中国与澳大利亚医疗各项卫生保障制度的对比研究

通过对中澳两国的现行的医疗保障制度的对比分析,结合我国现阶段医疗卫生发展的现状,从不同的视角探讨分析我国现行的医疗保障制度。由于受宏观经济制度的制约和影响,加之我国的地域特点是南北跨度大,经济、文化等区域发展不均衡,我国的医疗保障制度中存在着诸多的问题：保障制度总体水平不高,人群待遇差距较大;适应流动性方面不足;保证可持续性方面不足等。我国借鉴和吸收了国外的先进经验,建立了全民可及的、人人享有的医疗保障制度,但就如何进一步完善我国现行的各项医疗保障制度,推进我国的医疗卫生事业的不断发展,提出了相应的对策及建议：建立完善的、可持续性的卫生服务体制;借鉴澳大利亚的成功经验,结合我国的国情,加大资金投入,简化报销流程,不断完善我国现代医疗保障制度;加强全科医生的培养,可以在一定程度上解决”看病难、看病贵”的问题。完善我国现代医疗保障制度是一个关系到国计民生的、复杂的、系统的大工程。我国的医疗卫生保障制度的改革面临着巨大的挑战,只有加快经济发展的步伐,借鉴和吸收更多国外成功的经验,不断完善我国的医疗保障制度,才能最终实现全民可及的、免费医疗的卫生保障制度。     

建立适合中国国情的高效双向转诊机制

建立适应我国国情的高效双向转诊机制,对于推进我国的医疗体制改革具有至关重要的作用。本文通过对中西方现行卫生制度的对比,结合我国有中国特色的社会主义国家的国情,对我国的卫生制度中存在的问题进行了深入剖析,探讨如何才能有效地实现高效的双向转诊。目前,我国医疗卫生事业的问题覆盖多个方面：主要表现在医疗资源,医院管理,在岗医护人员的个人职业素质,卫生部门的监管,医疗资源的大量浪费,医院分级不平衡另多数患者普遍选择三级医院就诊,而选择二级以下医院就诊的患者则较少。如何在符合我国国情的基础上改变我国的医疗卫生现状、满足人民群众不断提高的医疗服务需求是我国医疗改革亟待解决的问题。建立高效率的双向转诊制度势在必行。目前,在双向转诊中遇到的问题：1．传统理念导致的对各级医疗机构职能的理解上存在偏差,2．医疗机构自身定位不明确,3．双向转诊制度的各项相关配套政策不完善,4．双向转诊制度的社会认同度低。高效双向转诊机制建立以后,可以节省大量的医疗资源,减少了不必要的浪费,推进了医疗资源的合理配置,减少了因地区差异引起的治疗时机延误,高效的双向转诊制度会使医疗卫生资源配置进一步优化、还可以加强医疗机构之间的协作、降低医疗费用支出、促进社区卫生服务迅速发展等有重大的意义。     

江苏省公立医院编制制度改革政策制定过程分析 ——基于多源流理论视角

随着我国医疗卫生事业的快速发展和居民健康需求的不断提升,现行的公立医院编制配置标准已经不适应当前医院发展的需要,亟需创新编制管理方式以适应当前我国卫生事业快速发展的需要。江苏省在国家推进事业单位分类改革、深化公立医院改革的政策指引下,率先出台了编制管理创新的文件,在全省公立医院开始推进编制备案制。本文从政策制定的多源流理论视角,以政策制定过程的三大源流（问题源流、政策源流和政治源流）为切入点,系统梳理和分析江苏省公立医院编制制度改革政策的制定和演变过程,并浅析多源流理论对分析我国政策制定过程的适配性和局限性。     

深圳市社会办医院发展的PEST嵌入式SWOT分析

多元化办医是推动我国公立医院改革和增加医疗卫生资源供给的有效方式。社会办医院是医疗卫生服务体系不可或缺的重要组成部分,是满足人民群众多层次、多元化医疗服务需求的有效途径。通过对深圳市社会办医院的发展现状进行梳理,利用PEST嵌入式SWOT分析模型总结深圳市社会办医院探索过程中的经验和问题,为今后制定和完善社会办医院的发展规划和政策决策提供支持。     

我国贫困地区医疗卫生服务体系建设探讨

健康扶贫是提高贫困地区人民群众的健康水平、实现健康中国的重要途径。构建和完善中国贫困地区的医疗服务体系,要重点加强医疗卫生机构标准化建设、公共卫生服务网络建设、远程医疗服务体系建设和中医药服务能力建设等方面,形成与当地经济发展和健康需求相适应的医疗卫生服务体系,保障贫困人群的健康,最终实现全民健康。     

医保体制下过度医疗的成因与控制策略分析

随着新一轮医改的不断深入,我国初步建立了一套适合我国国情的基本医疗卫生体系及医疗保障制度。伴随着医疗卫生事业的蓬勃发展,医疗费用也随之出现了快速增长,过度医疗是导致医疗费用快速上涨的重要原因之一。本文从需方、供方、医疗体制三方分析了其产生的原因,并探讨了国外开展的医疗费用控制对医疗市场参与主体的影响。最后,针对医疗市场自身必须适应国情、适合社会发展阶段的特点,为我国实现新医改目标提供了一些建设性的意见。     

大型公立医院对口支援县级医院的实践与思考

为将基本医疗卫生服务作为公共产品来满足全民需求,我国不断加大对基层医疗机构的扶持力度,以提高基层医疗机构医疗水平和服务能力,缓解偏远地区群众“看病贵、看病难”问题。通过对哈尔滨医科大学附属第一医院对口支援县级医院工作的回顾,总结了对口支援县级医院所取得的成果,提出了进一步完善对口支援工作的对策。     

新医疗改革背景下医院医疗行为改变的探讨

目前世界上各国政府均面临着卫生费用不断增长和医疗卫生服务需求日益增加的局面,无论是美国的市场主导型医疗保险市场,还是西欧国家实施的政府主导福利型医疗保险市场,都没有解决这个问题.在现有医保政策的引导下,一些公立医院也开始调整内部制度,引导医务人员行医行为契合医保政策要求.本论文通过研究某三级甲等医院内部控制费用政策的实施效果,为进一步促进医疗保险政策引导医疗市场各方行为提供了有建设性意义的意见.     

医院智能化工程建设常见问题成因与对策

伴随社会的全面发展,人民群众的物质文化需求不断提高,为了满足人民日益增长的物质文化需求,需要全面提高医疗卫生水平。医院智能化工程建设是提高医疗卫生事业水平的重要环节,受到社会范围的广泛关注。本文以我国医院智能化工程为研究视角,针对医院智能化工程建设过程中存在的问题进行分析,进而提出若干解决策略,旨在全面提高我国医院智能化工程建设水平,进而提高社会公用卫生事业水平的进步和发展,为人民群众创建更加优良的生活环境。     

神木“全民免费医疗”的可推广性探讨

神木模式是我国＂全民免费医疗＂的一次创造性探索,虽然它不是真正意义上的全民免费医疗制度,但对比目前新医改推广的＂全民医保＂制度而言,它在解决群众＂看病难、看病贵＂的问题上起到更积极的作用,对全国也起着一定的借鉴意义。     

Why it's time for a national health program in the United States.

The United States lacks a coherent national health program. Current programs leave major gaps in coverage and recently have become more restrictive. Influential policies that have failed to correct crucial problems of the health-care system include competitive strategies, corporate intervention, and public-sector cutbacks with bureaucratic expansion. A national health program that combines elements of national health insurance and a national health service is a policy that would help solve current health-care problems. Previous proposals for national health insurance contained weaknesses that would need correction under a national program. Based on the experiences of other economically advanced countries, a national health program could provide universal entitlement to health care while controlling costs and improving the health-care system through structural reorganization. Current proposals for a national health program contain several basic principles dealing with the scope of services, copayments, financing, cost controls, physician and professional associations, personnel and distribution, prevention, and participation in policy making. Support for a national health program is growing rapidly. Such a program would help protect all people who live in this country from unnecessary illness, suffering, and early death.     

Where Is the Malpractice Crisis Taking Us?

There have been several approaches taken to solve the malpractice insurance problem in this country. However, since the cost of malpractice insurance continues to climb, the changes so far have not solved the problem, and more changes seem inevitable. A major change could be the development of a patient insurance plan that would provide compensation for certain injuries related to medical care. The insurance coverage would be centered on hospital care. If certain requirements are met, the plan may not be more expensive than the current tort liability system, and would offer several advantages. In addition to the patient injury insurance, there could be federal assumption of liability for national immunization programs.     

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

Objectives

Medical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need.

Methods

Data are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics.

Results

Weighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05).

Conclusions

CSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.     

Insuring Care: Paperwork,Insurance Rules,and Clinical Labor at a U.S. Transgender Clinic

What is a clinician to do when people needing medical care do not have access to consistent or sufficient health insurance coverage and cannot pay for care privately? Analyzing ethnographically how clinicians at a university-based transgender clinic in the United States responded to this challenge, I examine the U.S. health insurance system, insurance paperwork, and administrative procedures that shape transgender care delivery. To buffer the impact of the system’s failure to provide sufficient health insurance coverage for transgender care, clinicians blended administrative routines with psychological therapy, counseled people’s minds and finances, and leveraged the prestige of their clinic in attempts to create space for gender nonconforming embodiments in gender conservative insurance policies. My analysis demonstrates that in a market-based health insurance system with multiple payers and gender binary insurance rules, health care may be unaffordable, or remain financially challenging, even for transgender people with health insurance. Moreover, insurance carriers’ “reliance” on clinicians’ insurance-related labor is problematic as it exacerbates existing insurance barriers to the accessibility and affordability of transgender care and obscures the workings of a financial payment model that prioritizes economic expediency over gender nonconforming health.     

神木" 全民免费医疗" 的可推广性探讨

神木模式是我国"全民免费医疗"的一次创造性探索,虽然它不是真正意义上的全民免费医疗制度,但对比目前新医改推广的"全民医保"制度而言,它在解决群众"看病难、看病贵"的问题上起到更积极的作用,对全国也起着一定的借鉴意义。     

Primary Health Care Utilization by the Mexican Indigenous Population: The Role of the Seguro Popular in Socially Inequitable Contexts

Objective

To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP) among Mexican indigenous people.

Methodology

A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758). Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization.

Results

25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05). Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01) for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions.

Conclusion

Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups.