包容性发展视野中我国医疗问题若干政策前瞻

包容性发展的实质是以人为本。将包容性发展的基本理念用于指导现阶段我国医疗问题若干政策的制定,使我国医疗政策的制度更具科学性和前瞻性,从而为＂十二五＂期间和今后相当长一段时期的公民生命健康权保障和实现提供政策保障。     

20世纪90年代以来中国共产党领导集体对台政策的创新

20世纪90年代以来,以江泽民为代表的中国共产党第三代领导集体和以胡锦涛为总书记的新一届中央领导集体面对海峡两岸关系的严峻形势,在继承党的第一二代领导集体对台政策的基础上,创造性地提出、实施了一系列新的对台方针政策:如对一个中国原则的发展、两岸谈判对象的扩大、祖国和平统一分步进行、以经贸关系为中心发展两岸关系、不承诺放弃使用武力方针具体化等,有力地促进了两岸关系的发展。     

“政策体制框架”研究进展与展望

“政策体制框架”（Policy Regime Framework,PR）起源于美国的复杂政策实践,经过20年左右的发展演进,已成为西方公共政策领域研究中一个热门框架。国内学界对该框架的关注极为有限,同时也缺乏全面系统的总结与展望。本文基于对“政策体制框架”文献的梳理,从概念、结构、前提条件与理论假设、影响因素以及评估标准等方面出发,系统阐述“政策体制框架”的已有研究成果和最新进展。经过梳理,认为该框架在理论建构和现实运用方面仍存在较多的局限性。未来除了需要完善相应的理论建构,还应继续推进政策过程研究与治理研究的深度耦合、拓展研究方法的多元运用以及深化中国情景下的本土化探索。     

发达国家医疗体制及保障制度述评

我国的医疗制度改革正朝着社区医疗服务的世界共同方向发展。国外特别是西方发达国家作为全球社区卫生的发源地,其许多成熟经验值得我们学习借鉴。借鉴部分发达国家在医疗体制和保障制度方面的经验做法,对于建立符合中国国情的医疗制度和模式,确定我国医疗卫生事业的改革方向,颇有裨益。     

20世纪50年代中国政府的南海政策

20世纪50年代，南海成为两极对峙的前沿阵地，南越、菲律宾在美国的支持下，肆无忌惮地侵占我南海岛礁，恶化我海洋政治环境。中国政府根据当时国际斗争形势以及海军实力，多次进行主权宣示行动，加强内政建设，彰显了捍卫海域主权之决心。     

农村医疗服务体系存在的问题和对策研究综述

从20世纪40年代开始,中国农村医疗服务体系产生,农村医疗服务体系发生了重要的制度变迁,在阅读大量文献资料的基础上,从农村医疗服务体系目前存在的主要问题和关于农村医疗服务体系的对策研究方面出发,对当前的农村医疗服务体系的热点问题和研究重点进行了归纳和综述,以期对该问题更深入的了解和进一步的研究。     

农村流动人口对城市医疗服务的使用与医疗消费分析——基于北京市丰台区农村流动人口的调查

农村流动人口群体是城乡二元社会结构中出现的一个特殊群体。进入到城市中的农村流动人口,收入成为影响其医疗消费支出的最主要因素,人口因素和社会经济因素与其对城市医疗服务使用和消费支出的相关关系都不显著,年龄和家庭的特殊结构以及广泛地缺乏社会医疗保障制度的保护是造成这种结果的主要原因。同时也反映出农村流动人口在医疗资源分配与社会权利享有上的不平等状态。     

关于优化农村医疗服务的思考

医疗服务与其他衣、食、住、行等消费品一样,都是农民生存与发展所必需的。在深化改革、着力发展民生的新时期,优化农村医疗服务至关重要。当前,我国农村医疗服务距离农民的需求还有很大距离,要解决农民看病难、看病贵的问题,要通过加强农村医疗卫生队伍建设、提高农村医疗服务质量、降低医疗价格等方式优化农村医疗服务,构建科学合理的农村医疗服务体系,真正做到使农民看得起病。     

医疗体制模式的国际比较与与借鉴

为了便于对各具特色的世界各国医疗管理体制的比较和借鉴,我们选择了具有明显体制差异的英国、美国和新加坡三个国家作为案例介绍。其中,英国的模式同我们过去在计划经济体制下的模式极其相似,其体制发展的结果也十分类似;     

政府购买基本医疗服务后对第三人的法律责任

政府向公民提供基本医疗服务是其宪法义务,但政府不具有提供该项服务的行为能力,唯有向社会医疗服务机构购买此项服务。作为购买人的政府在购买了基本医疗服务之后,由定点医疗服务机构向第三人实际提供此项服务。然而,定点医疗服务机构对第三人的这种直接服务并不减免政府对接受该项服务的第三人承担的法律责任,具体包括政府在宏观上对第三人的担保责任和在微观上对第三人的赔偿责任。为了确保政府购买基本医疗服务后对第三人承担的法律责任落到实处,我国须完善相关法律制度,即建立健全规制政府向社会购买公共服务之过程的法律制度,建立健全政府购买人、购买代理机构及其工作人员对国家承担法律责任的制度,建立健全基本医疗服务机构承担法律责任的制度,建立健全第三人权利救济制度。     

老年人社区卫生服务需求与利用研究

旨在通过了解老年人社区卫生服务需求与利用情况,为进一步完善和改进社区卫生服务质量、促进以社区为基础的健康老龄化提供科学依据,并为提高老年居民的生活质量提供可行性建议,推动城市老年社区卫生服务的发展。     

Health and Health Services Access Among Adults With Disabilities Who Receive Federal Housing Assistance

Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview Survey data, this study estimates the prevalence of disability among HUD-assisted adults and examines health disparities for this population. The linked data suggest a much higher prevalence of disability among HUD-assisted adults than previously suggested by HUD administrative data. Controlling for individual characteristics and HUD program type, assisted-housing residents who have disabilities experienced higher rates of self-reported fair or poor health, asthma, diabetes, hypertension, obesity, and cigarette smoking. Adults with disabilities had more frequent use of emergency rooms and increased concerns with affording the necessary health care. HUD-assisted adult residents with disabilities were more likely than residents without disabilities to be connected to the health-care system, having higher rates of insurance coverage and more frequent contact with specialists, general doctors, and mental health-care providers. Policy implications are discussed.     

External Actors and the Provision of Public Health Services in Somalia

Concentrating on the health sector, this article argues that the provision of collective goods through external actors depends on the level of state capacity and the complexity of the service that external actors intend to provide. It shows that external actors can contribute most effectively to collective good provision when the service is simple, and that simple services can even be provided under conditions of failed statehood. Effectively delivering complex services requires greater levels of state capacity. The article also indicates that legitimacy is a key factor to explain variance in health service delivery. To demonstrate this, the article assesses health projects in Somalia. It shows that simple services—malaria prevention and tuberculosis control—are provided effectively in all three Somali regions, including the war‐torn South‐Central region. In contrast, the HIV/AIDS project only achieved substantial results in Somaliland, the only region with a comparatively higher level of state capacity, and failed in the South‐Central region and Puntland.     

The Politics of Universalisation: Establishing National Health Services in Southern Europe

Italy, Portugal, Greece and Spain have enacted reform laws during the last 20 years with the intention of turning their health insurance systems into national health services. Universalisation of access to public health care was at the centre of the political debates which led to the passing of the reform laws. This article analyses the policy-making processes that allowed for such institutional change, as well as achievements and shortcomings of the implementation processes that followed. The analysis draws on the insights of the actor-centred neo-institutionalist approach in the policy sciences.     

Resource Tangibility and the Evolution of a Publicly Funded Health and Human Services Network

This article is a longitudinal examination of a publicly funded network of health and human services organizations that provide services to mentally ill adults. Data were collected at two points in time from a single network in a large U.S. metropolitan area: when the network was completely reorganized, and again when it had matured, four years later. Analysis focuses on changes in the patterns of interaction within and across five resource‐based subnetworks. The authors argue that the structure of network relationships depends on the type of resources involved—whether tangible or intangible, the stage of network evolution, and whether macro‐ or micro‐level interactions are considered. Implications for theory and for network management, governance, and policy are discussed.     

Outsourcing Public Health Laboratory Services: A Blueprint for Determining Whether to Privatize and How

In a continuing effort to reform and reinvent the way public organizations do business, the outsourcing of services has become a popular tool, particularly as resource constraints limit options available to governments. All too often, the decision is made, for reasons of ideology or resource constraints, to outsource services without giving careful consideration to the impact of privatization on the core missions of an agency, or whether privatization, in fact, offers real cost savings. Purchasing tools designed for traditional commodity purchases are often grossly unsuited for making decisions on specialized technical services.
This article suggests a process for the evaluation of an option to outsource laboratory services. It suggests that, prior to contracting or privatizing services, the concerned agency should evaluate:
the impact on the agency's core mission
the availability, stability, and reliability of private sector service providers
the relative costs of internal and external (public or private sector) service providers
the potential impact on regulatory enforcement
the ability to monitor the performance of external providers
potential conflicts of interest
Based on this model, the ongoing internal evaluation of services offers public agencies management tools to obtain the best value for the taxpayer dollar, not only in terms of the raw cost per test, but also in managing the quality of the services.     

Policy Transfer and Policy Learning: A Study of the 1991 NewZealand Health Services Taskforce

Research into policy transfer and lesson drawing has been criticized asfew authors have convincingly shown how cross-national policy learning actually influences policy formation in a particular jurisdiction. This article addresses this gap by presenting a study of the development of the 1991 health policy in New Zealand. By studying the process of policy development, rather than just a policy document, it was possible to disaggregate different aspects of the policy and to identify sources and influences. This article finds that the 'conspiracy' model of policy formation does not fit this case as it presents an overly simplistic view, which allows little space for policy learning. This case illustrates the subtle and multifaceted influence of different jurisdictions, different institutions, and different individuals on a given policy.     

Examining Policy Implementation in Health Care: Rule Abidance and Deviation in Emergency Medical Services

Passage of the Patient Protection and Affordable Care Act (ACA) has served to refocus attention on the complexity of health care delivery in the United States, with particular attention to concepts of quality, access, and outcomes. This article argues that our understanding of the ACA must be informed by an examination of policy implementation in health care, including the core public function of emergency medical services (EMS). Key concepts of implementation in frontline service—notably, rule abidance and deviation—are examined from the perspective of street‐level EMS workers. Results indicate that the intersection of rules, patient needs, and professional culture creates instances of both rule abidance and deviation, both of which contribute substantively to concepts of quality in a health care setting.