公立医院回归公益性的伦理探析

从制度及管理上的伦理缺陷分析了公立医院公益性淡化的原因.医疗产品和服务的特殊性、公立医院所承担的社会责任、对人的尊重、公平优先的原则为公立医院回归公益性提供了伦理依据.加大政府投入,加强行业监管,推进卫生系统的信息化,进行产权、财务制度、人事制度改革,完善基层合作是公立医院回归公益性的必要措施.     

博弈论视角下公立医院回归公益性改革研究

公立医院回归公益性改革正在进行,取得了一定成就,但群众“看病难、看病贵”现象仍未得到解决,医疗费用居高不下.以博弈论为视角,分析了政府、公立医院、居民三方之间的博弈关系,并从完善公立医院补偿机制、重视公立医院社会责任、增加居民博弈砝码等角度提出了完善公立医院回归公益性改革的路径选择.     

公立医院分流的必要性及其应当注意的问题

公立医院回归公益性的重要前提是合理的补偿,然而在有限的财政情况下,只有公立医院分流才能使各类医院准确定位和归位.深刻分析分流的必要性,指出应当如何分流以及分流过程中应注意的问题,如合理选择分流对象、国有资产保值增值及分流后各类医院的管理等.     

应当重视医生“公共人”的角色定位

“经济人”的价值理念刺激了医疗行业的逐利行为,我国公立医院公益性淡化已然是事实,医生的“公共性”日渐缺失.医患之间的信任危机从来没有像今天这样严峻,很重要的原因是医生的价值取向的迷失.医生确实面临多价值选择冲突,但过分强调“经济人”特性,而忽视公共性的重要,已然导致了种种恶果.所以,应当重视医生“公共人”的角色定位.医生和医院要回归对医疗职业本性的认识,让医生成长为“为了人类的幸福和自身的完美而工作”的“公共人”,让医院回归“为社会公众谋取利益,追求社会效益目标”的公益性.     

应当重视医生“公共人”的角色定位

“经济人”的价值理念刺激了医疗行业的逐利行为,我国公立医院公益性淡化已然是事实,医生的“公共性”日渐缺失.医患之间的信任危机从来没有像今天这样严峻,很重要的原因是医生的价值取向的迷失.医生确实面临多价值选择冲突,但过分强调“经济人”特性,而忽视公共性的重要,已然导致了种种恶果.所以,应当重视医生“公共人”的角色定位.医生和医院要回归对医疗职业本性的认识,让医生成长为“为了人类的幸福和自身的完美而工作”的“公共人”,让医院回归“为社会公众谋取利益,追求社会效益目标”的公益性.     

利益冲突对医药科技人员道德行为的影响及对策初探

从新药研制到药品的临床使用,部分研究者和医生背离了伦理道德,由此引发了利益冲突。阐述了药物临床前动物实验和临床人体试验中的乱象,在药物流通环节中医院和医生成为药商促销行贿的主要对象,以及伪装成继续医学教育的变相行贿等严峻现状和危害。探讨了提高医药领域科技人员职业道德和控制利益冲突的对策,将患者的利益放在首位,政府加大对医院的投入,使公立医院回归公益性,有益于规范医药科技人员和医生的职业行为。     

对医疗服务供给公益性若干认识误区的辨析

对公立医院公益性的认识误区进行辨析,为医疗服务供给公益性的实现路径提供参考。对我国公立医院公益性的几个常见认识误区进行了辨析,比较了公立医院公益性与非营利性、效率等概念的关系,结合我国新医改实践提出了医疗服务供给公益性的内涵及实现路径:实现医疗服务供给的公益性应由政府明确界定公益性评价标准,在医院公益性与营利性经营活动分离的基础上实现,政府应运用购买服务的手段提高公益性服务的供给效率,并借助需方力量加强对医疗服务质量的监管。     

我国医院公益性淡化的表现及其成因分析

新医改突出强调"坚持公共医疗卫生的公益性质",作为公共医疗卫生服务体系重要主体的医院如何回归"公益性",是医院经营方式和运行模式的改革中,不能回避的问题.就目前我国医院公益性缺失的主要表现及其成因进行分析,以期为医院改革过程中的公益性回归找到解决途径.     

颠覆医学职业潜规则的优先对策——在新医改进程中营造良好的医学职业伦理生态

医学职业潜规则的存在使新医改政策无法顺利推行,究其原因系医学伦理生态遭到污染.要颠覆医学职业潜规则,首要做的是营造良好的医学伦理生态,即在建设医学职业公益性生态的同时强化职业伦理的权威性,并切实保障公立医院公益性、伦理性的回归,同时强化医生群体的自律性,从而通过自律与他律的结合重构医学职业精神.     

大型公立医院网络信息公开路径的探讨

新医改方案强调医疗行业公益性和公平性,公开医务信息是对人民群众健康高度负责的体现.以自办网站为例,分6个方向、22项内容调查了123家大型公立医院的医务信息公开情况.结果表明,公立医院应按对象、种类、内容等分步骤、有策略地提高信息透明度,达到促进医院科学发展、医学进步的目的.     

公共政策制定程序对政策可接受性的影响

根据程序公正理论提出公共政策制定程序与公众对政策的可接受性的关系问题。研究一通过访谈不同领域的学者,初步揭示了公共政策及其制定程序存在的问题——对公共问题不敏感,解决问题的措施成效低。研究二用问卷调查公众对一个制定中的公共政策的态度,恰与政策制定者的愿望相反,公众并不认可政府解决问题的设想,也不认同政府举行的听证会的结果。研究三设计了一个非等组前后测准实验,在两个互联网站的电子公告板上比较根据不同的公共政策制定程序的政策的可接受性。结果证明,制定政策时了解公众态度可增强政策的针对性,提高解决问题措施的成效和可接受性     

Dis-inviting the Unruly Public

Abstract

Recently, Welsh and Wynne have argued that policy efforts to include ‘the public’ in dialogue about technoscience have been accompanied by a simultaneous rise in control over uninvited publics, particularly protestors. Research with a group of knowledge-based activists in the UK suggests a further category between invited and uninvited. The concept of an ‘unruly public’ functions within the sociotechnical imaginary to disinvite those whose response is unwanted or unpredictable, while still appearing to be engaging with ‘the public’ as a whole. Listening to the unexpected questions of the unruly public may in fact support, rather than hinder, efforts to incorporate social concerns into frameworks for responsible innovation at both national and European levels.     

Public Health Problems in the Medieval Statutes of Croatian Adriatic Coastal Towns: From Public Morality to Public Health

The article seeks out the regulations about public health in the oldest medieval statutes of fourteen cities of the eastern Croatian Adriatic coast, between the thirteenth and sixteenth century. The research revealed numerous examples of direct or indirect ways of protecting public health. Through the analyzed documents, a noteworthy relationship between public morality and public health can be noted. The described rules are important as a reflection of awareness about public health as a condition of survival and progress in the past. They witness a progressive transition from an original common law into a written law as well as the impact that religion had in influencing people’s general opinion and lifestyle in light of public health problems.     

Producing the Post-Fordist Public: The Political Economy of Public Engagement with Science

The commercial exploitation of scientific knowledge and increased public participation in democratic decision-making about science and technology have emerged as the two central themes of contemporary science policy in Britain. We argue that the prominence of participatory discourse in contemporary science policy is primarily due to the close fit of this discourse with the post-Fordist and post-industrial economic strategy of the British state. Participation is a form of immaterial labour which gains currency in this phase of capitalism, blurring the distinctions between production and consumption, and between the economy and the political or communicative public sphere. Participation is cognitive, interpretative, affective, and social work which enters into the construction of technologies as bundled material artefacts and cultural meanings. Participation operates both in the production and consumption of goods and in the legitimation of social and political relations. Public engagement exercises prepare the product for the market and the market for the product. Such exercises therefore instantiate the way in which immaterial labour is both productive and political. Participation activates, but also disciplines, the subjectivities of post-Fordist publics. Contrary to the rhetoric of democratization that has accompanied public engagement efforts, these programmes potentially operate as forms of control and co-optation, and promote the shaping of publics as markets.     

公共伦理与公共秩序 ——基于当前政府行政伦理状况的理论思考

现代社会公共秩序的核心是个体自由,而其价值表现则是公民伦理。我国公民伦理思想的历史积累并不丰厚,与此相关的公民社会亦不成熟,因而现实公共秩序及其规则的形成主要依靠传统习俗与权力意志,这导致现代公民伦理成长的孱弱性和漫长性。在现阶段,消费政治欲望的增长给公共秩序的结构转型带来了双重任务:社会重建与权力重建,两者并无先后轻重之分,只有如何应对之别。