印度农村医疗的现状与对策

自印度独立以来,政府就致力于采取各种有力措施来改善人们的健康情况并已卓见成效.尽管印度政府采取了一系列的发展政策,经济、地区发展不平衡及男女不平等还是为医疗部门带来了巨大的挑战.分析印度政府在农村所面临的问题以及为解决这些问题政府颁布的新政策.     

我国医疗改革的现状分析

目前,我国医疗改革面对卫生保障覆盖率低,资源分布不均,初级医疗服务滞后,药费居高不下,看病难、看病贵问题,以及医疗服务供给者及需求者双方均不满意的尴尬局面,由于政府的不当干预及责任缺失使改革举步维艰,医患矛盾日益突出。通过对我国医疗改革失败原因进行分析,从而为采取相应措施,促进医疗改革全新局面的形成提供理论基础。     

论医疗违约行为的认定及其标准

医疗违约以医师在诊疗过程中不履行或不完全履行其医疗债务为表现形式。然而，医疗债务属于手段债务，对其不完全履行无法从结果上判断，而只能从履行过程上判断是否违反诊疗义务。因此，医疗违约的认定首先应明确医疗合同中诊疗义务的具体内容，并在此基础上采取一定的标准和方法判定医师的诊疗行为是否构成违约。鉴于合同法上传统的违约认定方法并不适用于医疗合同，应考虑将医疗水平确立为违约的认定标准，并谨慎应对其适用中可能存在的问题。     

我国医疗改革的现状分析

目前,我国医疗改革面对卫生保障覆盖率低,资源分布不均,初级医疗服务滞后,药费居高不下,看病难、看病责问题,以及医疗服务供给者及需求者双方均不满意的尴尬局面,由于政府的不当干预及责任缺失使改革举步维艰,医患矛盾日益突出.通过对我国医疗改革失败原因进行分析,从而为采取相应措施,促进医疗改革全新局面的形成提供理论基础.     

政府责任与医疗弱势群体的医疗保障

本文系统探讨政府承担弱势群体医疗保障责任的问题。针对我国的实际情况,首先提出了“医疗弱势群体”的概念;然后以部分发达国家的实际作法为背景探讨了政府承担弱势群体医疗保障责任的理论与法理基础;随后分析了我国政府承担弱势群体医疗保障责任的历史与现状;最后,就我国政府承担医疗弱势群体医疗保障责任的总体思路等问题提出了建议。作者提出,政府不能逃避其应该承担的责任;要改变目前首先为有一定经济能力的人提供医疗保障的做法,优先解决医疗弱势群体的医疗保障问题;目前我国已具备将弱势群体一次性纳入医疗保障体系的财政能力。     

信息不对称理论之于医疗服务研究

信息不对称理论被广泛应用于揭示和解释经济学领域中存在的许多实际问题,包括医疗服务领域.运用信息不对称理论分析医疗服务中存在的问题,指出解决我国医疗服务信息不对称问题的根本之道在于发挥政府和市场的互动作用.     

30泰铢治疗所有疾病——泰国医疗保健制度的一种尝试

随着20世纪90年代民主政府的建立并实施一系列社会、经济和制度的变革以来,泰国的医疗体制也相继发生了变化,特别是30泰铢的普及医疗计划,提高了医疗服务的可及性,但是由于医疗资源配置方式的不健全,仍存在公立部门医务人员短缺、私人医疗机构不断膨胀的问题,为此必须要合理规范医疗市场,避免医疗服务的两极分化。     

网络医疗发展带来的法律问题

随着网络技术迅速发展,网络医疗以其方便快捷,患者足不出门便可得到一流的医院、最优秀的医生、最先进的医疗服务等,这些深受患者青睐。网络医疗对医学发展将起到不可低估的作用。然而网络医疗在其发展的同时,也存在一些不可忽视的问题。网络医疗在改变传统医患关系模式的同时也带来了一系列诸如保障患者隐私权、保护知识产权、法律关系改变等新的法律问题。这些问题不解决,对网络医疗健康发展,对医患合法权利保护等都会带来不利影响,针对这一系列问题展开论述,提出解决问题的办法。     

3O泰铢治疗所有疾病——泰国医疗保健制度的一种尝试

随着20世纪90年代民主政府的建立并实施一系列社会、经济和制度的变革以来,泰国的医疗体制也相继发生了变化,特别是30泰铢的普及医疗计划,提高了医疗服务的可及性,但是由于医疗资源配置方式的不健全,仍存在公立部门医务人员短缺、私人医疗机构不断膨胀的问题,为此必须要合理规范医疗市场,避免医疗服务的两极分化.     

网络医疗发展带来的法律问题

随着网络技术迅速发展,网络医疗以其方便快捷,患者足不出门便可得到一流的医院、最优秀的医生、最先进的医疗服务等,这些深受患者青睐.网络医疗对医学发展将起到不可低估的作用.然而网络医疗在其发展的同时,也存在一些不可忽视的问题.网络医疗在改变传统医患关系模式的同时也带来了一系列诸如保障患者隐私权、保护知识产权、法律关系改变等新的法律问题.这些问题不解决,对网络医疗健康发展,对医患合法权利保护等都会带来不利影响,针对这一系列问题展开论述,提出解决问题的办法.     

Public and private responsibility for mental health services. A report on the Tennessee Task Force

The "privatization" of mental health services during the last decade has literally reshaped the way state and county departments of mental health go about fulfilling their statutory responsibilities. In Tennessee, a conference and later a task force examined the implications of this trend for the future. Two issues came to the forefront: Is it appropriate or possible for the private sector to take over the delivery of all mental health services, and if so, who will ensure that the poor receive adequate care? The Tennessee task force concluded that the privatization trend is appropriate and should be encouraged by government. It further concluded that government is ultimately responsible for ensuring access to care for the poor and uninsured although private facilities should provide some free care. Government best serves the poor by providing them the financial means to purchase care from private providers.     

Medical tourism in india: perceptions of physicians in tertiary care hospitals

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.     

Affect and public health – Choreographing atmospheres of movement and participation

Attempts at improving physical activity rates among the population are central to many government, public health, and third sector approaches to encouraging health behaviours. However, to date there has been little attempt by public health to embrace different theoretical-methodological approaches, relying instead upon largely quantitative techniques. This paper argues that through a development of a framework of affect amplification, public health approaches to physical activity should incorporate the choreographing of spaces of movement. Drawing on two case studies, both incorporating ethnographic methodologies, this paper complicates the idea that public health can rely on individual or population level approaches that overlook affective and spatial entanglements. This paper concludes by outlining offer a series of ideas to encourage physical activity participation.     

英国的健康促进与个人自由

从英国的3种自由观——消极自由、积极自由和赋权自由出发,论述了健康促进和个人自由的关系。通过比较不同自由观的特征以及其对健康促进的影响,得出结论:当今英国政府主张的赋权自由,尊重和维护了公众的个人选择,提高了公众在健康教育过程中的参与性,有助于健康促进的开展。     

公共卫生的责任主体缺位是众多医学伦理问题产生的根源

我国的卫生、医疗服务系统近年来产生了大量严重的伦理问题,引起了国内外广泛的关注。通过对大量材料的归类、分析,找出我国众多严重伦理问题产生的主要根源是公共卫生责任主体的缺位。解决的主要措施是:加快卫生母法的建立;政府对“公共性”卫生服务责任到位,扭转卫生工作严重的市场化和趋利化倾向;彻底改变医疗费用的“后付制”和“第三方付费制”,实行政府正向投入;改变当前在疾病预防和初级卫生保健投入方面过于细化的分级财政体制;制止药品广告和虚假的医疗广告;加大控制政府公立医院建设的成本和降低医院运行费用的工作,严格收费价格纪律等。     

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.     

Psychosocial Factors Relating to Adaptive Capacity in a New Zealand District Health Board

ABSTRACT

Communities assume that health care systems are adequately preparing for disasters, yet health sector capacities are restricted. The current research examined factors associated with adaptive capacity of staff in the New Zealand health sector. Two studies were carried out in the context of large-scale emergency management exercises, with the assumption that such exercises provide information about psychosocial responses to real emergency situations. The focus of the research was on adaptive capacity to address routine work-related stressors, as high levels of routine demands in the health sector have implications for staff health and organizational functioning, both of which are important for managing the stressful demands arising from emergency situations. The implications of these findings are discussed.     

Healthcare sector reform and its influence on public hospitals in mainland China

The government has launched the healthcare sector reform since the 1980s. From the beginning, the reform has been controversial. What is then the real purpose of the reform? Is it only to reduce the government's burden of health care or establish a just and effective healthcare system? Can healthcare be geared by the market or should the government play a guiding role in it?     

政府与个人的责任——中国当代医疗改革的责任伦理学剖析

卫生改革的重点必须放在政府部门;公共卫生,预防与初级医疗保健是人类生存的需要,带有鲜明的公益性和福利性。应由政府投资为主筹集资源,以国家投资为主体负担费用,这个层次的卫生服务产品,属非商品经济部分,并不以赢利为目的,不能引进市场经济,个人对健康负有重要责任,包括：选择医疗保健,决定花费数额,生活方式和卫生习惯的养成,主动接受健康教育,抵抗压力,支持国家与地区的卫生保健政策;个人对自身健康负责是一种道德责任,健商（health quotient)这一重要概念,具有伦理价值和普遍的医学人类学意义;个人对健康负责是一种社会风尚。     

Managing Job Stress in the Netherlands

Compared with other countries, in the Netherlands work pressure and sickness absenteeism and work incapacitation rates due to work-related mental health problems are quite high. About a decade ago a new Working Conditions Act (WCA) was introduced that had far-reaching consequences for the way job stress is dealt with in organizations. The WCA emphasizes the central role to be played by commercially operating Occupational Health and Safety Services (OHSSs), and it defines a new kind of professional—the Work & Organizational Expert—who is primarily responsible for the assessment and prevention of job stress. Recently, a number of instruments have been developed for psychosocial risk assessment that are now widely used on a regular basis in a way prescribed by the WCA. Preventive measures are increasingly taken by organizations in order to reduce job stress and sickness absenteeism. Based on the Dutch approach some lessons may be learned. Recommendations pertain to (1) the role of government, (2) legal recognition of psychosocial work factors, (3) the privatization of the occupational health and safety sector, and (4) evaluation of job stress prevention programs.