我国铁路运输管理体制市场化改革的路径选择

20多年来,我国的铁路体现与整个经济体制一样,处在不断的调整和改革之中。由于铁路属于自然垄断产业,与其它自然垄断产业一样,改革和调整的难度很大,任务更艰巨。党的十五大明确提出我国经济体制改革的目标是建立社会主义市场经济体制。由此,我国铁路的改革也明确了市场化的发展方向,2000年4月4日,朱Rong基总理、吴邦国副总理再次听取铁道部关于铁路体制改革和思路,基本肯定了实业界、政府主管部门和理论界经过长期探索、讨论、筛选,提出来的“网运分离”的改革思路,同时强调铁路改革当前要抓紧推进“政企分开,社企分开,事企分开”和减员增效,继续完善、细化“网运分离”方案,并先在铁路局内部进行探索。这意味着铁路运输体制改革的总体框架已构成,走向已经明确,将进入一个在总体部署下系统推进体制转换和结构调整的新阶段。本文拟在总结我国铁路运输管理体制市场化改革的基本思路的基础上,进行经济学思考,并进一步分析自然垄断行业引入有效竞争机制的问题。     

2000年医改目标全面实施

目前，世界上有131个国家建立了包括医疗保险制度在内的较为完整的社会保障体系，其中有80个国家开征了社会保障税，且社会保障税占全部税收的比重近50％。多数国家建立了社会保障预算，包括医疗保险支出在内的社会保障支出占整个财政支出的48-51％。在我国，医疗制度改革作为社会保障制度的一项重要内容，已被纳入中国政府跨世纪施政纲领之中。认1991年起，国家先后在海南省、广东省深圳市、江苏省镇江市、江西省九江市进行了医改试点。1998年底，国务院出台了城镇职工医疗保险制度改革方案，一个牵动亿万人心的改革措施终于浮出水面。1999…     

需要勇气,也需要耐心

“咒骂地狱和赞美天堂都是容易的．难的是找到从地狱通往天堂的梯子。”而对一个具有社会责任感的媒体来说．还有更难的事——当所有人都以为找到了那架梯子时，你敢不敢大喊一声：那架梯子不是通往天堂．而是通往比地狱更可怕的炼狱!     

宏观调控当前更需要警惕经济下滑

通货膨胀的危险已经远去,宏观调控现在真正要警惕的是通货紧缩的到来。政府应收回继续紧缩的手,保持宏观稳定,或者在价格调控和非价格调控上采取松紧搭配。     

医改：世纪之交浮出水面

目前,世界上有１３１个国家建立了包括医疗保险制度在内的较为完整的社会保障体系,其中有８０个国家开征了社会保障税,且社会保障税占全部税收的比重近５０％。多数国家建立了社会保障预算,包括医疗保险支出在内的社会保障支出占整个财政支出的４８—５１％。在中国,医疗制度改革作为社会保障制度的一项重内容,己被纳入中国政府跨世纪大政纲领之中。从１９９１年起,国家先后在海南省、深圳市、江苏省镇江市、江西市九江市进行了医改试点。１９９８年底,国务院出台了城镇职工医疗保险制度改革方案,一个牵动亿万人心的改革措施终于浮…     

医改下一站,向左还是向右

医疗卫生事业关系到人民群众的身体健康和生老病死,与人民群众切身利益密切相关,是社会高度关注的热点.回顾我国医疗改革的过程,其实一直是沿着政府主导还是市场主导这样一个思路行进的.但医疗改革的失败使我们不得不对单纯的传统的政府主导的体制和近年来所谓的"市场化"进行反思.     

攻破既得利益格局坚冰

《中共中央关于制定国民经济和社会发展第十一个五年规划的建议》用了异常浓重的话语，强调深化改革的重要性。其中，给笔者印象最深的第七部分第（21）条款这样一段话，：“我国正处于改革的攻坚阶段，必须以更大决心加快推进改革，使关系经济社会发展全局的重大改革取得突破性进展。”     

我国医疗体制改革的政策选择

目前，看病难、看病贵已经成为全社会普遍关注的问题。而要解决好这一问题的关键是要正确把握好我国医疗体制未来改革的方向。从我国的医疗卫生资源和人口状况来看，实行市场化的医疗体制改革方向是不容置疑的。但仅仅依靠市场化改革是不够的，还必须充分发挥政府的积极作用。     

医改的有益尝试——重庆"惠民中国医疗行动"的创新与实践

高额的医疗费用引发的“看病贵”、“看病难”问题,严重影响了国家的经济发展和社会稳定。在试图解决这一问题时,医疗、医药流通、医保等多方面的改革都被简化为仅仅对药品定价的改革,药品强制性降价、药品集中招投标成了最主流的措施。药品价格成为“罪魁祸首”,大家众口一词,认为是药价高导致药品费用高,从而导致医疗费用高。一时间药价成了众矢之的。     

Deconstructing health care reform

As health reform is deconstructed, we need to stop and do some deconstructing of our thinking about it, looking at the context of our assumptions or frames. If we think of health as taking the supreme welfare of the people seriously, we will not allow it to be framed only in terms of for-profit interests and the status quo. Nurses have expertise and knowledge regarding what is needed for a quality health care system. We have to join the conversation with as many good questions as ideas. Working from a different frame, one that reflects more of your values, may give you new insights into holding the conversation.     

Immigration and health care reform: shared struggles

The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.     

Navajo nation public health nurses inspire thoughts on health care reform

The wisdom and experience of pubic health nurses serving on a Navajo Reservation, who work far from the typical hospital setting, may well hold some of the keys to how we can successfully plan for and navigate the future of our shifting health care system. As more of the nursing workforce moves outside the walls of the hospital, competencies in autonomy, clinical judgment, decision making, and communication will increase in importance. long with safety and quality implications, this may also influence changes in nursing education, job requirements, hiring, and measuring performance. In addition, there may be implications around how new nurses are oriented and how they get the experience needed to function in more independent roles. Within their routine days, the conditions they work in, the situations they face, and the many ways public health nurses find to meet the needs of the people they serve, is a wealth of knowledge that may well translate into solutions for some of the challenges our nation's health care system is facing.     

Palliative care: a paradigm of care responsive to the demands for health care reform in America

Palliative care is poised to become a universally available approach to health care which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services. Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life. Within the context of health care reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches. As leaders in health care, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's health care system.