“单位制”影响下的城市社区服务发展——以广州市D社区为个案

我国的社区服务是伴随着政府职能的转变和单位体制的改革而产生和发展起来的。时至今日,计划经济体制下形成的“单位办社会”管理格局仍深深影响着城市社区服务的发展。本文以广州市D社区为个案,从文化、组织体系、社会资本等多个角度,深入分析了单位制给社区服务带来的影响,并指出,社区服务的持续健康发展应以多元化参与为基础,在现阶段尤其应当重视非营利性社区服务组织的培育。     

Health Care Fraud and Industry Structure in the United States

The cost of health care fraud and abuse is enormous. Not only is it costing us a lot of money but one wonders how many more people could afford and receive medical insurance if fraud and abuse were significantly lower. This paper will show that the problem is embedded in the way America does health business. The problem needs to be better addressed by both the criminal justice community and the health care industry. Most importantly, those making the health care industry policy decisions need to make a paradigm shift. The system is out of balance because of past policies and decisions that have given excessive power and liberty to the medical services community and insurance providers. Using O’Toole's Compass Card of the four major ideas that have influenced political decision‐making as a guide, this paper recommends that current decision‐making needs to strengthen the equality and community poles and restrict the liberty and efficiency poles so that more balance might exist within the American health care system. Talcott Parsons saw the dangers of commercializing health care over half a century ago. The health care scene of today shows that he was correct in his appraisal.     

城市社区老人心理健康服务现状调查——来自重庆市主城社区的调查数据

以重庆市主城社区老人为调查对象,从老人的基本情况、心理健康状况、心理健康服务需求、心理服务支持系统等方面的调查数据进行详细分析,得出了家庭、邻里同辈群体是老人心理健康的重要支持系统、需要建立完善的城市社区老人心理健康服务体系等结论。     

THE CONTEXT FOR COMMUNITY PARTICIPATION IN HEALTH ACTION IN AUSTRALIA

Community participation is one of the underlying principles of democratic societies and the potential benefits of the participation process are well documented. Although a number of participatory mechanisms have been established by government departments and community agencies to facilitate community participation in health, few Australians regularly or actively participate. This paper examines the context for participation in health action in Australia including a political culture which serves to discourage participation in health, and many other areas, and barriers to participation associated with the complex structure and financing of the health care system.     

IMPOSED STRUCTURES AND CONTESTED MEANINGS: POLICIES AND POLITICS OF PUBLIC PARTICIPATION

This article explores the concept of structured community participation in health, which refers to groups that are established by health decision-makers to provide a ‘community’ viewpoint of health issues and services. The imposed nature of this form of participation is, however, potentially problematic in that it may not ensure that the community's views arc heard. Rather, structured community participation may entrench dominant interests. Drawing on the experiences of District Health Forums in Tasmania, this article explores issues surrounding this form of participation and argues that the political context of participation must be fully understood if it is to be effective. A recognition of the differences between bureaucratic and community needs and interests is essential to the success of structured community participation.     

Community Mental Health Services in a Remote Rural Area

A programme was developed by the authors to provide community mental health services to an isolated rural region situated within the large catchment area of a state psychiatric hospital. The programme functioned without psychiatrist or medical officer in the team. The authors believe their programme to be effective and economical both of monetary cost and of the scarce services of psychiatrically trained professional workers. They hope it will serve as a model for other community mental health workers.     

The end of the asylum (town): community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.     

Satisfaction with Health Care and Community Esteem Among Rural Women

The present study examines the ways in which satisfaction with health care may be associated with the lives of rural women. One hundred thirty one rural women between the ages of 45 and 70 years completed measures of community esteem, life satisfaction, satisfaction with health care, health status, and mood. The results showed that rural women's satisfaction with their health care was associated with the extent to which they hold their community in esteem and their degree of life satisfaction. Moreover, women who had poor health were less satisfied with the available health care than were healthier women. These findings are discussed in terms of their implications for the well-being of rural communities in general.     

Techniques for overcoming community resistance to family planning programs

Methods of overcoming resistance to publicly subsidized family planning programs are discussed. The main sources of opposition include groups that oppose family planning for moral reasons, and those who object to the spending of government funds to provide services and information. Such opposition can be weakened by indicating that family planning clinics fulf: 11 important medical needs. Presenting social justification for family planning can help to lower oppostion. In order to secure participation in the programs by low income groups it is essential to have community leaders involved in policy decisions and to use indigenous community paraprofessionals in the clinics. A coalition of representatives of the poor community and the health and welfare system, aided by the community organization, can lead to an effective family planning program.     

我国农村社区卫生服务的现状与对策

农村社区卫生服务是我国卫生事业改革的重要课题,也是建设社会主义新农村的重要内容。经过近些年的努力,我国农村社区卫生服务取得了较大成绩,但仍然存在硬软件、资金、管理及服务内容不到位等方面的问题,基于当前现状,应着力从服务理念、政府主导功能、多元化资金渠道、信息化建设以及服务评估制度等方面加以完善。     

我国农村社区卫生服务的现状与对策

农村社区卫生服务是我国卫生事业改革的重要课题,也是建设社会主义新农村的重要内容。经过近些年的努力,我国农村社区卫生服务取得了较大成绩,但仍然存在硬软件、资金、管理及服务内容不到位等方面的问题,基于当前现状,应着力从服务理念、政府主导功能、多元化资金渠道、信息化建设以及服务评估制度等方面加以完善。     

Health care insurance in Japan: Beyond a binary vision of State and family

Despite significant regional diversity in household structures and the existence of community solidarity in Japan, caring for elderly dependent persons has traditionally been considered an exclusively family, and female, responsibility. However, as a result of socio-demographic changes during the second half of the twentieth century, a public system of health care insurance was introduced in 2000. The objective of this development was to "socialize" family and female care activities. This article presents a critical analysis of Japan's health care insurance system and the context that gave rise to its introduction. An important issue is whether the system meets the needs of the elderly and their carers (family and non-family). A further issue is whether the system can take account of regional diversity, diversity in household situations (above and beyond financial concerns), and societal values and beliefs. The article concludes by arguing that demographic ageing presents a societal requirement for the ongoing adjustment of behaviour patterns and living arrangements.     

广州市越秀区社区健康教育的实践与探索

社区健康教育在促进社区居民健康,改善社区居民生活质量,以及在健康社区的建设中发挥着重要的作用。针对越秀区社区健康教育工作开展中面临的一些困难,广州市越秀区社区教育学院一院通过社区健康教育项目"健康直通车"的实施,将健康教育融入社区教育中,探索出有效促进社区健康教育发展的实践路径,通过对"健康直通车"项目实施成效的分析,提出了进一步推动越秀区社区健康教育发展的建议。     

Local Voices in an Internal Market: The Case of Community Health Services*

This paper presents findings from a study of contract specification and implementation in community health services (CHS). In this paper, we focus on one aspect of that study: the role of local people in informing the assessment of health needs and in determining the provision of community health services in the context of the NHS “internal market”. The paper is based on fieldwork undertaken in three districts within one region. Analysis of data obtained from these localities suggests that while there appears to be a genuine commitment to the principle of local involvement, ideas about how that involvement can be built into the activities of either purchasers or providers are less transparent.     

Community participation in primary health care

The medical profession lacks an analysis of society and medical care is individualistic rather than societal, curative rather than preventive. This paper, which reports on experience in the field, shows how community health should help people to reflect and discover the causes of their poverty and ill health so that they may be able to tackle effectively the issues of social injustice such as low wages and other forms of exploitation. Community health, then, becomes a way of motivating the people to mobilize themselves to resist the domination of the traditionally powerful. If this is not done, community health may remain only a social service that keeps the people dependent and not participants in the process of their own development.     

National Health Insurance: An Alternate Medical Viewpoint

Increasing medical technology, expertise and community expectations of health care are leading to an alarming escalation of health costs throughout the world. Many health planners are expressing doubts as to whether quality of health care can be maintained in the present circumstances. It is maintained that the Australian Government's proposal of National Health Insurance is an interim measure, intended to grant hospital and medical expenditure assistance to the entire community, at minimum cost. There is little evidence that the scheme threatens the medical market place, as it is seen at the moment, and a plea is made for productive and constructive discussion of the scheme by the medical profession.     

The role of "Theatre for Development" in mobilising rural communities for primary health care: the case of Liwonde PHC Unit in southern Malawi

The improved health conditions that are essential for development may depend more upon the self-help motivation of local people than upon the provision of Western-style health facilities. Such motivation can be created by the culturally-appropriate dissemination of health education at the community level. This article describes an effective health improvement strategy implemented in three villages in southern Malawi during the late 1980s. After an introduction, the paper presents an overview of current strategies used in Malawi for the dissemination of primary health care information and notes that these strategies have failed to reach the rural population. Next, the paper describes the health status of two of the villages, Mbela and Mwima, before the introduction of the Liwonde Agricultural Development Division Primary Health Care Program. None of the three village involved had access to modern health care facilities. This program involved the joint efforts of the community, a primary health care team, and the Chancellor College Theatre for Development. The paper continues by presenting a conceptual model of the process. Community involvement was assured by the election of the members of village health committees and the delivery of health training to two members of each committee. The Theatre for Development used interactive dramatic techniques and participatory research activities in Mwima and Mbela to help the communities assess their health needs and possible solutions in conjunction with the introduction of primary health care activities. The article also contrasts the Theatre for Development technique with the focus group approach and notes that the latter may not be successful in motivating self-help efforts. Finally, the relative success of the Theatre for Development methodology used in the two villages is described by comparing health indicators with those before the intervention and with those in the third village where this approach was not used in conjunction with introduction of primary health care services.     

The Role of Housing Managers in the Implementation of Community Care

This article will outline the response of housing management to the implementation of community care policy in the North East. It will locate housing's role within the broader development of community care policy, and briefly review the reasons for housing's relatively late arrival as a key partner, alongside social services and health, in the planning and delivery of services. Using information gathered from interviews with housing professionals, part-time housing students, voluntary organizations, and workers within health and social services, it outlines and evaluates five main factors which appear to be affecting the successful integration of housing management into the process of planning and delivering community care services in the North East.     

重庆市城市社区心理卫生现状调查及其对策思考

本文通过问卷调查、现场走访等方式,分析、描述了设为直辖市后重庆主城区社区居民心理健康观念、社区心理健康教育状况及其成因。作者认为,在现代社会,由于生活节奏的加快,各种竞争的加剧,人们在享受不断丰富的物质生活的同时,精神生活方面却越来越觉得并不十分完美,“亚健康”成为一个相当普遍的社会问题,增加人文关怀,进行城市社区心理健康教育,建立心理危机干预系统就显得很有必要。     

城市社区老人心理健康服务现状调查——来自重庆市主城社区的调查数据

以重庆市主城社区老人为调查对象,从老人的基本情况、心理健康状况、心理健康服务需求、心理服务支持系统等方面的调查数据进行详细分析,得出了家庭、邻里同辈群体是老人心理健康的重要支持系统、需要建立完善的城市社区老人心理健康服务体系等结论。