政府在基本医疗卫生服务法治化中的职责定位

明确基本医疗卫生服务作为公共产品向全民提供是新医改基本文件核心思想的基础上,辨析基本医疗卫生服务的提供模式,认为政府具体提供方式的差异性与共同性,需要理性看待;在全面依法治国和保障公民健康权的时代背景下,基本医疗卫生服务法治体系的建立,是基本医疗卫生服务提供过程中政府职责规范化的必然要求。提出应明确中央和地方各级政府的行政权力界限与行政违法责任,体现为基层医疗卫生服务机构、基本药物制度、基本医疗保险制度、全科医生制度四方面,从而实现政府行政职责的规范化。     

“功能-职责”视角下政府机构的改革过程与发展目标

政府机构改革既是现代政府治理的重要内容,也是政府创新的现实体现。政府机构改革是政府功能优化与职责重构双重作用的结果。功能优化是政府机构改革的内在动因,职责重构是政府机构改革的外在动因。我国政府机构改革是一个前后衔接、逐层递进、相互联系的改革进程,各次改革之间并非完全独立。根据“功能-职责”的发生动因,历次政府机构改革的演进逻辑可以大致从三个阶段来展现：功能优化导向的行政性改革、职责重构导向的适应性改革、“功能-职责”共进导向的治理性改革。基于“功能-职责”的双重动因,梳理历次政府机构改革的实践经验,可以将政府机构改革的发展目标归纳为：一是立足现实国情并总结政府机构改革的经验,更好推动政府创新;二是坚持行政权力的有限集中与适度下放,优化政策过程;三是根据时代发展逐层推进政府机构改革,以整体性视角推动政府机构改革的发展;四是机构改革具有稳定的周期性规律,但也不能局限于固定的周期之中;五是补足政府治理的现实短板,通过机构改革推动政府治理综合发展。     

总结经验 推进新一轮卫生改革

着眼于实现为人人提供保健服务目标的医疗改革,要求卫生服务与医药购销制度的改革必须适应广覆盖、低成本的医疗保险制度;确保公共卫生、社区卫生与合作医疗在整个保健服务体系中的主体地位,在基本卫生保健服务机构与大医院之间建立合作、互补、互制的关系;坚定地对大医院实行调整和管理;构建医药分开的管理与流通体制;政府主导作用到位,投入方向合理,以顺利推进新一轮医疗改革。     

对大型商业建筑中母婴室应用现状的调查分析——以郑州地区为例

据统计,2015年全国新生儿数量为1655万,城市母婴室的建立关乎一个庞大群体,新妈妈们遭遇哺乳尴尬的现象在全国各地方屡见不鲜。在"全面二孩"政策逐步落地和鼓励母乳喂养的大环境下,母婴室的建立越来越受到社会的重视。一项调查表明,42.4%的被访者在逛街时从未见过母婴室;同时仅有6.44%的被访者在外出的时候可以迅速找到母婴室。绝大多数妈妈们表示母婴室的数量和设施配备不能满足需求。在人流量巨大的大型商业建筑(本文特指大型综合商场)之中,母婴室不仅数量少并且位置也十分不好找,有的甚至被上锁或者堆满杂物。通过对郑州市区多处大型商业建筑中的母婴室调查,了解母婴室的现状,同时分析母婴室的空间设计与人性化设计。阐述适应国情的母婴室设计方案,使人们对大型商业建筑中的母婴室设计有进一步的了解。     

总结经验推进新一轮卫生改革

着眼于实现为人人提供保健服务目标的医疗改革,要求卫生服务与医药购销制度的改革必须适应广覆盖、低成本的医疗保险制度;确保公共卫生、社区卫生与合作医疗在整个保健服务体系中的主体地位,在基本卫生保健服务机构与大医院之间建立合作、互补、互制的关系;坚定地对大医院实行调整和管理;构建医药分开的管理与流通体制;政府主导作用到位,投入方向合理,以顺利推进新一轮医疗改革.     

居家养老服务中的政府责任

人口老龄化是我国面临的严峻现实问题,居家养老是目前最适合我国国情的重要养老模式。居家养老服务作为准公共产品,无论从理论还是从现实看,政府都必须承担完善政策法规、加强财政支持、强化科学管理和坚持服务导向等责任。但是,由于传统文化、管理体制和现实环境等因素的影响,政府在履责中还存在不少困难和问题。因此,政府应该明确履责的路径,切实履行自身的职责,积极推动居家养老服务事业的改革与发展。     

农村卫生改革面临的深层次的矛盾和问题

对健康缺失阻碍农村经济发展没有清楚的认识,是制约农村卫生发展的重要因素.农村卫生纯属公共品范畴,理所当然是政府实现公共服务目标的基本职责.我国财政整体分配格局不合理,是农村卫生投入不足的基本原因.农村卫生保健制度一个非常突出的问题,是基本模式的选择,忽视关键制度的设计与调整.卫生院是医疗服务的提供者,是合作医疗保障制度的利益主体,同时又是合作医疗的组织者与管理者,不符合医疗保障制度的要求,同时也难以形成纠错的机制.     

共治理念下地方政府债务的合作行政治理

随着中央和地方财权与事权的一系列改革措施的实施,地方政府债务不断扩大,债务风险也逐渐积累。目前,我国地方政府债务规模庞大并有隐性化趋势,面临着一定的违约风险。地方政府债务应纳入依法行政范围,有必要对地方政府债务进行行政法规制,从行政主体和行政程序两个方面规范和约束地方政府债务。同时,随着社会主义市场经济的发展完善,由政府、市场与社会组成的多元主体共同治理的合作行政模式已成为时代治理的新趋势。应深化机制改革,加快政府职能转变;推动建立共治模式,鼓励社会资本参与;建立完善信息披露制度,规范地方政府债务的监督管理体系。     

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。     

HIV母婴传播防治中的现存问题和对策

通过研究分析国内外艾滋病母婴传播的防治情况,了解HIV母婴传播防治中现存的一些的问题,并提出相应的应对措施,为今后HIV母婴传播防治工作中相关政策的制定以及我国如何建立预防艾滋病母婴传播的模式提供参考,以利于HIV母婴传播防治工作的顺利开展和有效进行.     

公共卫生语境下的政府责任

近年来,公共卫生的要求越来越多地进入到中国百姓的生活之中,问题的焦点也从公共卫生本身逐渐转向政府,转向政府所应当承载的责任乃至信用程度上来.政府在公共卫生问题上责任的缺失固然有责任意识的淡漠原因,但责任本身的模糊与混乱也是不容忽视的.只有保障机制与约束机制,特别是问责制,同时发挥效用,才能保证政府责任的有效实现.     

卫生立法迫在眉睫

涉及医疗机构的法律事务处理方面明显存在“两个强化”的趋势,一是强化医疗责任追究,二是强化病家利益维护。但医疗行业在处理法律事务方面仍处于长期形成的各自为阵,自行处理的局面。鉴于以上情况,提出区域性医学法律协作中心问题。     

The corporate social responsibility of the pharmaceutical industry: idealism without illusion and realism without resignation

In recent years society has come to expect more from the "socially-responsible" company and the global HIV/AIDS pandemic in particular has resulted in some critics saying that the "Big Pharma" companies have not been living up to their social responsibilities. Corporate social responsibility can be understood as the socio-economic product of the organizational division of labor in complex modern society. Global poverty and poor health conditions are in the main the responsibilities of the world's national governments and international governmental organizations, which possess society's mandate and appropriate organizational capabilities. Private enterprises have neither the societal mandate nor the organizational capabilities to feed the poor or provide health care to the sick in their home countries or in the developing world. Nevertheless, private enterprises do have responsibilities to society that can be categorized as what they must do, what they ought do, and what they can do.     

Luck Egalitarianism,Universal Health Care,and Non-Responsibility-Based Reasons for Responsibilization

In recent literature, there has been much debate about whether and how luck egalitarianism, given its focus on personal responsibility, can justify universal health care. In this paper we argue that, whether or not this is so, and in fact whether or not egalitarianism should be sensitive to responsibility at all, the question of personal responsibilization for health is not settled. This is the case because whether or not individuals are responsible for their own health condition is not all that is relevant when considering whether we should somehow hold them responsible for their own health condition, e.g. cost-wise. There may also be efficiency-based reasons to hold them responsible, and there may even be egalitarian reasons. Defining universal health care as an insurance system where everyone’s deductible and premium is 0, we will argue that efficiency-based reasons for cost-responsibilization are not convincing, but that there are egalitarian reasons for cost-responsibilization. Luck egalitarianism, therefore, cannot, at least not on its own term, justify universal health care.

     

Ethical issues in pediatric life-threatening illness: dilemmas of consent, assent, and communication

The treatment of life-threatening illnesses in childhood is replete with ethical issues and with clinical issues that have ethical implications. The central issues are those involved with a child's participation in the decision-making process and with communication of information about the illness and treatments to children. This article examines the questions of patient autonomy and of parental responsibility and prerogative in the context of pediatric oncology. Included in this examination of the ethical dimensions of pediatric life-threatening illness is a discussion of the many related aspects involved, including medical, cultural, psychosocial, legal, and developmental. A multidimensional approach that considers the ways in which these multiple aspects interact with one another, and which focuses on establishing a strong working alliance between the health care team and the pediatric patient's family, can help to avoid or resolve potential ethical and clinical conflicts.     

Health care responsibility

The general and deep dissatisfaction with the present-day status of health care is of such intensity that one speaks of a health care crisis. What is most disturbing to the physicians is that society directs its accusation mainly at the health care professional for being responsible for this crisis. If we want to abolish the crisis we must try to get a renewed look at its source, i.e., to answer the questions “where did health care go wrong primarily?” and “with whom lies the ultimate responsibility for health care?”. In the following discourse these questions are discussed. Based on the assumption that every human being is a free rational agent the ultimate health care responsibility is assigned to the citizen. Of course, whether such an approach will in fact solve the problems inherent in present-day health systems cannot be predicted.     

Understanding political responsibility in corporate citizenship: towards a shared responsibility for the common good

In this article, we explore the debate on corporate citizenship and the role of business in global governance. In the debate on political corporate social responsibility it is assumed that under globalization business is taking up a greater political role. Apart from economic responsibilities firms assume political responsibilities taking up traditional governmental tasks such as regulation of business and provision of public goods. We contrast this with a subsidiarity-based approach to governance, in which firms are seen as intermediate actors who have political co-responsibilities in society endowed upon them by (inter)national governmental institutions. We argue that both approaches face conceptual and empirical problems, and do not make clear the content and scope of political corporate responsibility. Based on Iris Marion Young’s account of political responsibility we argue that corporate actors and governmental actors have a shared responsibility to tackle societal problems. Taking political corporate responsibility not only entails engaging in private action or engaging in public–private partnerships, but it also includes aiding governmental actors to remedy injustice or even create public institutions where they do not yet exist. By adding this perspective we contribute to the debate on responsibility in corporate citizenship and clarify the political role business can play in global governance.     

Challenges to professional psychology education in the 21st century: response to Peterson

Professional psychology education faces many critical challenges brought about by the major changes occurring in the health care arena. This article shows that professional schools and programs have a good record of responding to these challenges and of taking proactive steps sponding to prepare their graduates for new health care roles and delivery systems. Data on admissions to psychology doctoral training programs demonstrate little support for the toral concerns raised by Donald R. Peterson (2003, this issue) about the preparation of students for graduate training in professional programs. Although quality concerns are important to investigate, such examination best resides with portant the American Psychological Association's Committee on Accreditation, which has the promotion of quality and excellence in professional psychology education and training as its major goal and responsibility.     

Responsibility for Health and Blaming Victims

If we are responsible for taking care of our health, are we blameworthy when we become sick because we failed to meet that responsibility? Or is it immoral to blame the victim of sickness? A moral perspective that is sensitive to therapeutic concerns will downplay blame, but banishing all blame is neither feasible nor desirable. We need to understand the ambiguities surrounding moral responsibility in four contexts: (1) preventing sickness, (2) assigning financial liabilities for health care costs, (3) giving meaning to human suffering, and (4) interacting with health care professionals. We also need to distinguish different kinds of blame, explore the interplay of justice and compassion in avoiding unjustified blaming of victims, and work toward a unified moral-therapeutic perspective that encourages individuals to accept responsibility while avoiding destructive forms of blaming.