浅议医师多点执业

《中共中央、国务院关于深化医药卫生体制改革的意见》指出,要稳步推动医务人员的合理流动,促进不同医疗机构之间人才的纵向和横向交流,研究探索注册医师多点执业。至此,医师多点执业在未来的医改道路上的方向已然明确。本文分析了多点执业可能引发的诸多问题,提出了一些可行性建议,对探讨多点执业试点具有一定的价值。     

廉政教育:改进医德建设的着力点

当前,在医学生和在职医务人员中培育和传播廉政意识的重要性日益突显,其原因主要是:近年来部分医务人员存在着服务意识不强、服务质量不高、为医不廉、廉政意识淡化模糊等现象,严重影响了医务工作者的整体形象,致使医患关系紧张,社会满意度不高。要改进医德建设,增强医务人员的职业道德,就必须加强廉政教育,特别是要加强未来医务接班人的廉政教育。     

Shifting from Undersupply to Oversupply: Does NHS Workforce Planning Need a Paradigm Shift?

The National Health Service in England is currently halfway through the most austere decade in its history. Finding ways to improve health care efficiency is crucial to ensure the sustainability of the health system. While evidence of supply‐induced demand (SID) has often been used as an economic argument to restrict labour supply, in the UK the risks of SID may be much less than in health care systems with more deregulated entry into the market post‐qualification and with fee‐for‐service payment systems. This article focuses on the problem of staff shortages in nursing. We argue that, although an oversupply of some types of labour can add to cost pressures by increasing demand for health care services and that the cost of training staff is high, undersupply and poor labour planning lead to unintended consequences such as poor labour productivity. As a result there is a case for public policy to target an oversupply of nurses in the future. If government reforms to nurse funding help, they are to be welcomed.     

Legislation and the American Dialysis Industry:

A bstract Monopoly power in the dialysis industry in the United States is linked to Public Lau'92-603 (section 2991) of the Social Security Amendments of 1972 under which 90 percent of all patients with end-stage renal disease became eligible for Medicare coverage In effect, Congress spawned a new government enterprise by removing the constraining factor of price to the consumer and legalizing government-subsidized monopoltes in renal care which were empowered with the right to supply renal care services within designated areas without competition Those who suffer from renal insufficiency encounter monopoly on the supply side of the product (dialysis units) market, and the labor market (kidney specialists) since outside nephrologists are not permitted to treat patients'assigned' to "closed staff" units     

我国医疗职业安全立法之调查分析

从医疗卫生工作人员面对自然环境中各种微生物的侵袭,阐述由于疾病及瘟疫给医务工作者带来的职业危害。面对医院内可能存在的医护人员的职业安全隐患,有必要采取一定的方式———职业安全立法,来保护广大医护人员的合法权益。     

药品供应链现状分析

由于药品的特殊性,使得药品供应链在整个运作过程中有着特殊要求。我国正处在医药改革转型时期,医药流通体系混乱,医药不分业、以药养医、医院的"双垄断"地位、政府主导药品定价等这些我国特有元素,致使我国药品供应链更加脆弱,面临诸多的运作风险和不确定性。文章在分析目前我国药品供应链结构特点及运作现状的基础上,结合我国实际国情,提出了具体应对措施,以进一步促进我国药品供应链的重构,优化药品供应链运作。     

The over‐training of apprentices by employers in advanced manufacturing: a theoretical and policy analysis

This article reports the results of a study of the ‘over‐training’ of apprentices by large manufacturers in the UK. The term ‘over‐training’ was traditionally used to refer to the way in which nationalised industries trained more apprentices than they needed, with the ‘surplus’ being released at the end of their training to find another employer. In contrast, the evidence reported in this article indicates that over‐training now typically involves large employers helping to train apprentices who are employed and paid by other firms from the outset. The project examines the extent and nature of over‐training, the reasons why employers become involved in over‐training, and policy implications. The evidence suggests that over‐training can increase the number of high‐quality apprenticeships. Large employers need to be made more aware of over‐training. Government can help promote over‐training via its ‘Catapult Centres’.     

What Dangers from Medical Monopoly?

Does the monopoly in the provision of health care by doctors in the united Kingdom obstruct the development of morkets, or is it the inevitable result of necessary specialisation? Dr Dovid Green, Research Fellow of the insitute of Economic affairs, has argued for the removal of the monopoly to establish consumer supremacy Professor A.J. Culyer of the University of Yorek Claims that Dr Green's solution will be ineffectual. Dr Green develops his argument.     

Government Time Discounting and Required Rates of Return: UK History and Current Issues

The UK government first set financial objectives for the nationalised industries in 1961 and subsequently promoted the use of ‘discounted cash flow’ for investment appraisal. The nationalised industry regime evolved until, in the 1990s, it was succeeded by economic regulation regimes for the privatised utilities. Meanwhile discounting conventions emerged and have continued to evolve for wider government policy analysis, including aspects of climate change. Issues about the size and functions of public expenditure notwithstanding, UK government conventions are currently fairly uncontroversial: however, in the world at large, government discounting remains subject to many academic and international controversies and misunderstandings.     

BACK TO THE FUTURE: TOWARDS A BETTER STATE OF HEALTHCARE

In 1948, the government nationalised more than 3,000 independent hospitals, homes and clinics to create a National Health Service that was supposed to deliver 'all medical, dental and nursing care'- free at the point of delivery. Demonstrating that the service failed to do this and instead substituted rational pricing signals with numerous forms of rationing, the authors examine the re-emergence of a sizeable independent health and social care sector today and its implications for the future.     

The Coalition's Economic Strategy; Has it made a bad thing worse?

The source of the present recession in the UK and elsewhere was the world‐wide financial crisis that followed a generalised collapse in inter‐bank and bank lending to the private sector, which led to huge falls in spending and a collapse in output in most developed countries. By effectively ignoring this amplified credit effect, supply‐side explanations place their emphasis instead on changes to the pattern of productivity shocks, downgrades in risk premia or shifts in aggregate production functions. Our review of some high profile examples of supply‐side accounts suggests that the evidence is against them and a world‐wide fall in aggregate demand seems a more likely explanation. Nonetheless, the supply‐side view still appears to be the approach preferred by the Treasury suggesting, as it does, that present levels of slack in the economy are small. The Coalition's main response to the recession here has been fiscal consolidation, based on the claim that the jump in the fiscal deficit was not due to the world recession and was instead caused by Labour's profligate spending. Also, the Coalition's strategy treats the two problems; that of ensuring recovery and that of achieving a sustainable debt ratio in the longer term as if they were the same problem. Not only are these two claims wholly wrong, the risks they pose to the economic future of the country are very large and of long duration. It is already evident that the “cuts now” programme has retarded the recovery as it assumes, incorrectly, that the deficit can be reduced by making cuts to spending without these having adverse effects on economic growth. And its precipitate rush to cut Welfare and non‐investment Education budgets are visibly leading to worse, not better, efficiency outcomes in these key sectors, in spite of government claims to the contrary. A low wage, low productivity economy seems a highly likely outcome of the present policy over the medium to longer term.     

Second-class doctors? The impact of a professional career structure on the employment conditions of overseas- and UK-qualified doctors

Career structures and their associated boundaries both offer and restrict career opportunities and provide the potential to be sites of unfair discrimination. Yet the impact of such structures is rarely explored. This article investigates the impact of a career structure on the employment conditions of a medical career grade in which some three-quarters of the doctors qualified overseas. The comparison of UK and overseas qualified doctors in the Staff and Associate Specialist Group provides an underexplored perspective on a professional career structure with a particular reference to reward, workload, autonomy and morale. The article draws on a quantitative study of 1,715 Staff and Associate Specialist doctors undertaken in 2004. The findings demonstrate a complex comparative picture with overseas-qualified doctors earning more, working for longer hours, having less autonomy and a lower morale than their UK-qualified comparators. We conclude by pointing to the potential for certain career structures to structurally and systematically disadvantage some groups.     

BANKING ON SOCIALISM

Terry Arthur argues that the current UK banking system represents the very opposite of a free market, and that a genuine free market, in which there is no place for a nationalised central bank, is the best solution. One of the most successful examples of such a market is the Scottish experience of the nineteenth century, destroyed only by Peel's Banking Acts of 1844–45.     

No Plan B: But is There a ‘Third Way'?

This paper reviews the argument for a slowdown in the fiscal consolidation policy of the UK government. It reviews the existing literature and the evidence of the interwar period in the UK where a recovery occurred without a relaxation of the tight fiscal regime of the period. It argues that even in a zero‐lower‐bound, the evidence for a plan B is weak. Given that there may have been significant capacity destruction, the paper suggests a third way that calls for a supply‐side framework that sets the condition for an improvement in long‐term growth and productivity.     

建立和谐医患关系 提高医疗服务水平

近年来,医疗纠纷不断出现,医患关系状况愈发紧张,患者及亲友对医生的暴力伤害事件频发,严重扰乱了社会公共秩序,是影响社会的发展不和谐因素。2011法治蓝皮书对此评价说:"医疗纠纷作为一种突出的社会矛盾,一直是困扰中国医疗卫生领域的顽疾。有效处理医疗纠纷,直接关系到医患双方合法权利的保护和社会的稳定。"所以缓解医患矛盾是构建和谐社会的必然要求,文章把坚持以人为本作为缓和医患紧张关系的出发点和落脚点,探讨了如何促进医患关系和谐。     

MARKET POWER AND THE PHARMACEUTICAL INDUSTRY IN SOUTH AFRICA

This paper examines the social cost of the pharmaceutical industry in South Africa. From a regulatory perspective the industry is seen to exhibit monopolylike behaviour resulting in monopoly prices on the supply (manufacturing) side and diminished consumption on the demand (consumer) side. The evidence presented here, which is complementary to that of previous studies, does not support that view. The findings contained here are relevant to the highly contentious subject of access to drugs.     

基于供需平衡的卷烟零售户合理化布局规划探讨

目前国内大多数卷烟专卖部门在卷烟零售网点布局规划中所普遍使用的规划听证方案存在较大误差,不利于卷烟市场的健康稳定持续发展。卷烟专卖管理部门应该通过普查和抽样调查获得当地卷烟消费情况的基本数据,并在此基础上结合卷烟供应状况得出各辖区卷烟供需差异,通过对数据和当地实际情况进行分析计算解决该地区是否应该新增持证烟草专卖零售户以及具体增加户数的问题。     

乡村医生继续学历教育管理模式探讨

乡村医生的卫生培训是集学历教育、职业教育和成人教育为一体的培训,培训的对象主要具有年龄和学历结构跨度大、知识结构层次悬殊较大、理论基础参差不齐、技术岗位多种多样等特点,根据培训要求较高的原则,为使这些乡村医生能够较高通过率地取得学历和执业医师资格证,我们国家开展了一系列的基层卫生人员学历教育,尝试集体备课并分层次进行教育、积极组织乡村医生参加执业医师证书考试和教学相结合的课题研究,同时及时更新教学方法,探索出一套更好更完善的教学常规管理机制的系统管理办法。     

A MORE FLEXIBLE LABOUR MARKET?

The firm downward trend in unemployment has been one of the most surprising aspects of the UK recovery to date. Unemployment has fallen at a much earlier stage of recovery than it did in the 1980s, despite the fact that measured growth has been fairly modest to date. More favourable demographic trends have contributed to this decline, as has early retirement and an expansion of higher education. It is also possible that growth is being understated. However, the decline in unemployment has also led to the suggestion that the UK labour market has become more flexible. In this Forecast Release, we examine this claim. We identify a number of ways in which both the demand for and the supply of labour have become more flexible. But in one crucial respect - real wage flexibility - the evidence is less persuasive. That should not prevent unemployment falling in the short term. But it could limit the extent to which a substantial further fall in unemployment could he sustained without inflation re-emerging.     

The Political Economy of Higher Education: An 'Austrian' Aalysis

One of the most wasteful inefficiencies of the nationalised industries is that, isolated from price signals in the market, they make mistaken investment decisions. State-run higher education is no different. Excessive investment, following the Robbins Report of 1963, has resulted in over-staffing, but university 'managers'– vice-chancellors, heads of department, etc. – have no incentive to maximise efficiency by firing less desirable members of staff. It is the better qualified lecturers who are leaving, bribed with severance payments, to take up jobs in the private sector.