of the United Nations

This paper argues that the image of the UN as a benevolent organization is a crucial factor in the functioning of the global drug prohibition regime. It contends, however, that from certain normative perspectives, particularly that of harm reduction, it is possible to identify the emergence of policy contradictions between what can be broadly defined as the United Nations drug control system and the core values of the UN as laid out in the Charter and other key instruments from which the UN derives its image of benevolence. Four interrelated areas of perceived conflict are discussed: sovereignty and jurisdiction; human rights; the promotion of solutions to international economic, social, health and related problems; and the maintenance of international peace and security. It is suggested that such a situation may undermine a key mechanism for regime adherence. The paper concludes by offering some options that may exploit systemic contradictions and assist in instigating incremental change to the regime.     

二类疫苗纳入深圳市社会医疗保险研究概述

目的为推广二类疫苗纳入社会医疗保险支付范围的卫生策略提供决策信息。方法综合运用问卷调查、专题访谈、专家咨询、基金风险测算等方法,研究深圳市二类疫苗纳入社会医疗保险支付范围的具体可操作政策。结果90%的社区居民认为将二类疫苗纳入社会医疗保险支付有必要;医务人员对社保支付二类疫苗基本持支持态度;二类疫苗纳入社保支付具有显著的经济效益;二类疫苗纳入社保支付的基金风险具有可控性。结论二类疫苗有必要纳入深圳市社会医疗保险支付,但在实施和技术操作方面仍然存一定的局限和挑战。     

Implications of long-term care capacity response policies for an aging population: A simulation analysis

Introduction

The demand for long-term care (LTC) services is likely to increase as a population ages. Keeping pace with rising demand for LTC poses a key challenge for health systems and policymakers, who may be slow to scale up capacity. Given that Singapore is likely to face increasing demand for both acute and LTC services, this paper examines the dynamic impact of different LTC capacity response policies, which differ in the amount of time over which LTC capacity is increased, on acute care utilization and the demand for LTC and acute care professionals.

Methods

The modeling methodology of System Dynamics (SD) was applied to create a simplified, aggregate, computer simulation model for policy exploration. This model stimulates the interaction between persons with LTC needs (i.e., elderly individuals aged 65 years and older who have functional limitations that require human assistance) and the capacity of the healthcare system (i.e., acute and LTC services, including community-based and institutional care) to provide care. Because the model is intended for policy exploration, stylized numbers were used as model inputs. To discern policy effects, the model was initialized in a steady state. The steady state was disturbed by doubling the number of people needing LTC over the 30-year simulation time. Under this demand change scenario, the effects of various LTC capacity response policies were studied and sensitivity analyses were performed.

Results

Compared to proactive and quick adjustment LTC capacity response policies, slower adjustment LTC capacity response policies (i.e., those for which the time to change LTC capacity is longer) tend to shift care demands to the acute care sector and increase total care needs.

Conclusions

Greater attention to demand in the acute care sector relative to demand for LTC may result in over-building acute care facilities and filling them with individuals whose needs are better suited for LTC. Policymakers must be equally proactive in expanding LTC capacity, lest unsustainable acute care utilization and significant deficits in the number of healthcare professionals arise. Delaying LTC expansion could, for example, lead to increased healthcare expenditure and longer wait lists for LTC and acute care patients.     

Does deregulation in community pharmacy impact accessibility of medicines,quality of pharmacy services and costs? Evidence from nine European countries

Objective

To analyse the impact of deregulation in community pharmacy on accessibility of medicines, quality of pharmacy services and costs.

Methods

We analysed and compared community pharmacy systems in five rather deregulated countries (England, Ireland, the Netherlands, Norway, Sweden) and four rather regulated countries (Austria, Denmark, Finland, Spain). Data were collected by literature review, a questionnaire survey and interviews.

Results

Following a deregulation, several new pharmacies and dispensaries of Over-the-Counter (OTC) medicines tended to be established, predominantly in urban areas. Unless prevented by regulation, specific stakeholders, e.g. wholesalers, were seen to gain market dominance which limited envisaged competition. There were indications for an increased workload for pharmacists in some deregulated countries. Economic pressure to increase the pharmacy turnover through the sale of OTC medicines and non-pharmaceuticals was observed in deregulated and regulated countries. Prices of OTC medicines were not found to decrease after a deregulation in pharmacy.

Conclusions

Access to pharmacies usually increases after a deregulation but this is likely to favour urban populations with already good accessibility. Policy-makers are recommended to take action to ensure equitable accessibility and sustainable competition in a more deregulated environment. No association between pharmaceutical expenditure and the extent of regulation/deregulation appears to exist.     

Well-being: its influence and local impact on public health

Objectives

To explore the emergence of the concept of well-being and examine its influences on the modernization of the public health structure at the local level.

Study design

The article applies a theoretical and policy orientated approach.

Methods

The article assesses the concept of well-being and applies its uses to local policy and practice.

Results

The concept of well-being has implications for the development of local public health structures, policy making and delivery.

Conclusions

In terms of local policy making, it enables public health professionals to develop locally based concepts and uses of well-being, engage communities, make links to social capital and consider wider determinants within them. In terms of delivery, it focuses attention on the need for collaboration between local statutory and voluntary organizations in applying local concepts of well-being to public health policy; and engaging with healthcare interventions grounded within local context and needs.     

美国医改实施:政府间政治与制度设计困境

《可负担的医疗法案》是在美国两党政治对立的情况下颁布和实施的。本文认为,美国联邦和州政府角色权限的分配,加剧了该法案执行过程中的政治冲突。联邦和州层面的政治参与者(特别是州长和州立法机构)就该法案进行制度协调的不同途径,已经阻碍了医疗保险交易所的建立和医疗救助扩展计划。通过比较,本文认为制度设计时尽量减少政治冲突的医疗保险监管机制改革,在执行过程中大幅度减少了政治摩擦。此外,本文强调了多层次制度设计对实施一些重要改革所产生的政治影响。     

新形势下我国科技期刊稿源变化趋势——面向作者和科技期刊编辑的问卷调查与分析

【目的】 分析科技评价体系改革和国家大力扶持期刊发展新形势下我国科技期刊稿源动态变化趋势,助力国内科技期刊加速发展。【方法】 针对作者和科技期刊编辑分别设计了“国内科技期刊作者投稿意愿调查”和“2020年国内科技期刊稿源情况调查”问卷,利用问卷星提供的问卷设计和问卷发放(借助科研、期刊交流微信群)、统计分析等功能完成问卷调查。【结果】 大多数(86.2%)期刊2020年的投稿量比2019年增加,但增加1倍以上的期刊仅占6.4%;大部分期刊稿件平均质量有所提高(49.4%)或基本持平(47.0%)。绝大多数作者比较认可中国科技期刊,但同时对期刊发文速度、审稿质量、传播力度等有越来越高的要求,对期刊服务能力、品牌特色有越来越多的期待。【结论】 科技评价体系改革和国家扶持期刊发展为中国科技期刊发展带来了机遇和挑战,面对作者投稿国内期刊意愿的变化,我国科技期刊应该采取更加积极的应对措施,稳步扩大出版量、优化出版流程以承载更多回流的优秀稿件。     

Loops and Building Blocks: a Knowledge co-Production Framework for Equitable Urban Health

This paper sets out a structured process for the co-production of knowledge between researchers and societal partners and illustrates its application in an urban health equity project in Accra, Ghana. The main insight of this approach is that research and knowledge co-production is always partial, both in the sense of being incomplete, as well as being circumscribed by the interests of participating researchers and societal partners. A second insight is that project-bound societal engagement takes place in a broader context of public and policy debate. The approach to co-production described here is formed of three recursive processes: co-designing, co-analysing, and co-creating knowledge. These ‘co-production loops’ are themselves iterative, each representing a stage of knowledge production. Each loop is operationalized through a series of research and engagement practices, which we call building blocks. Building blocks are activities and interaction-based methods aimed at bringing together a range of participants involved in joint knowledge production. In practice, recursive iterations within loops may be limited due of constraints on time, resources, or attention. We suggest that co-production loops and building blocks are deployed flexibly.     

Examining how changes in provincial policy on vape marketing impacted the distribution of vaping advertisements near secondary schools in London,Ontario

ObjectivesOn January 1, 2020, the Government of Ontario passed a regulation banning vaping advertisements by retailers, apart from specialty shops. A motivation for this ban was to limit youth exposure to vaping advertisements. The primary goal of this research was to evaluate the impact of this ban on the number and density of vaping advertisements surrounding secondary schools. Additionally, we examined whether the number of vaping advertisements varied by school socio-demographic characteristics.MethodsThis study used a pre-post design. Audits were conducted December 2019 (pre-ban) and again January to February 2020 (post-ban), to identify vaping advertisements within 800 m surrounding secondary schools (n = 18) in London, Ontario.ResultsPrior to the ban, there were 266 vaping advertisements within 800 m of secondary schools. After the ban, this was reduced to 58, a 78.2% reduction. The mean number of vaping advertisements surrounding schools significantly decreased from 18.1 before the ban to 3.6 after the ban (p < 0.001). A significant positive correlation was found, prior to the ban, between the number of vaping advertisements surrounding schools and school-level residential instability (r = 0.42, p = 0.02). After the ban, no significant correlations were found between the number of vaping advertisements and school socio-demographic characteristics.ConclusionThe provincial ban of vaping advertisements in select retail settings significantly reduced the number of vaping advertisements in the areas surrounding secondary schools in London, Ontario. The ban also reduced socio-demographic inequities in youths’ potential exposure to marketing of vaping products. Continued monitoring of the geographic accessibility and promotion of vaping products is warranted.