当前医疗服务环境的现状、问题及对策研究——基于河南的实证调查

本文采用定量与定性研究相结合的方法,在对河南医疗服务环境进行实证调研的基础上,论述了当前医疗服务环境的现状、存在的突出问题及其根源,并提出了系统的完善措施。     

论医疗社会工作的服务领域

从广义上看，医疗社会工作的服务领域包括医疗救治、精神健康服务、康复工作和公共卫生等。医疗社会工作介入医疗救治领域的内容包括心理疏导、改善环境、信息传达、个案管理、协调医患关系；医疗社会工作介入精神健康服务领域的内容包括帮助精神病患者消除孤独感和隔离感、帮助精神病患者融入家庭和社会；医疗社会工作介入康复工作领域的内容包括提高残疾人的日常生活能力和改善残疾人的教育环境、就业环境及社会环境；医疗社会工作介入公共卫生领域的内容包括疾病预防、处置突发公共卫生事件。     

论医疗服务的公共属性和社会属性

本文运用公共政策和社会政策的基本原理分析了医疗服务的性质。纵观我国医疗服务体制改革的有关政策措施,总体上缺乏对医疗服务的性质的明确认识。这种认识上的偏差导致了医疗服务政策从指导思想到具体规则的种种问题,同时更导致了医疗服务实践既缺乏效率也缺乏公正。本文通过对医疗服务性质的分析,论证了医疗服务的一部分属于公共服务,另一部分属于社会服务。     

完善制度 规范管理 打造孤残儿童服务环境

天津市儿童福利院始终坚持“一切为了孩子”的服务宗旨,努力完善制度,不断规范管理,实现了管理上的三次飞跃,构建了人性化的孤残儿童服务环境,使孩子的养育、医疗、康复、教育水平日益提高。     

我国医疗信息化顶层设计模式的逻辑与构建——新医改背景下理念和体制的创新

我国医疗信息化顶层设计模式通过建立自上而下、全方位的信息共享及跟踪机制,改变了旧有体制下医疗服务市场供需方信息不对称的结构,颠覆了不公平的信息遮蔽和包庇互利关系,节约了市场交易成本和监管成本,重新塑造政府、医疗服务提供者和患者三方信任机制,为建立低成本集约化的医疗创新模式提供有力支撑.该模式的逻辑是以政府主导、责任追踪和信任重建为三大要素,包括顶层设计和基层行动两大模块,在政府、医疗服务机构和医药企业三大主体之间构成一个信息输送、互动交流的全息网络,并以此建立起相应的信息风险责任机制.该模式反映了医疗服务领域公共治理理念的重大变革,对新医改背景下我国医疗信息化建设有重要指导意义.     

医疗健康服务供给的PPP模式探讨

在新医改大背景下,文章探索医疗健康服务供给的PPP模式,旨在整合盘活公立医院资源,为社会资本进入医疗健康服务领域打开制度通道。PPP是集融资、管理到治理而有关基本公共服务供给的一种创新机制,是解决当前公立医院财政投入不足、不良产能过剩、难以有效满足患者多元医疗健康诉求等问题的有力工具。基于对国内外医疗健康服务供给的PPP模式应用的考察和研究,文章构建了基于公共利益的医疗健康服务供给PPP模式的构建思路。     

从医疗过程的双重交易关系看中国社会医疗保险改革

医疗过程的双重交易关系——医疗机构与患者的医疗服务交易关系和医疗机构与药品生产代理商的医疗产品内部交易关系——决定了医疗服务提供方在医疗过程中的核心地位。所以,我国的社会医疗保险重点是要从约束供方着手,加之政府的责任,以保证社会医疗保险的顺利开展。     

医疗服务机构在医疗保险逆选择中的角色扮演

医疗保险中存在的逆选择问题阻碍了我国医疗保险事业发展。从医疗保险逆选择过程的第三方即医疗服务机构角度出发探究如何解决逆选择困境,结合预期效用理论对医疗服务机构在逆选择过程的角色扮演作出阐述,指出医疗服务机构行为构成逆选择的重要制约因素,认为实施群组保险等解决逆选择困境的措施必须与医疗服务机构改革相结合才能取得成效。     

在院舍照顾中的社会工作实践思考

院舍照顾服务是指为年满60岁以上,因个人、社会、健康、环境及其他原因,不能继续独居、或不能与家人同住的老人提供住宿设施、个人生活照料、基本医疗护理、康复等多方面的服务。目前,院舍照顾的主要服务对象是中老年龄段和高年龄段的老年人。     

上海市第三社会福利院：倾力打造人文关怀的机构养老服务体系

上海市第三社会福利院是国办公益性市级养老机构，以失智照料、介护照料、介助照料、医疗康复四大中心服务为特色，具有养老综合服务的功能。通过与荷兰鹿特丹市社会福利机构开展交流与合作，在福利院失智照料中心融入发达国家人性化的服务理念、设计模式和居家环境营造，科学划分空间功用及色彩布局，     

参加新型农村合作医疗的诸因素分析

自2003年以来新型农村合作医疗制度的建立与实施,使得参合农民就诊率和住院率均明显提高,就医经济负担有所减轻,农民因病致贫、因病返贫问题有所缓解。笔者在实证调查的基础上,发现性别、年龄、文化程度、收入水平、健康观念等因素对参加新型农村合作医疗的积极性有较大影响,我们在工作中应当重视以上因素,针对实际情况加以积极引导,提高农民参加新型农村合作医疗的积极性,从而保证新型农村合作医疗的持续健康发展。     

我国农村合作医疗变迁的制度环境分析

农村合作医疗是在其所处的制度环境框架内运行的,其性质、范围、进程及效果都不可避免地受制于基础性制度的影响。适宜的制度环境是历史上农村合作医疗获得快速发展的主要原因。制度环境的变迁是过渡时期和市场经济初期农村合作医疗缺乏生命力、迅速解体和难以恢复的根本性原因。制度环境沿着既定的轨迹修正和加强是新型农村合作医疗试行成功和可持续发展的保障。     

Application of Fairness Theory to Medical Tourists' Dissatisfaction and Complaint Behaviors: The Moderating Role of Patient Participation in Medical Tourism

ABSTRACT

Medical tourism is a worldwide phenomenon in which patients travel abroad to seek medical treatment. Although excellent health service quality of a foreign country has shown to attract more medical tourists, little is known about how an unfairly distributed service can increase dissatisfaction and trigger complaint behaviors. Fairness theory and consumer complaint behaviors provided the theoretical support for this study; and, 354 medical tourists who received cosmetic treatments in Korea agreed to provide feedback via online surveys. The findings indicated that outcome fairness is the strongest variable affecting dissatisfaction, followed by interpersonal, procedural, and informational fairness, and dissatisfaction triggers specific behaviors (e.g., switching, negative word of mouth, and complaining), and differs by levels of participation. The results suggest that a medical hosting country and its hospitals should provide a fair service to reduce dissatisfaction and conceive a way of managing complaint behaviors. Future research should focus on service recovery strategies that can correct service failures from the perspective of the medical tourist.     

Quacks and Clerks: Historical and Contemporary Perspectives on the Structure and Function of the British Medical Civil Service

The British government's requirement for expert medical advice from the 1850s led to the development of a medical civil service, which reached its peak in size and authority in the 1970s. By this time the Chief Medical Officer (CMO) had direct management of a staff of over 170 medically qualified civil servants, who provided expertise on the development and implementation of new medical treatments as well as on broader health protection and promotion issues. The successive Whitehall efficiency reviews from 1979 onwards culminated in 1994 in the merger of the parallel medical and civil service reporting hierarchies in the Department of Health, effectively reducing the CMO's ability to call upon the support of medical civil servants, at a time of increasing new health threats such as AIDS and MRSA. This article uses government reports to chart the rise and fall of the British medical civil service. It discusses how, in the last ten years, the British government has become more imaginative in its use of temporary specialist medical advisers (tsars) brought in from the NHS, in relaxing the formal civil service hierarchies, and quietly abandoning the statutory Standing Medical Advisory Committee (SMAC). This article suggests that when the government has failed to give adequate support to its CMOs, the medical civil service has suffered from poor morale, experienced recruitment difficulties, and the ability to respond to health crises has been compromised. It highlights the chronic lack of historical awareness in the development of health policy in Britain.     

我国农村基本公共卫生服务的均等化发展

以制度化设计为重点的均等化公共卫生服务可以减少居民消费不确定性,促进社会公平和稳定,是国外经济社会发展政策的普遍趋势。我国农村公共卫生服务从均等化发展的目标来衡量,仍面临城乡环境差距较大、卫生资源布局不合理等诸多障碍,因此,必须加大改革力度,从推进农村公共服务设施与城市衔接、加强农村基础设施投入和完善农村医疗卫生体系等重点领域进行突破,全面推进农村公共服务与城市的融合。     

我国农村基本公共卫生服务的均等化发展

以制度化设计为重点的均等化公共卫生服务可以减少居民消费不确定性,促进社会公平和稳定,是国外经济社会发展政策的普遍趋势。我国农村公共卫生服务从均等化发展的目标来衡量,仍面临城乡环境差距较大、卫生资源布局不合理等诸多障碍,因此,必须加大改革力度,从推进农村公共服务设施与城市衔接、加强农村基础设施投入和完善农村医疗卫生体系等重点领域进行突破,全面推进农村公共服务与城市的融合。     

Inequality and Service Access

Health care in the United States is of crucial concern to citizens and government officials as well as academicians. This study reviews the literature concerning stratification and inequality. The delivery of medical services is investigated as a component of social inequality as well as one component of models of change in inequality. The data used in this analysis were collected in four upstate New York counties. Interviews were done to obtain information concerning household use of various medical specialties. Socioeconomic data were also collected for the households in the sample. The inequality of medical service delivery was investigated by comparing the distribution of medical service utilization at different levels of socioeconomic status. The degree of inequality of medical service utilization is considered a function of how strongly related utilization is to various measures of socioeconomic status. Multiple regression revealed that education of head of house, family income, level of living, family size, and place of residence are all related to the use of medical services.     

医务社会工作在构建医院人文服务体系中的作用

医务社会工作是体现医院人文服务的重要途径。以个案、小组、社区、义工等服务形式为主体的医务社会工作关注患者的心理情绪困扰,着重解决患者因疾病引起的各类心理与社会问题,实现真正意义上的"全人关怀"。构建医院人文服务体系是当前医院服务改革的方向,应把握医务社会工作的特点和医院人文服务体系的发展方向,发挥医务社会工作在构建医院人文服务体系中的重要作用。     

完善养老服务体系的构想

我国目前养老基础设施还比较薄弱,体系不甚健全。为破解养老难题,需要不断完善涵盖养老服务机构、服务制度、供养服务、医疗服务、人力资源开发等内容的服务体系。笔者试就此作相关阐述。