德国卫生保健体系改革及相关伦理问题简析

从德国现有卫生保健及医疗保险体系在保障其社会稳定的重要作用角度出发,介绍了德国的原有整体医疗卫生保障体系的背景,指出政府的指导、政策稳定、完善的津贴体系保障了整体国民健康和卫生保健的公平分配,高素质,医术高超的医生队伍起到了核心作用.同时指出由于意识形态和经济原因,德国卫生保健体系改革所引发的问题.     

医学与人文社会科学融通的实践理性与理性实践

1重新认识医学与人文社会科学融通的重要性 随着医学和社会的发展,人们日益认识到医学各学科间以及医学技术与人文社会科学之间的整体联系,更加明确医学的技术发展与人文关怀是密不可分的.正如德国著名物理学家普朗克所指出:"科学是内在的整体,它被分解为单独的整体不是取决于事物的本质,而是取决于人类认识事物的局限性.实际上存在物理学到化学,通过生物学和人类学到社会科学的连续链条,这是任何一处都不能被打断的链条."既然医学是与人类生命直接相关的科学,医疗技术是增进健康、减少疾病的艺术,卫生保健是关系到人类幸福的事业,医学理当是科学技术与人文关怀融合的最好结合点."天人合一",科学技术与人文精神的渗透与融合是现代医学发展的必然归宿.     

海纳百川为我所用

2007年7月21日至23日,本刊邀请了马来西亚、印度、德国和台湾、香港以及内地的20多名学者,于山西省太原市举行"卫生保健体制改革比较研讨会".     

不同语境下的初级卫生保健

初级卫生保健一词在国内文献中涵义不同,研究发现《阿拉木图宣言》中的初级卫生保健更多的具有卫生体系变革的涵义,强调公平性、多部门合作、社区参与、适宜技术和适宜人力的原则;选择性初级卫生保健则以推广具有成本效益的卫生干预措施为重点;国内政策语境下的初级卫生保健则更多的是具体的卫生服务内容。     

加拿大安大略省卫生保健体系改革评析:整合的经验

建立整合型医疗卫生服务体系既是顺应全球医疗卫生事业发展的趋势,也是我国医疗卫生体制改革的重要内容。梳理加拿大安大略省卫生保健体系改革所显示的整合内涵、整合方式、整合评价,总结其特点,包括始终强调病人优先、健康公平;坚持各司其职、共同治理;鼓励民众参与、公开透明;保障绩效,推进可持续发展。从保障民众享有公平的医疗保健权利、梳理卫生体系管理者与医疗服务提供者的关系、建立多元主体共同治理三方面,提出对我国建立整合型医疗卫生服务体系的启示意义。     

卫生保健需要的重要性与意义

卫生保健需要在卫生计划和资源配置中的作用日益受到重视。卫生保健需要是有层次的,相对的,因确定者,不同个体以及时间而异,科学,全面地认识和测量卫生保健需要,分析其与卫生服务需求和提供的关系,是更好的满足整个人群的卫生保健需要,使需要,需求和提供三者相匹配的基本前提,才能确保实现充分利用有发的资源,更经济,有效地提供卫生服务,保障和促进人群健康的宗旨。     

国外循环经济立法:以德日为例

循环经济在我国还是一个全新的概念,而循环经济立法是保障和促进其发展的重要途径。本文通过对循环经济立法比较成熟的德国、日本和美国等国的立法模式、立法体系、基本法律制度进行介绍和比较研究,吸收并借鉴其先进经验,力求为构建我国循环经济立法体系提供有益的帮助。     

论发展我国全科医学

本文从全科医学的特点,国际发展状况,发展全科医学的必要性、可行性,建立全科医学教育结构等方面,论述了发展全科医学问题。指出发展全科医学是适应疾病谱、医学模式改变和人口老龄化的需要,是适应“２０００年人人享有卫生保健”的需要,是适应我国发展新型服务的需要。认为我国三级医疗保健网为发展全科医学提供了组织保证。最后从全科医学层次、过程、内容和职称结构方面讨论了发展、建立全科医学的教育结构体系模式问题。     

健康与卫生保健的公平性

１　对健康与卫生保健公平性问题广泛的国际关注近年来,在世界范围内,随着卫生改革的普及与深入,健康与卫生保健公平性的研究越来越引起卫生政策研究者与决策者的重视。９０年代中期,ＷＨＯ提出了有关公平性的全球性启动项目,其总目标是“促进和支持减少可避免的健康和卫生保健中社会差距的政策与行动”［１］。ＷＨＯ指出这个项目是构建在２０年前的“人人健康”（ＨｅａｌｔｈｆｏｒＡｌｌ）目标的基础上的。其具体目标是：１１　减少健康与卫生保健方面的社会差距,在优先选择的国家与国际组织中采取政策与行动,调整目前在经济、…     

医生是卫生保健改革的关键

来自波士顿哈佛大学医学院阿诺德教授的报告指出：关于美国现今的卫生保健改革应该加强初级保健方面的运作,提高应用于初级保健的资金,使大医院真正拿出人力、物力支持卫生初级保健系统。这样,就要求医生对此项改革给予大力支持,使医生真正成为卫生保健改革的关键。     

Mental health care and the politics of inclusion: A social systems account of psychiatric deinstitutionalization

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed.     

Paying for medical care: a Jewish view

According to Jewish law, there is a clear obligation to try to heal, and this duty devolves upon both the physician and the society. Jewish sources make it clear that health care is not only an individual and familial responsibility, but also a communal one. This social aspect of health care manifests itself in Jewish law in two ways: first, no community is complete until it has the personnel (and, one assumes, the facilities) to provide health care; second, the community must pay for the health care of those who cannot afford it as part of its provision for the poor. The community, in turn, must use its resources wisely, which is the moral basis within the Jewish tradition for some system of managed care. The community must balance its commitment to provide health care with the provision of other services.     

社会正义是对健康的最好保障

健康是公民的一项基本权利,社会或政府有义务保障公民的这一权利。公民的健康除了由医疗卫生和生理因素决定外,还由诸多社会因素决定。这些健康的社会决定因素所反映的实际上是社会正义问题,因此要保障公民的健康权利,最根本的是要营造一个正义的社会环境,并建立一个正义的社会保障支持系统。     

Religion as a support component in the health behavior of Black Americans

The use of religion as a support component in an effort to change the health behavior of Black Americans is historical and pervasive. The Black church's role as a social agent in the Black community has been a stabilizing factor in its overall health status. Political and social barriers that have deprived Black people of proper health care have been overcome through religious intervention. This intervention has been offered in the hope that proper health behavior would prevail. This article addresses the role of the Black church as an institution that uses different components of social support for the people in its surrounding community. Historical, theoretical, and health behavior are addressed in an effort to provide an explanation for the need to understand the marriage between social support and the Black church. In addition, related literature that provides support for the arguments of this article is also addressed.     

日本医疗保险制度改革及对我国的启示

日本是个高收入、高福利的发达国家,人均寿命长居世界第一,社会医疗保障体系比较完备,在许多方面值得我国借鉴。介绍了日本医疗保险制度的现状,医疗费用的审查及支付方式,后期高龄者医疗制度及针对生活习惯病的特定健康检查、特定保健指导。最后结合我国的具体国情总结了其对我国医疗保障体系建立和完善的几点启示。     

论影响卫生资源分配公平性的因素

公平分配卫生资源是促进社会公正的重要方面.观念、体制与政策是影响卫生资源公平分配的重要因素.重医疗、轻预防的观念使宏观卫生资源分配失去公平,而城市尤其是大中城市优先的制度安排、按医疗项目付费方式的弊端、医疗保障体制的不公平等体制与政策因素则使微观卫生资源分配失去公平.从观念因素、体制与政策因素两个方面入手,改进卫生资源分配的公平性,是我国提高全民健康水平、促进社会公正的必由之路.     

Is Social Justice Relative When It Comes to Oral Health? The Realities of a Complex Health Issue

For decades pastoral theology has emphasized care for the whole person and, more recently, this focus has been expanded to include caring for the physical health of parishioners. However, an overlooked area of general fitness has been the importance of oral health. Dental caries and periodontal disease are among the most common chronic diseases that disproportionately affect the most vulnerable populations. Despite significant progress in preventing and managing these oral diseases, there is a large segment of the population that have not experienced the same gains. This paper seeks to begin to fill this gap by identifying key epidemiological, professional and ethical issues related to social justice and oral health. Disparities of oral disease and access to oral health care in the United States will be addressed by examining questions and issues related to social justice. Critical problems are identified, including inadequate financial resources, a disjointed infrastructure of care, separation from the general medical care system, and poor understanding of important oral health determinants. Furthermore, if oral health is integral to one’s overall health and general well-being, then the concept of a basic human right should be entertained. Faith-based groups could provide a link for bridging this disparity gap in oral health among their parishioners through active listening, advocacy and targeted educational programs.     

医疗保健是权利还是特权

分析了医疗保健是权利还是特权的问题,美国和中国的医疗保健供给体制在医疗保健的概念上被界定为医疗市场的一种商品。虽然作为商品的医疗保健的性质已被讨论,但更具社会责任感的论证应是强调医疗保健是一种权利。社会表示对其成员健康的关不的主要方式主要是通过国家健康保险而体现的,从这个角度出发回顾了美国和中国的医疗保健情况。     

The Lost Voice: How Libertarianism and Consumerism Obliterate the Need for a Relational Ethics in the National Health Care Service

This article analyzes the contribution Christian ethics mightbe able to make to the ethical debate on policy and caregivingin health and social care in the United Kingdom. The articledeals particularly with the concepts of solidarity and subsidiaritywhich are essential in Christian social ethics and health careethics, and which may be relevant for the ethical debate onhealth and social caregiving in the United Kingdom. An importantargument in the article is that utilitarian and market-drivenpolicies in the National Health Service (NHS) and the socialcare system have marginalized the position of the elderly andhave seriously impoverished the quality of care for the elderly.The neglect of the elderly and other vulnerable groups is alsothe result of widespread consumerist attitudes among patientsand of libertarian models of noninterference which are affirmedby a public ethos of self-sufficiency and counter-dependency.Those who need care dare not make their need known to othersand ask for help, while simultaneously those who could helpare so intimidated by the public affirmation of privacy andnegative rights that they do not dare to offer help except ifthis is explicitly demanded. This distant and standoffish attitudeis in an important way responsible for the fact that the voiceof those in need is altogether lost to the public forum. Christianethics puts much emphasis on responsibility and solidarity withthe needy other but is not able to have much impact on the deliveryof care in a secularized society and health care system likethe NHS. Nonetheless, Christianity still has a powerful andrespected voice, by speaking up for those who cannot speak forthemselves, such as the elderly and the handicapped. Christianscan find allies in the ethics of care and other relational approachesin health care ethics in order to combat libertarianism, consumerism,and utilitarianism.     

Do the bishops have it right on health care reform?

The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right.