古巴的医疗外交

针对美国的敌视和封锁,古巴以医疗外交为利器,积极拓展外交空间。古巴利用具有优势的医疗资源,积极向他国提供医疗援助和开展医疗合作,其医疗外交的战略重点主要集中在拉美和加勒比地区,并扩展到非洲和亚太国家。古巴医疗外交的主要内容集中在传染病防治、灾后医疗援助和医务人员培训等方面。通过三方医疗合作、医务人员费用的共同分担制、医疗援助与医疗技术合作并举等方式,古巴的医疗外交实现了诸多创新。古巴的医疗外交成就斐然,前景广阔,具有多重意义。     

古巴医疗外交的特点、动因与意义——兼论新冠肺炎疫情给古巴医疗外交带来的契机

随着重大传染病和生物安全风险等非传统安全问题成为全人类面临的重大生存和发展威胁之一,加强全球医疗合作的重要性和紧迫性日益凸显。在此次新冠肺炎疫情中,长期遭受美国封锁的古巴克服自身困难,积极开展对外医疗援助,受到全球瞩目。古巴是发展中国家阵营中开展医疗外交最成功的国家之一,其合作对象覆盖了世界上大部分国家和地区,合作领域包括灾难救援、长期医疗援助、教育培训、医药合作等多种形式。古巴的医疗外交管理体制健全,在合作中倡导能力建设,且长期坚持人道主义和国际主义精神,因此广受合作国赞誉。在半个多世纪的实践中,古巴医疗外交不仅给本国在外交和经济上带来了诸多利好,而且客观上带动了世界医疗卫生事业的发展。当前,古巴医疗外交面临的外部环境较为严峻,美国加大对古制裁、地区政治生态变化等因素均给古巴带来不小的挑战。但也应看到"危中藏机",随着共同合作应对传染病等全球性威胁的重要性日益上升,古巴的医疗外交也将迎来新的契机。     

新加坡的医疗保障体系

新加坡医疗保障体系以其投入低、效率高为世人所称道。文章介绍了新加坡医疗保障体系的筹资和医疗服务供给系统,并对其进行公平和效率评估,认为新加坡医疗体制的成功实际上并不能归功于医疗个人账户制度,而是源于其内设的对低收入者就医的补贴制度和个人自付费用对医疗服务消费的控制。     

俄罗斯免费医疗:发展历程、效果分析、困境及未来发展方向

俄罗斯现有的免费医疗体系,主要根源于苏联时期的医疗保障体系。苏联解体后,面对复杂的社会形势和严峻的经济形势,一方面,国家财政负担日益加重,已无法维持苏联时期的免费医疗体系,各种弊端逐渐显露;另一方面,原来的医疗制度已不能适应市场化的经济体制,苏联时期的免费医疗模式逐渐浮现出越来越多的负面影响,民众满意度逐渐下降。在这种大背景下,俄罗斯在沿袭苏联免费医疗体系的基础上对其进行了一系列改革,从原先无限免费医疗服务转变为当前有限基本医疗免费的新型基本医疗免费制度,形成了免费的法定强制医疗保险和自费的私人医疗保险相结合的医疗保障制度。这些改革措施使俄罗斯人免费享受到基本医疗服务,大大增强了民众对国家医疗服务体系的信心,总体来看取得了积极成效,但依然面临着医疗机制之困、医疗资金之困、医疗服务能力之困、医疗公平之困等诸多挑战,未来俄罗斯还需朝完善法律制度、加强顶层设计、加大医疗投入、扩大医疗筹资来源、完善硬软件设施、引入竞争机制、提高卫生服务供给能力等方向继续努力,兼顾免费医疗服务供给的公平性和效率性,实现全民均可享有的高质量的免费医疗服务。     

古巴社会主义研究的新成果--《古巴社会主义研究》评介

2005年9月,在中古建交45周年之际,中国社科院拉美所资深研究员毛相麟所著《古巴社会主义研究》一书与读者见面了,这部书的出版是中国学者研究古巴社会主义的最新成果,可喜可贺。古巴在十分困难的条件下,坚持社会主义。古巴社会主义革命和建设的曲折进程蕴含着十分丰富的经验,这是古巴对世界社会主义运动的宝贵贡献。毛相麟研究员《古巴社会主义研究》一书令人信服地回答了人们所关心的一些问题:古巴是如何在革命胜利后不久就选择走社会主义道路的?为什么曾经同前苏联和东欧有密切关系的古巴,没有发生像前苏联和东欧国家那样的社会制度的剧变…     

古巴革命以来的对外政策研究

古巴革命胜利后至今,其外交政策可分为两个主要阶段.第一阶段从1959年革命胜利到20世纪80年代末90年代初东欧剧变、苏联解体.在这一时期古巴奉行"无产阶级国际主义",加强与"苏联和其他社会主义国家兄弟般的友谊、帮助与合作,以及拉丁美洲和全世界工人和人民的团结".第二阶段从20世纪80年代末90年代初至今.在这一时期,古巴努力贯彻全方位多边外交政策,力求打破美国封锁和孤立政策,扩大生存空间,改善国际环境.拓展经贸合作.古巴十分重视同中国、越南等社会主义国家的友好关系,积极发展同亚洲和非洲发展中国家之间的关系.在不结盟运动、伊比利亚美洲首脑会议、联合国等国际组织中积极开展多边合作.     

国际体系变迁与中国的战略选择

俄格冲突、北京奥运、美国金融海啸、国际恐怖主义再度升级、H1N1全球性蔓延、气候变化与新能源合作成为热点,近年来如此多的重大国际性事件的发生,预示着后冷战时代大体告一段落、新兴大国崛起时代已然到来、全球合作应对全球性问题的时代全面开启,国际体系变迁正在由量变发生质变.美欧日俄印澳等大国均加紧因应,谋求以战略之变应对体系之变.中国作为体系变迁的重要推力,在体系变迁中既要"自转"也要"公转",比别国更多一份应对体系变迁的压力.如何把握新时期的角色转换,并适时进行战略调整,是中国无法回避的重大课题.     

古巴中国戏院的历史变迁——从表演木偶戏、粤剧到放映电影

随着19世纪中期以来契约华工源源不断流入古巴,古巴华侨华人社会逐渐形成.1873年哈瓦那唐人街诞生了第一家中国戏院,此后中国戏院作为古巴华侨华人的一项经营,长期存在于古巴社会.木偶戏、粤剧、电影先后占据古巴中国戏院的主要舞台.中国戏院不仅是古巴华侨华人闲暇时间娱乐休闲及社交活动的重要场所,也为中国传统文化在古巴的传承和发展提供了舞台,同时它还充当了古巴华侨华人社会公益事业筹款活动的主体.此外,古巴中国戏院对古巴文化也产生了重要影响.中国戏院之所以在古巴能够长期存在,最重要的原因是古巴华侨华人对祖国家乡文化的巨大需求.     

中国崛起:世界体系发展的终结还是延续?

中国经济崛起是世界体系发展的延续和补充,还是作为一种独特的发展模式对世界体系的终结?这是过去三十多年在国际学术界和国内学术界引起广泛争论的一个学术命题。从世界体系与国家兴衰的关系出发,对世界体系在过去500年形成的三个历史阶段的基本特征进行分析,可以发现:1500-1750/1800年重商主义阶段主要基于"地理大发现"和"殖民主义",1800/1850-1914/1945年的自由主义经济阶段主要基于"工业革命"和"自由贸易",而1945-2030年的混合经济阶段则主要基于"经济全球化"和"制度创新"。在此基础上,"地理大发现"、"国际贸易与金融"、"科学与技术"、"国际制度与机制"是世界体系得以延续500年的四大基本动力。世界体系是过去500年每个国家兴衰的背景,而中国过去30年经济上的成功主要得益于不断融入这个延续至今的"世界体系",所以,中国未来发展所面临的挑战也主要来自于世界体系以及这个体系对中国国内政治、经济和社会结构的影响。     

从古共六大到古共七大：古巴社会主义模式的更新CSSCI

2006年劳尔·卡斯特罗上台后提出了更新古巴模式的思想,并实施了一系列改革措施。2011年4月,古共六大通过了《党和革命的经济社会政策的纲要》(简称《纲要》),为古巴的经济社会改革确定了方向。2016年4月,古共召开了七大,通过了《古巴社会主义经济社会模式的理念》和《到2030年全国经济社会发展计划:国家的建议、轴心和战略部门》,并对六大《纲要》进行了调整和补充,使古巴模式的更新进一步深化,并上升到理论,落实到中长期规划中。自古共六大提出更新社会主义模式以来,更新模式已成为古巴国内不可逆转的共识,古巴在法制、领导体制、经济政策、社会和外交政策等方面都发生了积极的变化。但与此同时,古巴社会主义模式的更新仍面临着新的问题与挑战:模式更新的经济效果不明显,体制更新困难重重;某些观念还需要不断更新,姓"资"姓"社"的问题仍存在争论;经济基础比较薄弱,美国长期的封锁和禁运给古巴造成巨大损失;人口老化和减少将影响经济发展;拉美政局变化对古巴造成消极影响。     

美国全球卫生安全战略及其对世界卫生安全体系的挑战

进入21世纪以来,新型冠状病毒、埃博拉、重症急性呼吸综合征以及甲流感等新发和复发传染病危机对全球卫生安全构成严重威胁,因此,如何促进全球卫生安全治理是当今国际社会亟待解决的问题。尽管美国曾经在全球卫生安全治理中发挥了重要作用,但尚未形成清晰的全球卫生安全治理政策。美国于2019年5月首次发布《全球卫生安全战略》,标志着特朗普政府全球卫生安全政策正式出台。该《全球卫生安全战略》以应对传染病威胁为核心,呈现出了以国家安全为导向和"全政府"路径的特点,充分体现了特朗普政府的"负担分担""美国优先"和反多边主义的思维。在全球卫生安全领域,各国已成为"因病相依"的全球命运共同体。有效的全球卫生安全治理需要全球多边主义,特朗普政府以国家安全为导向和以"美国优先"为原则的《全球卫生安全战略》与全球卫生安全的实现之间存在张力。特朗普政府的上述思维不仅侵蚀了全球卫生安全体系建构所必需的国际政治合作基础,也恶化了全球卫生安全的融资体系,因此对全球卫生安全体系构成了挑战。     

全球公共卫生治理的制度重叠及其应对之策

近年来,全球公共卫生治理体系彼此通过议题联结、成员联系和功能互动形成了密切的国际制度重叠,包括以世卫组织为核心的联合国诸公共卫生制度、以盖茨基金会等为代表的非正式公共卫生制度、以二十国集团为代表的涉卫新型国际制度以及特朗普政府试图打造的美式国际公共卫生制度。制度重叠是国际公共卫生秩序的结构性特征,可能会约束与限制世卫组织治理有效性的发挥。全球公共卫生议题的复杂性、全球公共卫生治理的政治化倾向和世卫组织的治理限度决定了协同治理具有必然性和紧迫性,为此,国际社会需要秉持人类卫生健康共同体理念,坚持公共卫生多边主义,警惕美国另起炉灶对全球公共卫生治理的冲击。同时,世卫组织发挥协同治理功能的制度化需求迫在眉睫。此外,新型国际公共卫生治理制度是推动多元制度协同治理的重要力量,将发挥愈加凸显的关键作用。作为国际公共卫生体系的重要成员,中国的负责任国际承诺为国际公共卫生制度重叠提供了重要的协调路径,中国支持世卫组织发挥领导作用,加强在联合国、二十国集团、世贸组织、金砖国家集团等多边制度框架内的协调配合和相互支撑,推动构建人类卫生健康共同体。     

Performance-based partnership Agreements for the reconstruction of the health system in Afghanistan

The reconstruction of the health system in Afghanistan is in its early stages, and donors have proposed Performance-based Partnership Agreements (PPAs) through which to subcontract the delivery of health services to private organisations, both for-profit and not-for-profit. Beyond ideological debates, this article sets out to explain the model underlying the PPA initiative and sheds light on empirical data concerning the assumed benefits of such an approach. The article studies privatisation and the contracting-out of health services, though there is as yet no information that can demonstrate the superiority of private over public service provision. Similarly, the merits of subcontracting have not been fully proven and such arrangements raise several ethical issues. Where PPAs are to be attempted, it is important to remain cautious and to ensure that operations are organised in such a way as to permit proper comparison. The paper concludes with recommendations to organisations involved in or considering the advantages of PPAs.     

Frames,Paradigms and Power: Global Health Policy-Making under Neoliberalism

The study of global health governance has developed rapidly over recent years. That literature has identified a range of factors which help explain the “failure” of global health governance, but it has largely neglected the global public policy processes which perpetuate that failure. In this paper we argue that there is such a thing as “global health policy” and set out a new framework for analyzing the processes through which it is made, highlighting the mixture of power and ideas, agency and structure, which impact upon the policy cycle. The framework rests upon four pillars: framing; paradigms; power; and the “deep core” of neoliberalism. Through integrating insights from a range of literatures, in particular from the global health governance and public policy analysis fields, we seek to enrich the conceptual basis of current work on global health governance.     

Equity in health and economic globalisation

This article proposes that equity in health is inseparable from social equity in its broadest sense. An equitable system allows the lowest income sectors to have access to an acceptable level of basic goods and services. Equity in health thus entails decreasing the differences in access to, and use of all health services. Globalization, on the other hand, means the process by which economic power is expanding and increasingly concentrated in the hands of corporations that are progressively entering national economies worldwide through the international free-market ideology. Explored in this article were some ways in which globalization leads to inequities.     

Electoral reform and public policy outcomes in Thailand: the politics of the 30-Baht health scheme

How do changes in electoral rules affect the nature of public policy outcomes? The current evidence supporting institutional theories that answer this question stems almost entirely from quantitative cross-country studies, the data of which contain very little within-unit variation. Indeed, while there are many country-level accounts of how changes in electoral rules affect such phenomena as the number of parties or voter turnout, there are few studies of how electoral reform affects public policy outcomes. This article contributes to this latter endeavor by providing a detailed analysis of electoral reform and the public policy process in Thailand through an examination of the 1997 electoral reforms. Specifically, the author examines four aspects of policy-making: policy formulation, policy platforms, policy content, and policy outcomes. The article finds that candidates in the pre-1997 era campaigned on broad, generic platforms; parties had no independent means of technical policy expertise; the government targeted health resources to narrow geographic areas; and health was underprovided in Thai society. Conversely, candidates in the post-1997 era relied more on a strong, detailed national health policy; parties created mechanisms to formulate health policy independently; the government allocated health resources broadly to the entire nation through the introduction of a universal health care system, and health outcomes improved. The author attributes these changes in the policy process to the 1997 electoral reform, which increased both constituency breadth (the proportion of the population to which politicians were accountable) and majoritarianism.     

Negotiating Integrative Medicine: A Framework for Provider–Patient Conversations

Efforts to integrate complementary and alternative medical (CAM) therapies into conventional medical settings are creating a variety of negotiation challenges between various stakeholders. Focusing on the two-party encounter between physician and patient offers a way to understand the application of principled negotiation to perhaps the most fundamental and emotionally charged place within the health care system in which the introduction of CAM therapies is likely to disrupt relationships and produce conflict. This article suggest ways in which the theory and analysis of principled negotiation can add to current liability and ethical frameworks, and might thereby contribute to optimal future health care by helping to wisely integrate CAM therapies into conventional medical care.     

Older women, health, and social care in Singapore

A key demographic feature in the high-income country of Singapore is that women have longer years of life than men, and the aging pattern in Singapore is similar to that of Northern Europe. This paper describes how this current generation of older Singaporean women aged 65 and above experiences declines in health status and well-being as they age. Their vulnerability is the higher risk of chronic illnesses stemming from longer life expectancy and a lower likelihood of access to appropriate health and social care. This is because health and social care in old age are mainly financed by individual out-of-pocket spending which includes support from adult children. Unlike Northern Europe, Singapore does not yet have a well-developed social welfare system to support women in old age.     

Health service utilization among widows living with HIV/AIDS: an interview survey in Manipur, India

Widows living with HIV/AIDS (WLHA) are a vulnerable and often overlooked group. The North Eastern Indian state of Manipur, which has one of the highest concentrations of HIV/AIDS cases in India, is not an exception. This paper aims to describe the pattern of and factors contributing to the use of health services by WLHA in Manipur. Structured face-to-face interviews were conducted among 510 respondents. Only 49% of the respondents were aware of available health facilities. The place of residence (67.8%) and appointment at a convenient time (70.8%) were the main factors affecting the use of health services. To improve access to health services, it is imperative that the services of trained health providers are made easily available. Policy makers and organizations working on HIV/AIDs should work together to remove the barriers to the use of health services, making them user friendly for vulnerable groups such as WLHA.     

The historical contribution of faith-based health providers in the Ecuadorian health system: an overview of the evidence

ABSTRACT

Faith-based health providers (FBHPs) have historically shaped the national health system in Ecuador, yet there is little robust evidence of this role, or their current contribution to the national health system. This article situates FBHPs in the Ecuadorian health system, using secondary analyses of national health surveys to consider changes in contribution from 1998 to 2014, and synthesising this with secondary literature. The research confirms the important role that FBHPs have historically played in Ecuador, but also shows that their current role needs to be better understood if universalisation of health service coverage is to be achieved.