Health Policy and the Politics of Evidence

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence‐based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre‐eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision‐making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision‐making.     

健康经济研究领域的潜在问题分析

从卫生服务的成本核算与定价、疾病负担与生命质量的测算、健康经济学技术分析方法的改进以及健康投资主体的微观化等六个方面阐述了当前健康经济研究领域的潜在问题。     

社会支持因素对城市老年人健康自评的影响——以北京市朝阳区为例

利用2010年北京市朝阳区城乡老年人口状况调查数据,应用Ordinal Logit回归方法分析了社会支持对我国城市老年人健康自评的影响。研究结果表明,在情感性支持方面,子女孝顺、家庭和睦对老年人的健康自评存在积极影响;在实质性支持方面,社会保障收入高低、看病是否方便和医疗保障状况也都对老年人的健康自评存在影响。作为控制变量的人口社会经济特征和客观健康指标也影响到城市老年人的健康自评。     

中国老年健康研究评述以及展望

本文重点围绕改革开放以来中国老年健康研究中涉及到的概念、测量手段、数据来源、研究热点问题以及研究方法等方面进行了系统、全面地回顾和评述,指出了我国老年健康研究的特点,并展望了其未来走向。     

徐渭养生生活初探

养生文化是中国传统文化的一部分,历来被士人阶层所推崇。中国古代士人的养生生活实际是儒、医、道、佛四者相结合的混合体,四者相互结合、融会贯通。抒写真我,期于自得,不为人事所累,是以徐渭为代表的明代士人的终极追求。徐渭养生生活,与明代中后期政治黑暗、仕途阻塞、士人群体的失意与困惑不无关系。     

制约学校体育实施健康教育的诸因素分析

本文主要对影响学校体育实施健康教育的因素进行了分类研究 ,为学校体育实施健康教育提供科学的参考依据。     

村民是如何化解环境健康风险的?

污染—疾病科学关系不清及制度安排问题等因素致信息不全,加之村民相关科学知识的缺乏,是村民环境健康风险认知的根本性障碍,但村民并没有如简单预设的那样处于"束手待毙"的状态。在乡村社区,村民利用"熟人社会"的社会结构和文化机制把有限的信息无限利用,有效地应对了信息不全的困境。面对外源性污染,并且无法改变污染现状的格局下,村民根据生活经验和常识策略性地化解健康风险。村落社会中的亲缘、地缘关系结构以及精英—大众结构也影响了村民对环境健康风险的规避。村民化解环境健康风险虽然缺乏成熟的科学指导,却有其独特的实践逻辑。     

免费婚检、孕检的投入产出分析——以广东某区为例

本文从经济学的角度,以投入产出模型和机会成本为理论基础,通过构建以出生缺陷减少为产出收益的免费婚检、孕检投入产出分析模型,并以广东省某区的经验数据进行实证检验,对免费婚检、孕检推行的可行性进行分析。发现推行免费婚孕检的产出与投入的净现值指数为2．08,观显大于1。说明免费婚检、孕检项目可行且效益明显,值得在更大范围内推广。     

重视健康教育 改革体育教学

加强高校大学生健康教育,必须加强体育课程建设,提高教师健康教育素质,建立大学生体质监控机制,实施大学生素质教育.     

Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case?

This article examines the involvement of ministries of health in making health service coverage decisions in Denmark, England, France and Germany. The study aims to inform debate in England about the feasibility of reducing perceived ministerial and bureaucratic ‘interference’ in decisions affecting the National Health Service, based on interviews with senior government officials and other health system stakeholders. Ministries of health differ in their involvement in health system governance and coverage decisions (‘the benefits package’), reflecting differences in institutional arrangements. In all four countries, organizations at arm's length or independent from government are either involved in providing technical advice to the ministry of health or have been mandated to take these decisions themselves. However, ministries of health occasionally intervene in the decision‐making process or ignore the advice of these organizations. The Department of Health in England is not an aberrant case, at least in relation to coverage decisions. Indeed, ministries of health in Denmark and France play a larger role in making these decisions. Public pressure, often amplified by the media, is a shared reason for ministerial and ministry involvement in all four countries. This dynamic may thus limit the feasibility of attempts to further separate the NHS from both the Department of Health and wider political pressures.