看病难，看病贵：不能解决，还是不想解决？——关于医改舍本求末、屡改屡败的沉重思考

看病难、看病贵的问题长期困扰着国民,政府主管部门采取的解决措施却是隔靴搔痒,投鼠忌器,职能部门归咎的原因讳莫如深,避实就虚。看病难、看病贵的真正原因是国家医疗卫生体制市场化改革滞后;国家医疗卫生行政部门因保护部门权益不想改革;公立医疗卫生服务行业人员因既得利益不热心改革。当前医患冲突不断升级,已经成为一个社会问题,影响社会的和谐和稳定。针对今后的医疗改革,推行医疗服务市场化是解决看病难、看病贵的根本;实施以技养医是解决看病难、看病贵的关键。     

Reconstructing consumer participation in evidence‐based health care: a polemic

Consumer participation in the evidence‐based health‐care movement is largely seen as important by those who promote evidence‐based health care but is surrounded by a range of competing discourses that variously critique medicine, nursing or health‐care systems; situate consumers as powerless players within systems characterized by controlling health professionals; or politicize the role of the consumer as activist and defender of patient rights. This paper explores these competing discourses and develops an argument that asserts that the social construction of the evidence‐based movement has rendered previously accepted terminology regarding the user or receiver of health services relatively meaningless. The result has been the ‘politicisation’ and ‘professionalisation’ of consumer participation and the time has come to reconstruct consumer participation in evidence‐based health care – from the generation of evidence to guideline development.     

Contradictions in food consumption

This study asked consumers to identify the possible contradictions in their food consumption. The article takes the so‐called ‘antinomies of taste’– health vs. indulgence, convenience vs. care, extravagance vs. economy, novelty vs. tradition and together vs. alone – by Warde and Mäkelä as a starting point. The empirical part of the research analyses between which opposing poles the contradictions emerge when the consumers themselves are asked. Findings from a survey (745 respondents) indicate that consumers prefer to engage in food‐related activities that would be more aesthetic, healthful, tasty, convenient, caring and economic, but state significant barriers for not being able to fulfil these desires. Finally, the article draws theoretical conclusions about the connections between the prevailing food consumption‐related contradictions and contemporary consumer society.     

Social Capital and Consumer Value Co-Created Within an Online Health Community

Many health providers sponsor online communities that enable health consumers to connect and share experiences. This qualitative study draws upon both social capital and consumer behavior theories to demonstrate that consumers participating in the creation of social capital co-create value for themselves and each other. This netnographic study contributes and operationalizes theoretical frameworks for identifying social capital and consumer value within online communities. Results identify 14 social-capital-building practices and further reveal that these practices represent two distinct themes: practices that create a caring environment and practices that assist others. Findings indicate that members of online health communities gain affective, functional, social, and rational benefits such as empathy, self-esteem, status, connectedness, and efficiency. As a managerial and practical contribution, this study establishes online communities as an important component of patients’ healthcare networks not only for exchanging information and support but also as settings for accessing social capital.     

Risking the Sustainability of the Public Health System: Ethical Conundrums and Ideologically Embedded Reform

The purpose of this paper is to examine the outcomes arising from ideologically driven health reforms, which confronted an enduring socialized model of public health care in New Zealand. The primary focus is on the narratives arising from the unprecedented strike action of junior doctors, symbolic of industrial unrest in the public health sector. Analysis revealed the way in which moral obligations ingrained in the professional identities of junior doctors can be both enacted and persistently challenged by ongoing and extensive ideologically embedded reform. A socialized public healthcare system privileges cooperation and relies on a public service ethos, espousing commitment and goodwill of health professionals. The inverse tenets of a pursuit of efficiency through New Public Management validate an ideology of market principles which legitimate competitive and self-interested behavior. The value-based disconnect that occurred not only affected the goodwill and trust of junior doctors, but also destabilized their commitment to their work in a way that threatened the ongoing sustainability of the public health service. This paper suggests four areas in which research might help solve the ethical conundrums currently undermining a public health service. The suggested direction moves the emphasis on systems and activities toward the cognitive and emotional needs of healthcare professionals.     

Rating healthcare services: consumer satisfaction vs. health system performance

The complex healthcare services and the consumer’s lack of technical knowledge to assess them engender a debate over using consumer satisfaction ratings as a quality-of-care marker. This paper aims firstly to investigate the effect of socio-demographic, socio-economic and spatial characteristics on the perception of quality of healthcare and secondly to evaluate the relationship between consumer satisfaction and health system performance. Reporting a Eurobarometer survey and the scores of the Euro Health Consumer Index, the finding is that some socio-demographic groups are more likely to get unsatisfied with healthcare services than others (e.g. women, those over 24 years old, those who self-define themselves as working class). Moreover, a strong relationship is revealed between consumer satisfaction and health system performance. The higher the performance of a health system, the higher the propensity to have consumers with positive perception of the healthcare services (satisfied consumers). The implications of the findings are then discussed.     

Internet pharmaceutical sales: attributes, concerns, and future forecast

Internet pharmaceutical sales continue to skyrocket as healthcare providers and consumers are increasingly relying on the efficiencies and convenience that is available via such transactions. Managed care companies, increasing demands to reduce healthcare inefficiencies while maximizing the quality of patient care is a significant contributing factor to the expanding utilization and success of online pharmaceutical sales. However, with the expansion of Internet pharmaceutical sales, healthcare providers, pharmacy benefit management and insurance companies, and consumers realize new opportunities and risks. This paper will review the attributes and concerns associated with online pharmaceutical sales, discussing current and pending legislation intended to more effectively manage these parameters.     

Modernizing times: UK hearing‐impaired consumers at the policy crossroads

Although there is now a long‐standing belief in the UK that free consumer choice improves market efficiency, the supply of some consumer products and services remained controlled by the state. In the interests of consumers, it regards as vulnerable to misdirection and malpractice or unlikely to have the technical expertise to make informed decisions. Historically, the supply of hearings aids has been restricted to the National Health Service and specific licensed practitioners in the independent sector. Recent changes to both product and service provision have brought about a radical alteration to this situation, and to the framework of control. This case study of a changing healthcare system demonstrates more generally the difficulties experienced by people trying to improve or maintain auditory functions for speech communication. Access to appropriate technological solutions may be precluded by cost, distribution arrangements or lack of knowledge. Overarching these difficulties, regional health policy variations within the UK mean that consumer experiences vary according to where they live. Consumer influence over the direction and scope of changes to the hearing aid market is limited despite the rhetoric of choice. This article examines the emerging ‘liberalized’ market and its contradictions.     

Research Quality

Advertising is under attack all over the world, from a disparate range of enemies, with differing motives. Even though very few governments have specific policies against advertising, there has been a continuous and worldwide flow of new restrictive legislation. At the centre of the attack are the manufacturers of tobacco and alcohol, but many other products have been declared suspect, and multinational companies are singled out for special mention in most draft legislation. When such restrictions are implemented, consumers do not automatically benefit, yet those concerned with production are seriously hampered and even sustain financial loss. The attackers pursue ‘single-issue’ politics by every available means. Specific industries defend their own interests, but usually only after a direct attack, with no coordination of objectives or resources. Those responsible for business policy-making must be prepared to define and defend their rights to produce, distribute and promote.     

Policy implications

Abstract: In the European Union, the framework of financial services legislation at EU level has been aimed primarily at forming a single market for banks, insurers and other financial services firms. Substantial progress has been made towards this objective. Also, the EU initiatives have stimulated a reappraisal of national regulatory systems. Most of this EU legislation (with the exception of the consumer credit directives) has not had consumer protection as one of its main aims, although it has been assumed that consumers will eventually benefit from a wide choice of financial services providers and from price competition. However, partly in response to consumer pressure, the European Commission is developing a set of initiatives more closely geared to protecting consumers’ interests. Within the context of the EU’s approach, there remain considerable variations in the approach to protecting consumers’ interests in different member states as a result of legal and cultural differences.     

城市化加速进程中农村土地制度研究:一个综述

通过梳理和评述城市化进程中农村土地制度的主要研究视角、存在的矛盾与困境、未来改革思路,对后续研究作出展望。研究发现:国内外学者从多个领域对农村土地制度进行了深入探讨并取得不少研究成果,但也存在不足;城市化加速进程中农村土地制度存在着城市化与耕地、农民流动与宅基地区位固定等矛盾,主要困境在于产权不完善、土地细碎化现象突出;未来应完善农地产权制度,建立城乡统一的土地市场,创新宅基地制度,切实维护农民权益。     

Patient care,satisfaction and service quality in health care

It is becoming increasingly important in the healthcare setting to treat patients as consumers and measure their satisfaction with medical services rendered. As such, patient satisfaction should be considered an important output of a country's healthcare system, basically reflecting the stage of its development. The conducted study tested students’ satisfaction with the quality of service provided by student polyclinics. In particular, the study has analysed the impacts of personal relationships, promptness and tangibility on student satisfaction. The findings imply that all three factors significantly affect patient satisfaction, with personal relationships having the strongest impact. Such results suggest that healthcare providers should encourage their doctors to devote more time to their patients and show genuine concern for patients’ problems if they wish to improve overall satisfaction of their patients with the delivered services.     

Chinese Consumers’ Perceptions of Functional Foods: A Netnography Study of Foods that Help the Immune System Recover from Air Pollution

In China, persistent and severe episodes of poor air quality have raised the population’s awareness of the deleterious impact that air pollution can have on their health and lead many people to explore physical means to limit their exposure to air pollution and therapies to help their immune system cope with this stress. Using a netnographic approach we explored Chinese consumers’ understandings of the impacts on their health caused by air pollution, and the key attributes (expected benefits, forms, and patterns of consumption) they expect of functional foods designed to help them recover from the pollution-driven impact. Relevant Chinese consumers’ discussions were selected from two Community Question Answering websites, “Zhihu” and “Baidu Knows”. The impact of pollution on the respiratory system was considered to be of the most concern and homemade TCM therapies and diet adjustment were the main forms of remedies discussed online. Results from this study will support the commercial success of functional food products designed to help Chinese consumers recover from the impact of air pollution on their health.     

电子商务中消费者权益保护的经济分析

在电子商务环境下 ,经营者和消费者的信息不对称尤其严重 ,这使得电子商务中的消费者权益保护问题更为突出。采用不完全信息的动态博弈模型对电子商务中的消费者权益保护问题进行深入的分析 ,同时 ,为了减少电子商务中经营者和消费者之间的信息不对称 ,以维护电子商务中消费者的权益 ,必须制定相应措施     

Creating consumer satisfaction in maternity care: the neglected needs of migrants,asylum seekers and refugees

An estimated 190 million people are now living outside their countries of birth or citizenship, and the rate of this migration is expected to remain high. The resulting growing cultural and ethnic diversity in societies adds specific challenges to the requirement of delivering public services such as health care to consumers. Globally, about half of the migrant population are women. Migrants’ outcomes of pregnancy are known to be poor, showing significant disparities when compared with those of native populations. Although these disparities have been noted, knowledge is limited regarding the availability and accessibility of healthcare services, as well as the acceptability of maternity care for women with experiences of free and forced migration. Healthcare research in general, and maternity care research specifically, have often neglected this population. This paper examines the existing international guidelines intended to address inequities in health outcomes, policies which have been introduced at national levels, and the widely used concepts of ‘patient‐centred’ and ‘woman‐centred’ health services. The ideals implicit in those guidelines and concepts are contrasted with the available evidence of many overseas nationals’ experiences with healthcare provisions in general, and maternity care in particular. This is followed by reflections on deficiencies in current studies and on those methodological problems which make research on maternity care for migrant women particularly challenging. The conclusion considers the appropriateness and relevance of guidelines currently promoting equity in maternity care and suggests a future agenda for priority research.     

Lemon Laws: Intent,Experience, and a Pro-Consumer Model

Under deregulation, public policies regarding consumer rights and product warranties have shifted. This paper reviews the rationale for lemon laws, state legislation intended to help consumers resolve new car performance, and repair problems. It then compares consumers’ redress under these laws to redress under other remedies. Experience with Vermont's legislation, one of the most aggressive lemon laws, is reviewed and analyzed in detail as the basis for formulating public policy recommendations in this area.     

从网络点击合同效力分析看消费者权益法律保护

网络点击合同的效力不等同于传统格式合同效力,从主体缔约能力的确定、意思表示的真实性、电子格式条款的效力判定分析有助于维护消费者权益,实现网上交易的公平。设立网店实名制度和撤销权制度等配套制度、规制网络点击合同电子格式条款是网络消费者权益保护的法律应对措施。     

Consumer-Driven Health Plans: New Developments and the Long Road Ahead

The continued rise in U.S. healthcare spending, along with growth in the number of uninsured, has spurred the move toward consumer-driven health plans. We review new legislation covering such plans, analyze their penetration in the marketplace, and predict their growth. We also use current information about plans that are compatible with Health Savings Accounts to compare them to traditional Preferred Provider Organization plans. Next, we discuss some concerns about the impact of these plans on vulnerable populations, such as the poor and sick. Finally, we suggest how consumer-driven health plans may help to improve the functioning of the healthcare market, especially by producing more transparent information on cost and quality. JEL Classification I110, I180