香港医疗制度与改革

香港的医疗制度由一个"二元医疗体系"组成,在体制模式、融资制度及服务规管三方面的安排都有其独特之处,为香港七百多万人提供了一个全民医疗安全网,能够达到公平、有效、可及性高及质素佳的要求.但是这个医疗系统也存在不少问题和隐忧,需要有效的改革,包括管治、管理、服务安排和融资模式改革等.     

医疗体制改革应该以二级制为基础

香港特别行政区域政府委托美国哈佛大学一个专家小组对香港的医疗制度作了一个全面评估,并就目前的融资安排提出改革方案。小组发表的报告对香港医疗制度作了很多中肯批评,但所提出的融资改革方案却极受争议。方案的主要缺点是违背医疗二级制的精神,令自由选择、关怀和社会主义等价值难以得到实现。     

医疗体制改革应该以二级制为基础——评《哈佛报告》

香港特别行政区政府委托美国哈佛大学一个专家小组对香港的医疗制度作了一个全面评估,并就目前的融资安排（ｆｉｎａｎｃｉａｌａｒｒａｎｇｅｍｅｎｔ）提出改革方案。小组发表的报告对香港医疗制度作了很多中肯批评,但所提出的融资改革方案却极受争议。方案的主要缺点是违背医疗二级制的精神,令自由选择、关怀和社会公义（ｓｏｃｉａｌｊｕｓｔｉｃｅ）等价值难以得到实现。     

"以病人为中心"医疗服务模式的理念与发展

纵观20世纪医疗服务的发展历程,医疗服务的发展经历了“以疾病为中心”的传统医疗服务模式到“以病人为中心”的新的医疗服务模式的转变;目前,以“以病人为中心”的医疗服务模式已经成为我国现代医院改革与发展的主题。因此,在阐述医疗服务模式变革与发展的基础上,系统论述了“以病人为中心”的医疗服务模式的内涵与特点,新的理念、新的认识,也带来了新的希望,新的医疗服务模式将不断地改善与提高人们的健康状况与生活质量。     

医学整合全程关爱

整合医学在具体的医疗改革、医疗模式上有两个维度,即要对患者全程关爱,医院-社区-家庭的医疗服务做到无缝隙链接;要实现多学科的有效沟通、统一结合.以现代心血管疾病诊疗模式为例,提出要更好地落实医学整合/全程关爱,一定要团队协作、共同决策、进行医疗服务整合.借鉴国外较为理想的整合医学模式,提出要实现整合医疗/全程关爱的八项基本要求;医学人文进临床,要坚持三个不变和三个转变.总之,医学整合/全程关爱才能体现医学人文的核心价值观,是实现医学目的的必由之路,是当今医疗卫生体制改革的方向和医学教育、医疗服务模式的改革需求.     

对"医疗服务商品和市场"存在客观性和必然性的理性思考--兼评《对中国医疗卫生体制改革的评价与建议》

针对国务院发展研究中心课题组发表的<对中国医疗卫生体制改革的评价与建议>提出的卫生改革带来"问题的根源在于商业化、市场化的走向违背了医疗卫生事业发展的基本规律."提出"医疗服务商品"、"医疗服务市场"的存在是客观的,并通过反驳<评价与建议>提出的四对矛盾,提出"医疗服务商品"、"医疗服务市场"的存在也是必然的,最后分析了所谓"卫生改革失败"的真正原因.     

医疗差错的归因与治理：一个组织伦理的视角

我国当前往往将医疗差错归因于医务人员的经验不足、责任心不够等主观方面并按照"谁出错、谁负责"的原则对医务人员进行惩戒。这种归因和治理模式对医疗差错发生根源的系统性和复杂性认知不足,已不能完全适应当前高度组织化、社会化的医疗服务模式。归因上的偏倚取决于用以观察、评估医疗差错的知识框架。这种以个人负责为特征的归因和治理模式源于当前以个体理性为基础的临床伦理学,它将焦点集中在医务人员个人的道德修养上,忽视了组织结构等因素的伦理性。应当适时更新医学伦理观念,通过引入组织伦理的视角,将关注的对象转向医疗服务的组织、系统、制度和结构,进而提出更具针对性的医疗差错治理路径。     

国际临床医疗技术的利用与发展趋势——以心肌梗塞患者的临床治疗为基础

1　前言卫生保健服务作为一种产业 ,已经逐步成为世界经济发展的一个重要部分。生物医学知识与技术的全球化 ,导致全球范围内临床治疗所使用的医疗技术与药品以及医疗设备逐步趋同。随着社会对卫生保健服务的日益关注 ,国际间卫生保健制度与医疗服务模式的比较研究也在逐步发展。从国际卫生保健服务发展的过程看 ,目前卫生保健服务仍然是一种区域性的服务模式 ,各国的卫生保健体制与医疗服务模式都受到其传统文化、社会经济水平、卫生服务保障制度、医疗服务市场环境与卫生保健政策等因素的影响。正是这些差异的存在 ,不同国家之间临床医疗…     

中国医疗事业发展的思考

中国医疗事业有了很发展,医疗资源显著增加,城乡居民医疗服务水平明显提高。面临的主要问题是医疗资源的城乡及地区判别仍很大;干部,职工及农民的医疗服务水平存在明显差距。医疗机构的服务效率及效益逐年下降,医疗资源不足与浪费现象同时存在。中国医疗改革的策略应是：改革现行医疗保健制度提高城市居民的医疗保健水平;改革现行医疗机构的经济补偿机制,以控制医药费上升速度;加强政府对医疗事业的宏观管理,调整医疗资源的     

中美两国医疗救助模式比较分析

医疗救助作为保障贫困人群健康权的最后一道防线,在世界各国均备受关注.各国因国情的不同,医疗救助模式也大有不同.为进一步完善我国医疗救助制度,从救助对象的选择、救助项目、筹资及运作方式几个方面对中美两国医疗救助进行了比较分析.发现中美两国的医疗救助在救助对象的选择、救助项目、筹资及运作方式方面有所不同,而这些不同给我国医疗救助制度、模式乃至理念带来很多可借鉴之处,推动我国进一步完善医疗救助制度.     

近五十年美国医疗保健制度演进对我国医疗制度改革的启示

通过对美国自1945年以来50余年医疗保健制度演进的研究。涵概了四个发展时期;民办医疗保险体制;公办免费医疗保健制度和健康维持组织;医疗费用控制政策的实施;医疗保健制度的全面改革,以求对我国从计划经济向市场经济转轨后,医疗保健制度的改革提供借鉴。     

Education and Training of Children's Mental Health Professionals: The Existing and Potential Role of Schools of Public Health

Since the early 1980s, increasing attention has been devoted in the literature to the conceptualization, development, and implementation of integrated and comprehensive mental health systems of care for children and adolescents. In establishing this new children's mental health paradigm of community-based systems of care, there are presently very few well-trained professionals and leaders focused on collaborative (including interagency) initiatives in the delivery of children's mental health services. Nevertheless, the field of public health offers an interdisciplinary setting for the education and training of individuals in children's mental health services. This national survey of all 27 accredited schools of public health in the United States and Puerto Rico examined the existing capacity for and potential to expand educational and training opportunities in the organization, financing, and delivery of children's mental health services.     

The Reinvention of Behavioral Health Services in the VA System

The Veterans Health Administration under the direction of Kenneth Kizer, M.D., has faced the challenge of providing high-quality health care while controlling costs. Under Dr. Kizer's direction, VA hospitals are moving toward managed patient centered primary care. Hospital organization, funding, and clinical practices have been changed. Reorganization has meant a variety of possibilities for psychologists employed in the VA system.     

21世纪医疗保障制度改革与发展趋势管窥

21世纪的医疗保障制度改革与发展主要表现为:在理论上,强调医疗保障是人权的基本内容;在保障的对象上强调全民性和公平性;在保障的内容上更加重视预防保健;在医疗保障的运行机制上,强调政府主导与市场机制相结合;在服务模式方面,积极构建多层次网络化的社区卫生服务体系,推行医疗适宜技术;在筹资模式上,更注意建立以政府投入为主导的多元化筹资机制。     

Report of the Working Group on Clinical Services

Prepared by the Working Group on Clinical Services from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper focuses upon issues related to the effects of health care reform and changes to the health care system on psychologists practicing within academic health care settings. Discussion of the changes in the health care economic system and the call for cost-effectiveness produced five specific suggestions for psychology to establish accountable, data-based models of behavioral health care.     

A Statement of Principles for Health Care Journalists

Many journalism organizations have published codes of ethics in recent years. The Association of Newspaper Editors, for example, lists 47 different codes on its website. But an organization of health care journalists felt that none of those codes addressed the unique challenges of covering complex health care topics. The Association of Health Care Journalists (AHCJ) is an independent, non-profit organization dedicated to advancing public understanding of health care issues. Its mission is to improve the quality, accuracy and visibility of health care reporting, writing and editing. AHCJ has written a statement of principles for its 750 members. In it, AHCJ states some of the unique challenges faced by journalists covering health care, and offers suggestions on how to face those challenges. Bioethicists are invited to comment on the statement, and to help generate continued discussion of the issues addressed therein.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.     

从深层次研究和认识卫生改革的方向与目标

20年的卫生改革是伴随着社会经济改革与发展的过程慢慢地进行摸索,改革的‘彼岸’并没有一个清晰的图景;由于改革的目标模式所提供的信息是不充分的,我们没有更多的信息来判断我们改革的进程与结果。因此,卫生改革最迫切的事情是需要更大的耐心,以新的认识,新的理念和勇气,来进行系统的反思,以促进卫生改革从一种经验性的改革进入到一种理性的改革过程。     

Factors affecting behavioral health provider turnover in US Air Force primary care behavioral health services

Turnover and retention of integrated behavioral health practitioners in primary care is a significant challenge with limited empirical evidence to inform risk factors. This study used retrospective archival data from the Air Force Medical Service’s Behavioral Health Optimization Program on all civilian contractors hired from September 2012 to November 2014 to examine the potential influence of training background (e.g., social work v. psychology), size of healthcare facility, or the presence of on-site mentors. Turnover was evaluated across a large managed healthcare organization of 121 civilian contractors (psychologists and social workers) in 72 specific clinic settings. These sites varied considerably in regards to geographic location, population diversity, size of patient empanelment, rural, suburban, and urban settings and all provided care to active duty military, their civilian dependents and civilian retirees. Results found that 54% of all psychologists and social workers hired for these positions quit or were fired within 8 months of employment. Smaller medical facilities were found to have a more significant attrition rate compared to medium- and large-sized facilities; no other differences were noted. Findings provide initial insight into a potential critical period in the first year of a behavioral health consultants on-boarding, as well as unique considerations for consultants placed in smaller facilities who may be at elevated risk for attrition. These preliminary findings suggest targeted interventions for new integrated care programs as well as important avenues for future research.