基于公益性的我国公立医院公共服务职能探讨

从公益性角度分析并结合我国公立医院公共服务的实践,提出公立医院确保基础医疗服务、提高扶持基层医疗的水平、开展公共卫生和卫生应急服务、控制成本和提供针对弱势群体的医疗服务的公共服务职能,推动公立医院切实履行公益性,为人民群众提供安全、有效、方便、价廉的医疗卫生服务。     

公立医院治理公法人化刍议

公立医院公法人是一项重要的组织手段与法律制度,其目的在于通过法人的身份独立与行为自主,实现公立医院的自治与绩效,使公立医院由官僚化的单位治理模式向自主化的法人治理模式的演变;使公立医院在以法人化的方式应对行政科层制的弊端的同时,须强化对公立医院的监督,实现公益性。介绍了公立医院事业法人的弊端、公立医院治理公法人化的时代背景及意义,构建了我国公立医院公法人化的基本框架。     

基于公益性和公共服务责任的公立综合医院战略绩效评价内容框架研究

以实现公益性和公共服务责任为目标的战略绩效评价内容导向是公立医院（简称医院）的本质要求,也是扭转当前医院绩效战略缺失,偏重短期经济效益的有效手段。公益性和公共服务责任为遴选战略绩效评价内容设置了10项原则,运用该原则构建了4类医院战略绩效评价内容框架体系。战略绩效评价与既往绩效评价内容存在7个方面显著差异,由此推测将分3个阶段影响医院未来发展。     

新医改背景下公立医院公益性回归的路径依赖分析

我国的公立医院改革表现出强有力的路径依赖,出现了过度市场化倾向,淡化了机构理应承担的社会职责,阻碍着它的改革。从报酬递增、交易费用和不完全市场3个方面对公立医院公益性回归进行路径依赖分析,由此提出通过加大政府投入,优化卫生资源配置、强调价值回归,适度放松经济性规制、加强社会性规制等方面来实现公立医院公益性回归。     

Patient and public involvement: Two sides of the same coin or different coins altogether?

Patient and public involvement (PPI) has gained widespread support in health research and health policy circles, but there is little consensus on the precise meaning or justifications of PPI. We argue that an important step towards clarifying the meaning and justification for PPI is to split apart the familiar acronym and draw a distinction between patient and public involvement. Specifically, we argue that patient involvement should refer to the practice of involving individuals in health research or policy on the basis of their experience with a particular condition, while public involvement should refer to the practice of involving individuals in health policy or research based on their status as members of a relevant population. Analyzing cases from the UK, Australia, and the USA, we show how our proposed distinction can deliver much needed clarity to conversations on PPI, while guiding the development and evaluation of future PPI‐based policies.     

我国公立医院财政补偿机制与方法研究

财政补偿机制改革关系到公立医院改革目标的实现。在深入理解医院公益性内涵的基础上,针对财政补偿对医院公益性的影响,结合当前补偿思路存在的问题,以解决“看病难、看病贵”问题为目标,提出了基于时序比较的财政补偿机制,给出了相应的财政补偿方法。     

Smoking at the workplace: effects of genetic and environmental causal accounts on attitudes toward smoking employees and restrictive policies

People hold diverse beliefs regarding the etiologies of individual and group differences in behaviors which, in turn, might affect their attitudes and behaviors. It is important to establish how perceived etiologies of smoking might affect the effectiveness of policy initiatives and prevention efforts. The present study assessed whether exposure to genetic vs. environmental accounts for smoking affects attitudes toward (a) workplace-related smoking policies and (b) smokers at the workplace. Results indicate that exposure to a genetic explanation led to stronger objections to a smoking restrictive policy compared with a non-genetic explanation. Additionally, participants in the genetic condition were more accepting of a smoker in the workplace than those in the environmental condition. Evidently, beliefs about the etiology of smoking influence a range of attitudes related to smokers and smoking-related policies.     

Human genetic banking: altruism,benefit and consent

This article considers how we should frame the ethical issues raised by current proposals for large‐scale genebanks with on‐going links to medical and lifestyle data, such as the Wellcome Trust and Medical Research Council's ‘UK Biobank’. As recent scandals such as Alder Hey have emphasised, there are complex issues concerning the informed consent of donors that need to be carefully considered. However, we believe that a preoccupation with informed consent obscures important questions about the purposes to which such collections are put, not least that they may be only haphazardly used for research (especially that of commercial interest)—an end that would not fairly reflect the original altruistic motivation of donors, and the trust they must invest. We therefore argue that custodians of such databases take on a weighty pro‐active duty, to encourage public debate about the ends of such collections and to sponsor research that reflects publicly agreed priorities and provides public benefits.     

湖北省公立医院公益性实现情况调查分析

目的 了解湖北省公立医院运行现状,分析影响公立医院公益性实现的因素,从而挖掘百姓“看病贵”的深层次原因。方法 随机抽取湖北省6家公立医院进行现场调查,并结合相关统计资料进行分析。结果 湖北省公立医院在参与突发卫生事件救治、医疗救助、“三支”等非常规公益性活动的力度逐年增强,但是宏观经济体制和卫生政策的变革,不合理的激励分配机制,使公立医院全面、持久地实施公益性面临很多困难。结论 解决百姓“看病贵” 的问题还需要相关部门共同努力。     

我国公立医院公益性财政补偿现状与对策

目的 分析我国目前的公立医院公益性财政补偿现状,为完善新医改后的补偿机制提出建议。方法 采用描述性分析方法,对当前现状进行剖析。结果 我国公立医院公益性财政补偿存在政府投入不足、不合理、不到位,补偿机制不完善等问题。结论 可通过规划卫生资源、调整医疗收费、推广成本核算等方式加以改善。     

我国公立医院的“公立”障碍及解决思路

通过了解公立医院公益淡化的过程，分析公立医院所遭遇的“公立”障碍，试图从制度设计、医院治理模式、政府监管部门、配套制度等角度提出相应的解决思路。     

Ethical models underpinning responses to threats to public health: a comparison of approaches to communicable disease control in Europe

Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring or intentionally instigated by bioterrorism. According to the World Health Organisation, global partnerships are necessary to gather the most up-to-date information and to mobilize resources to tackle GIDs when necessary. Communicable disease control also depends upon national public health laws and policies. The containment of an infectious disease typically involves detection, notification, quarantine and isolation of actual or suspected cases; the protection and monitoring of those not infected; and possibly even treatment. Some measures are clearly contentious and raise conflicts between individual and societal interests. In Europe national policies against infectious diseases are very heterogeneous. Some countries have a more communitarian approach to public health ethics, in which the interests of individual and society are more closely intertwined and interdependent, while others take a more liberal approach and give priority to individual freedoms in communicable disease control. This paper provides an overview of the different policies around communicable disease control that exist across a select number of countries across Europe. It then proposes ethical arguments to be considered in the making of public health laws, mostly concerning their effectiveness for public health protection.     

Filling the Ark: Animal Welfare in Disasters

ABSTRACT

Populations of feral domestic cats and free-roaming, owned cats have increased throughout the United States, affecting wildlife and public health and warranting attention from a variety of management agencies. The contentious issue of feral cat management requires a greater understanding of public attitudes towards cats and preferences. We used an anonymous internet survey of randomly selected Athens-Clarke County, Georgia households to identify general public perceptions of domestic cats and preferences for cat management. We examined factors that may influence attitudes towards cats, and management including: knowledge about cats, experiences with cats and demographic variables. Results indicate that more residents have positive experiences with feral cats than negative, cat owners have greater knowledge of cats than non-cat owners, and animal welfare or conservation organization membership has a significant effect on attitudes towards cats. A majority of survey respondents agreed that more effective feral cat management is needed yet did not approve of trap-neuter-release (TNR) legislation recently passed in Athens-Clarke County. Logistic regression revealed that residents' attitudes were found to be more important than experiences or knowledge in supporting cat management legislation. Cat sanctuaries were found to be the most acceptable option to reduce feral cat populations (56%), followed by TNR (49%) and capturing and euthanizing cats (44%).     

Compulsory moral bioenhancement should be covert

Some theorists argue that moral bioenhancement ought to be compulsory. I take this argument one step further, arguing that if moral bioenhancement ought to be compulsory, then its administration ought to be covert rather than overt. This is to say that it is morally preferable for compulsory moral bioenhancement to be administered without the recipients knowing that they are receiving the enhancement. My argument for this is that if moral bioenhancement ought to be compulsory, then its administration is a matter of public health, and for this reason should be governed by public health ethics. I argue that the covert administration of a compulsory moral bioenhancement program better conforms to public health ethics than does an overt compulsory program. In particular, a covert compulsory program promotes values such as liberty, utility, equality, and autonomy better than an overt program does. Thus, a covert compulsory moral bioenhancement program is morally preferable to an overt moral bioenhancement program.     

The Return of the King or Bringing Snails to the Garden? The Human Dimensions of a Proposed Restoration of European Bison (Bison bonasus) in Germany

Human dimensions research can help resource and wildlife managers make informed decisions, target information efforts, and gain a greater understanding of the factors that comprise attitudes toward wildlife management efforts. Despite these often-stated merits, studies addressing the human dimensions of resource and wildlife management efforts are rare in Europe. A proposed restoration of free-ranging European bison ( Bison bonasus ) in North Rhine-Westphalia, Germany, has presented an opportunity to help address this research gap. During May to July 2006, we used a randomly distributed, self-administered questionnaire ( n = 398) to assess local residents' attitudes, beliefs, and levels of support or opposition toward the proposed restoration. These factors were compared across two administrative regions spanned by the proposed restoration area. We found that respondents from the Siegen-Wittgenstein region held significantly more positive attitudes and significantly higher knowledge levels than respondents from the Hochsauerlandkreis region. Principal components analysis revealed that attitudes comprised a general attitude factor pertaining to issues such as the importance of conserving bison for future generations and a lifestyle impact factor, which included items pertaining to bison-caused damages to trees and crops. Logistic regression was used to show the influence of fear of bison on attitudes. We discuss the likely causes and management implications of our findings and provide suggestions to managers wishing to target information efforts and address the concerns of those affected by the proposed restoration.     

Divergence between general public's risk perception and environmental risk assessment: A case study of p-xylene projects in China

The growing public opposition to p-xylene (PX) project proposals in China requires understanding the divergence between the general public's risk perception and environmental risk assessment (ERA) results and its implications on its decision-making. In a case study in Fujian Province of China, a questionnaire was designed to investigate the public perception of risks of a proposed PX project, interviews were further conducted in Zhangzhou City and Xiamen City, and the survey results were compared with the ERA results of the proposed PX project. Results indicate that the environmental risk is acceptable according to current technical ERA guidelines and standards, while the public acceptance of the PX project is very low. The underlying factors causing the difference between the general public's risk perception and ERA results were identified from the ERA technical perspective. A better understanding of the risk perception divergence from different disciplinary perspectives is helpful for the public acceptance of these kinds of projects, which are on high demand in China. This study not only highlights the necessity to improve the risk communication but also provides insights on future research of ERA for this kind of large-scale project proposal.     

Conflicts of interest in e-cigarette research: A public good and public interest perspective

The tobacco industry’s involvement in the electronic cigarette research that informs public health policy is controversial. On the one hand, some are concerned that their involvement presents conflicts of interest that bias research outputs and invalidate the policies that use them. On the other hand, some have argued that the tobacco industry may support valid research and contribute to the goals of public health, for instance, if the interests of the e-cigarette industry could be part of a tobacco smoking cessation policy. We approach this debate from the ethical perspective of the public interest and the public good, considering how legitimate researchers can square their expert opinion with validating tobacco industry-funded research, given the perfidy of the tobacco industry and paucity of robust, conclusive evidence on the public health impacts of liberalizing e-cigarette use.     

Public perceptions of climate change adaptation in Singapore dealing with forecasted sea level rise

Abstract

Perceptions of the populace play a central and decisive role in advancing pro-environmental policies. To study attitudes and perceptions towards environmental measures, we apply several items of New Ecological Paradigm (NEP) and Value-Belief-Norm (VBN) theories to cross-examine the public perceptions of climate change in the urban city-state of Singapore through analysis of quantitative questionnaires and qualitative semi-structured interviews. The perceptions were explored about ecological orientation (two dimensions of NEP: level of concern, self-reported knowledge) and environmental behavior (two dimensions of VBN: acceptance and support of national adaptation measures, confidence in adaptation). There is a moderate to high concern for climate change, in general, and sea level rise and flooding, in particular, and the concern is expected to increase in the future. Individuals who indicated a higher level of concern are likely to be more accepting and supportive of climate change measures. Also, while the majority of the populace are amenable to legislative measures from the government, such as enacting pro-environmental laws and more are agreeable to accepting cuts on living standards, as opposed to paying more in prices and taxes. Ecological orientation does not translate directly into environmental behavior, highlighting the gulf between perception and behavior in Singapore.