英国医疗卫生服务标准化建设及启示分析

为了提高医疗卫生服务质量,英国较早开始质量管理,并建立起由国家卫生与临床质量研究所、医疗和社会照顾职业标准管理局、照顾质量委员会三大机构组成的医疗卫生服务标准化管理体系。这三大机构分工明确、功能互补,形成了医疗卫生服务标准制修订、标准执行和服务质量监管的管理闭环。英国建立的医疗卫生服务相关的质量标准体系为英国医疗卫生服务提供者、医疗卫生服务购买者和享受医疗卫生服务的国民提供了参照,有效地保障了医疗卫生服务质量。英国的医疗卫生服务标准化实践为我国的医疗服务质量管理提供了经验借鉴。     

我国医疗卫生服务业面临的挑战与改革思路

医疗卫生服务行业的改革与发展是当前社会普遍关注的焦点问题,面临着严峻的挑战,突出地表现在医疗服务业发展严重不平衡、医疗卫生资源配置不公平、医疗卫生投入效率低、医疗卫生机制不健全等几个方面。医疗服务业改革和发展要坚持公平优先、兼顾效率这一基本原则。推进我国医疗卫生服务业改革与发展要发挥政府的主导作用,既要加强公共财政对公共卫生和基本医疗卫生服务的投入,也要适度引入市场竞争机制。严格界定两类不同性质的医疗服务机构,并实施差别公共政策,把加强和改善农村医疗卫生服务作为重中之重。     

我国公共医疗卫生政策中的政府角色分析

公共医疗卫生政策关系老百姓的切身利益,近些年来的一系列的天价医疗费事件和医疗改革的成效讨论早已就是人们关注的焦点。本文从当前的热点人手,着重从政策过程角度提出了我国政府在公共医疗卫生政策中的角色定位。     

公共医疗卫生资源公平分配的伦理和法律问题——以英国NHS分配伦理和法律为参照

公共医疗卫生资源公平分配的伦理和法律问题,在各国都是一个政治上颇具争议的话题。在英国,针对个人的资源配给决定,主要考虑平等原则、医疗需求、健康受益最佳化等伦理因素,涉及一些技术手段,并以"平等的司法"予以保障。这就提示我国的基本医疗卫生制度,应当在平等原则、伦理因素、分配工具和法治环境与司法机制等方面加强建设,以实现基本医疗卫生服务的公平获得。     

民族地区健康扶贫优化发展的路径研究——基于医疗供给侧结构性改革的视角

健康扶贫中的"扶"与"贫",从某种意义上说就是一种"供给"与"需求"的关系,基于医疗供给侧结构性改革去分析民族地区的健康扶贫是一种研究视角的创新。这一创新能从根本上审视目前民族地区推进健康扶贫面对的两大现实问题:一方面是贫困群体对医疗卫生资源的需求得不到较好满足,另一方面是国家对医疗卫生资源配置体系如何实现精准化和精细化。因此,需要通过供给侧改革来指导健康扶贫的理念、目标和方式的转变,调整医疗资源要素配置和使用中的结构性问题,使国家的医疗服务供给与民族地区的健康需求有机结合,提高供给的质量和效率。具体而言,应从医疗资源配置方式、财政投入机制、管理服务体系,以及民族贫困地区社会结构和民族传统医疗观等外植和内生因素去探索当前民族地区健康扶贫优化发展的路径,从根本上提升民族地区贫困人口的医疗保障和健康水平。     

我国外资医疗机构经营效率实证研究——基于DEA模型的两阶段分析

随着医疗卫生体制改革的深入和医疗卫生服务对外开放的发展,医疗卫生资源配置效率越来越受到医疗卫生体制改革的关注.外资医疗机构作为医疗卫生体制的重要组成部分,其经营效率直接影响到医疗卫生资源的配置和医疗卫生服务对外开放的发展.我国医疗服务对外开放的实践证明,外资医疗机构在注重技术投入的同时,更注重服务品质的提高,其经营效率明显高于国内公立医院.进一步对外开放医疗服务,不仅能满足医疗服务的多元化需求,而且有助于我国公立医院改革的;深化和经营管理水平的提升.     

公共政策对农村卫生服务能力的影响

农村医疗卫生服务,不仅承担农村居民健康保障问题,更关系深层问题.农村卫生具有典型的公共品属性,并且医疗卫生向来属于国家福利范畴,通过提升民众的健康水平,为经济社会发展提供优质人力资源,增强农村人口的就业和创业竞争能力,是实现我国彻底消除贫困的重要基础.从某种意义上说,提高农村卫生应该是国家经济社会发展政策的核心内容之一,这是因为无论从上述任何角度讲,建设健全的农村医疗卫生服务制度都需要国家进行较大范围的公共干预.     

江西奉新县:提升农村留守老人养老水平

提供三个保障.一是日常照料保障.村组干部、党员充分发挥离留守老人最近的优势,与其结成“对子”,经常到老人家中走走看看,及时掌握老人的身体等状况,开展帮农活、搞卫生等日常服务.同时,鼓励老年人互助、志愿者服务等,及时帮助他们解决具体问题.二是医疗健康保障.加大扶助乡、村卫生院(室)建设力度,各村卫生室至少配备一名专职医生,为老人建立健康档案,提供医疗咨询、测量血压等服务,开展定期上门、健康教育等活动,保障老人有病能得到及时治疗.三是经济生活保障.对一些高龄、长期患病且家庭困难的留守老人,在每月领取55元的基础上,适当提高一些标准.     

试论现代企业竞争中的服务质量管理策略

服务质量是现代企业竞争的着力点,也是影响企业竞争优势的主要因素所在。要完善服务质量管理体系,不断提高服务质量,必须深刻把握和实际权衡顾客预期服务质量与实际服务质量的四个制衡点;通过提供人性化服务、实行服务承诺制、及时进行服务补救等情感投资来培育服务质量的竞争优势;通过完善服务质量的内部管理体系,即建立服务质量信息系统、提升内部服务质量、培养企业的团队精神,从而为企业在市场竞争中始终立于不败之地而蓄积竞争优势。     

三医联动改革对策研究

医疗卫生体制改革是一个涉及多方利益的综合性改革,其中医疗、医药和医保是医疗卫生系统中尤为重要的三个子系统,只有加强医保、医药、医疗三者之间的联动改革才能真正发挥医药卫生作用,最终实现"人人享有基本医疗卫生服务"的目标。     

The Fiscal Crisis of National Health Insurance in the Republic of Korea: In Search of a New Paradigm

In 2001, National Health Insurance (NHI) in Korea, the social insurance system for health care with universal population coverage, experienced a serious fiscal crisis as its accumulated surplus was depleted. This fiscal crisis is attributed to its chronic imbalance: health care expenditure has increased more rapidly than have insurance contributions. The recent failure in implementing pharmaceutical reform was a further blow to the deteriorating fiscal status of the NHI. Although the NHI has since recovered from the immediate fiscal crisis, this has mainly been because of a temporary increase in government subsidy into the NHI. The strong influence of the medical profession in health policy‐making remains a major barrier to the introduction of policy changes, such as a reform of the payment system to strengthen the fiscal foundations of the NHI. Korea also has to restructure its national health insurance in an era of very rapid population ageing. A new paradigm is called for in the governance of the NHI: to empower groups of consumers and payers in the policy and major decision‐making process of the NHI. The fiscal crisis in Korean national health insurance sheds light on the vulnerability of the social health insurance system to financial instability, the crucial role of provider payment schemes in health cost containment, the importance of governance in health policy, and the unintended burdens of health care reform on health care financing systems.     

Advocacy Coalitions and Health Politics in Korea

This article analyses the political dynamics underlying health care reform in Korea after the Asian economic crisis. The reform was a significant volte‐face in respect of the social policy paradigm, which now aims to enhance equity in National Health Insurance. The article pays special attention to the evolution of the advocacy coalition for equity in health policy and how it developed the two attributes required for successful policy change: institutional strength and the elaboration of policy rationale for reform. This process was not a simple linear development but a combination of setbacks and advances. The article also takes into consideration the structural conditions that set the policy environment over the course of the advocacy coalition's evolution since the 1960s. In short, the policy reform of 2000 was not a simple policy change in response to the economic crisis, but rather the outcome of the long‐term evolution of the advocacy coalition for equity in health policy.     

Why Health Care Reform Now? Strategic Framing and the Passage of Obamacare

Economic reform and health care reform were both focal points outlined in President Obama's policy agenda, with increasing pressure to address economic and social insecurity given that President Obama entered office during the Great Recession (2007–09). The Patient Protection and Affordable Care Act (commonly known as ‘Obamacare’) successfully passed in March 2010 in the context of the economic crisis. We argue that the strategic framing of the economic crisis, through reasoning and arguments linking health care reform with economic downfall, is important in understanding the successful passage of Obamacare, and that this is reflected through strategic frames in speeches delivered by the President on health care reform. Health care reform has been successful not in spite of but rather because of the economic crisis of 2008, that allowed President Obama to use a strategic frame focusing on costs and economic problems. The two main frames identified are the ‘market’ and ‘rights’ frames. President Obama's strategic frames specifically surrounding the economic and cost‐containment priority of health care reform are categorized as a ‘market’ frame in this article. He used this frame until the passage of the law in 2010, when the frame shifted to ‘rights’ frames, largely portrayed through anecdotes and focused on the concept of ‘access’ to care rather than the ‘cost’ of care. This is observable through tracking speeches and statements made in support of health care reform between 2009 and 2013.     

Welfare reform and future challenges in the Republic of Korea: Beyond the developmental welfare state?

Since the economic crisis of 1997–98, the Republic of Korea has carried out vigorous social policy initiatives including the reform of the National Pension Programme and National Health Insurance. This paper seeks to answer whether the country's welfare state has moved beyond welfare developmentalism, by examining the cases of those two programmes. By the reform, the coverage of the National Pension Programme was extended to the whole population; and its financial sustainability and accountability were enhanced. Regarding National Health Insurance, efficiency reform was carried out on the management structure, while reform regarding financing was put on hold. These reforms were in clear contrast to the welfare developmentalism that used to place overwhelming emphasis on economic considerations. Despite these reforms, however, the Republic of Korea's welfare state faces the issues of ineffectual implementation and lack of financial sustainability of social policy. The National Pension Programme has failed to cover the majority of irregular workers, whose numbers are on the increase, and National Health Insurance needs to find a way to meet increasing health expenditure.     

Handicapped by old and new traps: Hungary's health care reform

Since the early 1980s, grave challenges have faced Hungarian health policy. The health status of the population stagnated between the mid-1960s and mid-1970s, and has dramatically deteriorated since then. In the 1980s the multidimensional crisis of the health care system deepened. Its overhaul must embrace every component: policy-making, ownership, financing, management, service structure, patient rights, medical education, etc. The main purpose of this paper is to describe how health policy has (or has not) responded to these challenges. First it summarizes the inheritance of the state-socialist regime, then it outlines the recent changes in social insurance legislation, and finally it compares official goals with the way the reform is actually proceeding. The paper is intended to discuss the connection between health care reform and the historic transformation of the political regime and the economy.     

Social Work in Accident and Emergency Departments: A Better Deal for Older Patients' Health?

Correspondence to Eileen McLeod, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. Summary Well-established internationally, the current development ofsocial work in UK accident and emergency (A&E) departmentsis part of a conjoint health/social care policy drive to divertolder people from ‘unnecessary’ admission to acutehospital care on social grounds. However, from older serviceusers' standpoint, the prime criterion for assessing A&Esocial work is not its powers of diversion, but its contributionto optimum health and social care. Our account indicates thatA&E based social work can provide important benefits, includinghelp with negotiating the A&E environment and readier accessto social services. Nevertheless, continuing professional–serviceuser power imbalances, together with shortages in health andsocial care services, undermine its positive contribution bothwithin A&E and following discharge. Notably, under-resourcedcommunity based health and social care can lead to servicesimplemented through A&E, swiftly unravelling. This has seriousconsequences for older service users facing interlinked healthand social problems, and may be implicated in re-attendanceat A&E.     

Improving health care delivery to aging adults with disabilities: social work with dual eligibles in a climate of health care reform

Adults aging with disabilities comprise a diverse group. In this article, we identify the prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid. We articulate challenges in the delivery of health, social, and support services to adults aging with disabilities, particularly how existing health care policy and financing contributes to fragmentation of care. Finally, we identify opportunities for social workers to advocate for and promote system improvements in the delivery of care for aging adults with disabilities in the current climate of health care reform.     

Racial and ethnic diversity in senior centers: comparing participant characteristics in more and less multicultural settings

The 2008 Health Indicators Project surveyed a probability sample (N = 1,870) of New York City senior center participants. Attendees of racially and ethnically diverse and nondiverse senior centers were compared across 5 domains: demographics; health and quality of life; social support networks; neighborhood perceptions and engagement; health service access/utilization. Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics. Implications and future directions for research, practice and policy are discussed.     

Social health protection in Cambodia: Challenges of policy design and implementation

The Government of Cambodia is implementing ambitious reform initiatives to improve the country's social health protection system. In January 2018, it was announced that the Health Equity Fund (HEF), which is fully subsidized by a joint government‐donor initiative for the reimbursement of user fees for the poor at public health facilities, is to be expanded to some segments of informal workers belonging to associations, as well as to commune and village chiefs. Since 2017, the National Social Security Fund (NSSF) has provided social health insurance for formal economy workers in enterprises with eight employees or more. In January 2018, it was expanded to civil servants and all employees regardless of the size of the enterprise. However, this article highlights that the new ambitious reforms are not accompanied by careful planning as regards funding, service delivery, human resources and institutional design. This article therefore aims to examine key policy issues and challenges for Cambodia's ambitious reform of its social health protection system in terms of resource generation, population coverage, strategic purchasing and governance.     

Health Care in Asia and the Pacific: Increasing the focus on social health insurance

This paper focuses on health insurance reform within the broader frameworks of both social security and health services system development. In most countries in Asia and the Pacific, it is indeed the reform of the health services system, through policy changes in health care financing, that has led to an increased focus on health insurance. The underlying issue in this reform is the shift in responsibility that has taken place in most countries in the region over recent years. In the past, governments were responsible for financing health care for their populations. This shifted to defining, legislating and implementing an appropriate health care financing mechanism, presenting several challenges: to reach universal health insurance coverage through new initiatives for new populations, mainly the informal sector accounting for the majority of the population in almost all these countries; to apply provider payment systems that enable control over costs and the volume of utilization; and to strengthen primary health care as a foundation for rational utilization and more resources for prevention, including prevention of chronic diseases among the ageing population. This approach will require an active partnership between health insurance schemes and government that should reflect the new division of responsibilities to guarantee access to high-quality health care for all.