对卫生服务机构监督机制研究

卫生服务是城市卫生工作的重要组成部分,是实现人人享有初级卫生保健目标的基础环节。向社会公众提供经济、便捷和公平的卫生服务是政府的基本职责。全国各地的卫生监督机构正在逐步建立,与原卫生防疫站体制相比,卫生监督人员数量有所增加,综合执法能力得到加强,卫生执法力度显著加大。但伴随着深层次的问题和矛盾日益显现,论文分析目前基层卫生监督所的现状及困难,并提出了加强卫生监督的对策思考。     

建立城乡一体的基本医疗保障制度体系探讨

建立城乡一体的基本医疗保障体系,关系到统筹城乡协调发展,实现人人享有基本医疗卫生服务的公共政策目标.本文认为:"基本医疗保障"是一种公共筹资制度,应在兼顾公平与效率,实行立法与政府保障的制度设计下,针对我国现行基本医疗保障的特点通过明确基本医疗保障范围,整合现有保障方式,构建起城乡居民公平享有的基本医疗保障制度.     

医保城乡统筹的实现路径

新医改实施5年来,我国基本医疗保险制度已实现全民覆盖,在制度全覆盖后,我国基本医疗保险制度面临着从城乡分立到城乡统筹的转型,从人人享有转向人人公平享有。特别是城镇化背景下,需要通过参保登记全民化、制度架构统一化、基本待遇均等化、经办服务一体化和管理体制垂直化等城乡统筹的制度安排,建立统一的更加公平。     

浅析乡镇卫生院财务管理存在的问题及建议

<正>近年来,为了适应社会主义市场经济的发展要求,逐步改善人民群众的医疗卫生服务条件,使人人享有卫生保健,提高民族的健康素质,各级财政对乡镇卫生院的投入逐年加大,全民医疗保险制度顺利实施,乡镇卫生院业务收支量逐年上升,     

基层公共卫生服务的支付方式及改革探索

<正>公共卫生事业是造福人民的事业,关系广大人民群众的切身利益。人人享有基本卫生保健服务,人民群众健康水平不断提高,是人民生活质量改善的重要标志,是全面建设小康社会、推进社会主义现代化建设的重要目标。一、我国基层卫生系统财政支付现状改革开放以来,我国不断加强公共卫生服务体系建设,基本建成了覆盖全国城乡的疾病预防控制体系和应急医疗救治体系,但"看病难、看病贵"的问题依然存在。国家     

时讯

关注卫生"十二五"规划发布国务院近日发布《卫生事业发展"十二五"规划》,重点部署了我国医药卫生体系建设,要求到2015年,初步建立覆盖城乡居民的基本医疗卫生制度,使全体居民人人享有基本医疗保障,人人享有基本公共卫生服务。60岁以上老年人口将突破2亿根据全国老龄委的统计,截至去年底,中国60岁及以上的老年人口约有1.9亿,占总人口的14%。2013年,这一数字将突破2亿,预计到2050年老年人口将达到全国人口的三分之一。     

建立城乡一体的基本医疗保障制度体系探讨

建立城乡一体的基本医疗保障体系，关系到统筹城乡协调发展，实现人人享有基本医疗卫生服务的公共政策目标。本文认为：“基本医疗保障”是一种公共筹资制度，应在兼顾公平与效率，实行立法与政府保障的制度设计下，针对我国现行基本医疗保障的特点通过明确基本医疗保障范围，整合现有保障方式，构建起城乡居民公平享有的基本医疗保障制度。     

社区卫生服务机构财务管理初探

<正>当前,《中共中央国务院关于深化医药卫生体制改革的意见》和《医药卫生体制改革近期重点实施方案(2009至2011年)》已正式发布,首次提出"把基本医疗卫生制度作为公共产品向全民提供,实现人人享有基本医疗卫生服务",为群众提供安全、有效、方便、价廉的医疗卫生服务。毫无疑问,财政对社区卫生服务机构的资金保障力度将逐步加大,同时对其财务管理将提出更高的要求。     

襄樊市区社会养老保险基金支付风险成因及对策

推行新型农村合作医疗制度,初期目标应以建立体系完整的初级卫生保健体系为重点。只有让广大农民享受到初级卫生保健服务,才有可能大大降低农民患病的机率,既节省了合作医疗预期承担的医疗费用,又有效地控制了各类传染病的蔓延流行。     

河南新乡农村合作医疗保险调研

《中共中央、国务院关于进一步加强农村卫生工作的决定》(以下简称《决定)》明确指出，到2010年，在全国建立起与社会主义市场经济体制和经济发展水平相适应的农村卫生服务体系和农民基本医疗保障体系，保证广大农民人人享有初级卫生保健，农村居民健康指标达到发展中国家的先进水平。为贯彻落实《决定》精神，各地都积极稳妥地开展了新型农村合作医疗试点工作。在试点的过程中，积累了一些经验，发现了一些问题，也存在一些困惑和争论。     

Redefining competition in health care

The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.     

城乡居民医保逆选择的破解——一个基于不同人口年龄需求的设计

逆选择困扰了我国城乡居民医保事业的可持续发展.在原有的大病和重病保障之外,基于不同人口年龄需求设计一个有条件、有限度和有年龄差别的特殊医保待遇方案,让参保者在没有享受到大病重病医保待遇的情况下,也可获得一些与年龄相称的医保待遇.这一设计除了能增加参保的弹性,让各年龄群体都自愿积极参保,还可增强居民的健康意识,提高居民的健康水平,减少居民和医保的医药开支.此外,它还能促进基层医疗服务业的发展.     

Health and the welfare of U.S. business

Business leaders continue to blame the skyrocketing cost of health care for jeopardizing the global competitiveness of U.S. industries, and they continue to turn to Washington for the solution. Yet after a study of 16 countries, Wharton researchers David Brailer and R. Lawrence Van Horn have discovered that health care costs do not directly hinder U.S. competitiveness. Their conclusion: there is indeed a health care crisis in the United States as well as a competitiveness crisis. But the two are unrelated, and confusing them makes it difficult to solve either one. The real problem, according to the authors, is the hands-off approach that employers typically adopt when it comes to health care. No matter how Washington responds to the health care crisis, employers must explore their own role in ensuring the health of their work force. And they must realize that their role can be a strategic one. Instead of containing costs by fine-tuning benefits packages, companies can control costs and improve health care delivery by treating health care like any other crucial component of production. Brailer and Van Horn propose three strategies for managing health care delivery: First, companies must intervene in the supply side of the health care market. This may mean creating a clinic alone or with other companies, or joining with other companies to procure health care. Second, companies need to translate corporate health benefits into the most cost-effective set of services at the local level. Finally, companies must encourage and educate employees to participate in decisions regarding health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary care physicians: increasing demand, shrinking supply

Any serious proposal for reforming the U.S. health care system must include a consistent, coherent national policy for increasing the supply of primary care physicians.     

印度的医疗卫生融资改革

印度公共医疗卫生支出水平较低,且在各邦之间分布不均。中央政府拨款对于各邦政府自身医疗卫生支出具有替代性。本文认为,要推进印度医疗卫生事业改革,必须扩大公共医疗卫生支出,提高政府支出效率,并重新设计转移支付制度。     

Health care challenges and opportunities in the 1990s

The 1990s offer both substantial challenges and opportunities for those involved in the delivery of health care. Increasing costs must be managed to ensure that the health of both Americans and America's economy are maintained. Managed care offers the brightest hope for effectively controlling costs while increasing the quality of care.     

The case of the unhealthy hospital

On a cold March morning, Bruce Reid, Blake Memorial Hospital's new CEO, visited the Lorris housing project clinic, one of six off-site clinics operated by Blake Memorial. He was not encouraged by what he saw: peeling paint, leaking pipes, and cramped conditions. When he asked Renée Dawson, the clinic's primary care physician, how she endured the conditions, she just stared at him. "What are my options?" she asked. That was a good question. Blake Memorial was in poor financial health, due to rising costs and stagnating revenue. The hospital's quality of care was also a major problem. In addition, the clinics were losing over $250,000 a year. As Reid worked on Blake Memorial's 1992 budget, he saw he would have to cut some services in order to fund others. One of the services he was considering cutting was the clinic program. But there were a number of conflicting forces that Reid had to consider. On the political front, the recently appointed commissioner of health services said she would challenge Blake Memorial's tax-exempt status if Reid dismantled the clinics. Within the hospital were two warring factions. One wanted more high-tech services for the hospital and favored closing the clinics. "Instead of clinics, we should have a shuttle bus from the housing projects to the hospital," one doctor suggested. The other faction wanted to expand the clinics. "Wherever the service is most needed, that is where the hospital should be," argued the clinics' director. Reid must decide what to cut and what to keep. But to do so, he must first settle on Blake Memorial's long-term mission.(ABSTRACT TRUNCATED AT 250 WORDS)     

Universal basic benefits preempt mandated benefits

Many states seek to expand health care access to uninsured people. As part of their efforts, states must define a basic level of health services to which all residents would have access. Presumably, this level of services would be leaner than that now covered by most health care policies. As it is, private insurers are already mandated by all states to include certain benefits, which differ widely from state to state. However, simple fairness argues that once a state defines a basic level of health services, that level should function as a floor for everyone and replace the previously mandated benefits (which, nonetheless, may be a useful guide in defining a basic level of health services).     

Communicating the need for additional savings in the face of retiree health benefit cutbacks.

In preparing for retirement, employees need to consider not only their pension benefits but also the challenge of financing their retirement health care needs. Various trends evolving in our society indicate that future retirees will be increasingly dependent on their own retirement savings. Evidence suggests that employees are not fully aware of the significance of health costs in retirement and must be educated to the need to save for retiree health care expenses. This article discusses the issues of Medicare reduction and retiree health benefit cutbacks and the relative communication and education challenges such issues pose to employers.     

美国医疗保险扩面改革之路的里程碑

虽然美国有两大类三大层次的医疗保险体系,但没有实现如其他大多数发达国家那样的全民医保,缺乏一张覆盖全国的社会医疗网络,始终是美国近10年来备受诟病的社会问题.没有医疗保险的问题始终处于社会政策争议的前沿和核心.之前克林顿总统失败的改革方案核心就是实现全民医保,15年后,奥巴马新医改方案又明确将扩大覆盖面作为其改革的重中之重.然而,历经波折得以通过的奥巴马医改法案却依然面临诸多反对和抗议,其中最为核心的是关乎强制参险的条款.2012年6月28日,美国最高法院裁定奥巴马医疗保险改革的大部分条款合乎宪法,最具争议的强制参险也得以保留,这意味着美国在实现全民医保时代的进程中向前迈出了一大步.