关于医德（滑坡）原因的哲学思考

关于医德“滑坡”原因的哲学思考新乡医学院（４５３１００）郑宗秀，马振江医德“滑坡”是一种客观存在的现象。由于医疗卫生事业的特殊性，这一现象引起各界人们的普遍关注。无论是从事医疗卫生管理，还是从事医学伦理学研究的同志，都在积极研究产生这一现象的原因，寻...     

医疗卫生产业组织研究与卫生政策

产业组织理论是经济学的重要分支之一,卫生经济的发展需要借鉴它的手段和方法,需要研究医疗卫生产业组织的相关问题.农村新型合作医疗的建立和发展,城市医疗卫生服务体系的再造,都离不开医疗卫生产业组织研究.市场,特别是非完全竞争的医疗服务市场,它的市场结构、市场主体行为和市场绩效之间内在的本质联系,是卫生政策能够发生应有效力的作用点.     

卫生经济伦理学对医疗完全市场化的质疑

不管处于什么发展水平的国家,都需要进行持续的卫生保健改革,这已成为整个社会政治改革的一部分,卫生保健改革已经融入整个世界的社会大变革中。卫生经济问题无一不具有道德成分,无一能离开伦理政策得以解决。我们对中国医疗卫生体制改革的伦理学展望中,提倡一种“公平优先,兼顾效率”的价值观。我们需要正确认识市场的目标、价值和规律,正确理解和发挥政府和市场的调节作用,促进医疗卫生体制改革的健康发展。     

卫生经济伦理学对医疗完全市场化的质疑

不管处于什么发展水平的国家,都需要进行持续的卫生保健改革,这已成为整个社会政治改革的一部分,卫生保健改革已经融入整个世界的社会大变革中.卫生经济问题无一不具有道德成分,无一能离开伦理政策得以解决.我们对中国医疗卫生体制改革的伦理学展望中,提倡一种"公平优先,兼顾效率"的价值观.我们需要正确认识市场的目标、价值和规律,正确理解和发挥政府和市场的调节作用,促进医疗卫生体制改革的健康发展.     

公民的基本医疗卫生权利与义务内容浅探

介绍了基本医疗卫生权利与义务的用语规范、政策内涵与法律渊源,分析了其主体及其与法律法规的关系,提出公民基本医疗卫生权利的研究应该且必须从法理学入手;立足于新医改背景和基本医疗卫生法框架,且加快立法步伐,这是全面落实医药卫生体制改革和完善社会主义法律体系的出发点。建议从法理学入手加强基本医疗卫生权利理论研究;以新医改实践为基础构建基本医疗卫生法框架,以完善社会主义法律体系为目标加快基本医疗卫生立法步伐。     

健康管理:在国家、市场及个体之间

十九大报告后,国家层面的医疗卫生体制建设、市场层面的健康产业发展及个体层面的健康文明生活方式倡导都成为实施健康中国战略的必要部分,参与到广义的健康管理中。国家、市场以及个体都出于自身目标需求并利用自身权力进行健康管理:国家出于对政权合法性的构建建立起健康管理制度,市场出于利益追逐推进加深健康的资本化,个体则为了获得健康状态不断产生健康需求。国家、市场及个体承担自身责任是实现健康管理的前提,但也各自的主体局限性也会影响健康管理的目标,明确三者的角色定位是科学有效进行健康管理的前提。     

政府转型与中国医疗服务体系的改革取向

在中国的医疗卫生服务领域,出现了市场失灵和政府失灵并存的现象.市场与政府双失灵造成的恶果是,无论是市场主导的还是政府主导的医疗卫生资源,都涌向城市、涌向经济发达地区;在农村地区,在经济落后地区,在城乡结合部,不仅高层次医疗卫生专业力量不足,设备不足,甚至连机构的数量也不足.针对这些问题,一种流行的解决思路是恢复医疗卫生服务的计划体制,但计划经济时代农村同样是缺医少药.正确而且唯一的改革道路,就是两条腿走路:第一条腿是全面放宽对社会资本进入医疗卫生服务领域的管制,为所有的医疗机构(不论民营还是公立,不论是非营利性还是营利性)创造一个公平竞争的制度环境;第二条腿是政府将新增公共资源更多地投入到市场不足的地方和市场失灵的领域,从而引导整个医疗卫生服务体系健康均衡地发展.     

灾害医学的哲学反思

我国是自然灾害频发的国家之一,近百年来发生过多次重大的自然灾害。在灾害面前人类并非束手无策,人类可凭借自己的智慧和所掌握的科学技术来防范和减轻灾害的破坏和损失。因此,建立应对这类危机的国家医疗卫生机制十分重要。     

汶川大地震：医学哲学的思考：灾害医学的哲学反思

我国是自然灾害频发的国家之一,近百年来发生过多次重大的自然灾害。在灾害面前人类并非束手无策,人类可凭借自己的智慧和所掌握的科学技术来防范和减轻灾害的破坏和损失。因此,建立应对这类危机的国家医疗卫生机制十分重要。     

“健康国家”战略发展的过程与国际经验

基于健康价值概念,居民健康所面临的挑战,以及医疗卫生服务发展趋势,系统描述了“健康国家”战略的发展过程与国际社会实施“健康国家”战略的基本情况,并提出了可借鉴与学习的经验。     

初级卫生保健立法的探讨

我国在初级卫生保健方面所作的努力及取得的成就就是有目共睹的。但是,由于立法滞后,在初级卫生保健工作的落实与推广中存在不少问题。论证初级卫生保健立法的必要性和可行性,并对初级卫生保健立法框架提出设想,将促进初级卫生保健立法工作,推动初级卫生保健工作的发展。     

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.     

社区卫生服务中心手术功能的经济学研究

社区卫生服务中心是否应当保留或设置手术功能。调研南京市社区卫生服务中心手术功能科室的成本—效益和费用,及医院和社区卫生服务中心费用的不同。大多数中心设置外科手术功能,能维持成本;3甲医院、综合医院单病种手术平均住院费用明显高于社区卫生服务中心。社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

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。     

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.     

Psychosocial Predictors of Health Status and Health Care Costs among People with Fibromyalgia

The purpose of the present study was to examine the effects of psychosocial characteristics on health status and the relationship between health status and health care use and costs in a group of people with fibromyalgia (FMS) over a 1-year period. The participants were 600 members of a large health maintenance organization. Demographic characteristics (age, education, employment status, ethnicity and income), need variables (comorbid conditions and baseline health status), and psychosocial variables (self-efficacy, helplessness, coping, and depression) were examined. Better health status at baseline, use of emotion-focused coping, and higher self-efficacy predicted better health status the following year. Higher health care use at baseline, being Caucasian, being older, and having more co-morbid conditions predicted higher health care use at 1 year. Only health care costs at baseline predicted health care costs the following year. Our results indicate that health care use and cost tend to be stable. Intense interventions focused on changing patterns of health care use and methods for coping with the change need to be developed and tested.     

Betrayal Trauma,Health Care Relationships,and Health in Patients with a Chronic Neurovascular Condition

Individuals who have been exposed to trauma are at a greater risk of developing a chronic physical health condition and use health services more frequently than individuals who have not experienced trauma. The mechanism by which trauma affects health is not fully understood, but relationships with health care providers could be important in understanding this association. The purpose of this study was to explore the relationships among betrayal trauma, health care relationships, and physical and mental health in a chronic medical population. Participants (N = 272) diagnosed with a chronic neurovascular condition (cavernous malformation) completed an online survey. Questionnaires assessed self-rated health, instances of betrayal trauma, posttraumatic stress disorder (PTSD) and depression symptoms, income, and other demographic factors, and health care relationships. Level of income and the experience of betrayal trauma predicted mental health symptoms (depression, PTSD, or both) and also predicted health care relationships. After controlling for income and previous trauma, mental health symptoms significantly predicted health care relationships. Finally, mental health symptoms, health care relationships, and income predicted self-rated health, although the associations were not straightforward. These results suggest complex interrelations among trauma, mental health, income, health care relationships, and physical health, and a model is proposed for explaining these associations.     

Managed care: how economic incentive reforms went wrong

In its response to pressures to rationalize health care resource allocation, the American health care system has embraced managed care without concurrent comprehensive health care reform, either in the form of the centralized tax-based systems found in Europe and Canada or that of the Clinton reform plan. What survives is managed care without managed competition, employer mandates, or universal access. Two problems inherent in the incentive structure of managed care plans developed in the absence of comprehensive health care reform work against the public interest. First, sacrifices in terms of medical innovation and quality of care may not be offset by greater equity in the distribution of health care. Second, such managed care plans fail to address the need for long-term accountability.     

A blessing in disguise? Empowering Catholic health care institutions in the current health care environment.

Health care institutions, including Roman Catholic institutions, are in a time of crisis. This crisis may provide an important opportunity to reinvigorate Roman Catholic health care. The current health care crisis offers Roman Catholic health care institutions a special opportunity to rethink their fundamental commitments and to plan for the future. The author argues that what Catholic health care institutions must first do is articulate the nature of their identity and their commitments. By a renewed commitment to the praxis of health care on their own distinctive terms, Roman Catholic health care institutions may reestablish a vision of human nature and human service in an increasingly secular society. Health care could then reclaim its place as a powerful setting for the expression of Roman Catholic faith, life and witness.