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.     

关于在医疗机构中建立医疗救助制度的思考

医疗救助制度是医疗保障制度的一个重要组成部分,而医疗机构中的医疗救助制度则是社会医疗救助制度的一种补充形式。在分析我国医疗救助制度发展现状的基础上,提出了在医疗机构中建立医疗救助制度的构想,并对医疗机构中的医疗救助制度的性质以及建立医疗救助制度的必要性进行分析,进而对在医疗机构中建立医疗救助制度的几个关键问题进行了探讨。     

关于在医疗机构中建立医疗救助制度的思考

医疗救助制度是医疗保障制度的一个重要组成部分,而医疗机构中的医疗救助制度则是社会医疗救助制度的一种补充形式.在分析我国医疗救助制度发展现状的基础上,提出了在医疗机构中建立医疗救助制度的构想,并对医疗机构中的医疗救助制度的性质以及建立医疗救助制度的必要性进行分析,进而对在医疗机构中建立医疗救助制度的几个关键问题进行了探讨.     

新疆农村医疗救助制度实施效果评价

为评价新疆农村医疗救助制度实施效果,利用2008年和2012年两次横断面调查资料,分析医疗救助对象和非医疗救助对象的卫生服务需要、利用及费用变化.救助对象的两周患病率由2008年的181.34‰下降到2012年的87.81‰,2008年两周患病率救助对象高于非救助对象.救助对象两周就诊率由2008年的110.92‰下降至2012年的46.93‰,2012年两周就诊率救助对象高于非救助对象.年住院率救助对象均高于非救助对象.新疆农村医疗救助制度提高了贫困人口对卫生服务的利用,应将医疗救助制度与新农合紧密结合,持续资助贫困家庭参合.     

超越统合救助模型:城市低保制度改革中的分类救助问题研究

城市低保制度深化改革过程中形成的分类救助模型相对于过去的统合救助模型而言是一个重大的进展与超越,是我国低保制度走向完善的重要标志之一。与统合救助模型对贫困群体采取整齐划一的救助办法不同,分类救助模型基于贫困人群内部的需求差异,通过制定合理、科学的救助标准体系,对不同需求人群实施有差别的救助,提高了救助的精确度、公平性与效率。由于这一模型出台的时间还不长,实施过程中还存在着一些不足与问题,诸如分类标准的制定比较粗疏、对特殊困难低保对象救助的力度不足、与再就业机制缺乏有效衔接、贫困边缘人群难以被现行制度覆盖、资金筹集及管理工作难以适应实际需要等等,影响、制约了新模型功能的充分发挥。本文对进一步完善分类救助模型的政策选择进行了全面、深入、针对性的分析探讨。     

中国社会救助体系的整合

经历近20年的建设和发展,我国社会救助体系正处于从覆盖到整合关键期.本文从中国社会救助体系的现状出发,分析了政出多头、城乡分裂、制度分割和轻视服务等主要问题,为此,本文提出了社会救助体系整合的目标为:构建制度完整、相互协调、功能配套的社会救助体系,实现多层次的"基础+分类"的社会救助体系的定型化,同时,还从整合路径和在整合重点方面进行了分析和探讨.     

贫困地区艾滋病社会救助机制构建的对策探讨 --对安徽阜阳地区艾滋病的调研

在调查阜阳地区艾滋病家庭的生存危机和社会救助现状之后,着重分析了目前阜阳地区艾滋病社会救助存在的问题,并从我国艾滋病社会救助整体角度出发,对今后完善艾滋病社会救助机制提出了建议.     

第三方支付:医疗救助费用支付的福利经济学分析

医疗救助是为缓解贫困群体的医疗困境而制定的一项医疗保障制度.我国医疗救助在实施过程中多采用事后报销的救助方式,救助效果不甚明显.通过分析第三方支付所产生的福利影响,提出将第三方支付的费用支付方式引入到医疗救助中,以期发挥更大的救助效果.     

相关利益人对医疗救助的认识研究

为了解相关利益人对医疗救助的认识和评价,于2008年7月对宁夏和山东的6个县进行了机构访谈和家庭问卷调查.结果表明,卫生部门和财政部门对医疗救助不很了解,相关部门管理者对医疗救助的看法不一致;农村居民对提供医疗救助的机构和医疗救助的政策内容知晓率非常低.因此,要完善医疗救助管理平台,加大医疗救助政策宣传力度,从而提高医疗救助管理效率和促进医疗救助的有效需求.     

农村医疗救助的目标探讨

为探讨新形势下农村医疗救助制度目标机制的设计,提高制度靶向的准确性及效果,利用定性分析方法,结合医疗救助制度的功能分析,对现阶段该制度的目标对象及纳入依据进行了分析.研究认为,农民的医疗需求具有必需品性质,救助的水平以新农合为基本依托,同时,农村城镇化发展带来新的弱势人群的医疗保障问题提示,需因时、因地、因阶段设计医疗救助制度目标人群的纳入机制,提出按城乡划分、按阶层划分、按收入划分作为目标机制设计的依托是解决当前农村救助制度不公平问题的有效方式.     

医疗救助制度与主体医疗保障制度衔接与整合研究

对江苏省城乡医疗救助制度和主体医疗保障制度衔接与整合方式进行概述,并就进一步优化城乡医疗救助制度和主体医疗保障制度衔接、整合提出几点意见：充分认识其现实意义、改进和保持两类医保方案间衔接、多途径实现实时救助以及营造有利城乡医疗救助管理运行体制创新的外部环境。     

艾滋病、非洲与国际援助

艾滋病的流行不仅严重地影响了人类的健康,而且对社会经济等诸多方面都产生了不利的影响。从艾滋病在全球流行的基本状况入手,指出艾滋病对流行地区,尤其是撒哈拉以南非洲社会经济等方面的影响程度,并结合该地区多数国家经济发展水平落后和发达国家对外援助的现实状况,提出加大国际援助非洲控制艾滋病的紧迫性。     

Development of an Interactive Decision Aid for Female BRCA1/BRCA2 Carriers

Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer.     

Development of a Communication Aid to Facilitate Risk Communication in Consultations with Unaffected Women from High Risk Breast Cancer Families: A Pilot Study

The literature on risk perception in women from high-risk breast cancer families reveals persistent over-estimation of risk, even after counseling. In this study, a communication aid was designed to facilitate discussion of risk between clinical geneticists and genetic counselors and women from this high-risk population. Method: Stage 1. The aid was developed by an expert panel of clinical geneticists, genetic counselors, psychologists, an epidemiologist, an oncologist, linguists and a consumer. It was guided by the international literature on risk communication and a large multi-centre Australian study of risk communication. The 13 page full-color communication aid used varying formats of words, numbers, graphs and pie-charts to address (a) the woman’s subjective risk; (b) the population risk of breast cancer; c) the risk of inherited breast cancer; (d) the cumulative risk for women with BRCA1 and BRCA2 mutations; (e) family risk factors; (f) the woman’s suitability for genetic testing; (h) screening and management recommendations, and (i) a re-assessment of the woman’s subjective risk. Stage 2: A before–after pilot study of 38 women who were unaffected with breast cancer and were attending four Australian familial cancer clinics was undertaken. Baseline and follow-up questionnaires were completed by 27 women. Outcomes were compared to those observed in 107 similar women undergoing genetic counseling without the communication aid in 2001. Results: The risk communication aid appears to be beneficial; breast cancer genetics knowledge improved in some areas and importantly, risk perceptions improved in the cohort receiving the communication aid. Psychological measures showed no difference in anxiety or depression between the group receiving the communication aid and the comparison cohort. Women and clinicians were very positive about the usefulness of the communication aid as an adjunct to the genetic counseling consultation.     

农村健康保障制度与反贫困

从我国农村健康保障现实出发,认为建立农村健康保障制度是反贫困的迫切要求和重要组成部分,并提出了一些政策建议,如树立公共健康投资理念、政府职能转变与市场机制结合等.     

The political responsibility of bystanders: the case of Mali

It has been a commonplace since the 2012 coup to hear how fragile the Malian democracy had become. Among the many causes is the political role that non-governmental organizations (NGOs) have played as a fourth branch of government. As deliberative democratic processes were replaced by a corrupt elite consensus during the past eight years, NGOs assumed an important place in this system. This included humanitarian NGOs. However, these same NGOs until recently were blind to the political impact they were having. This essay suggests one explanation for this blindness and argues for the importance of a conception of humanitarian aid that balances moral responsibility with political responsibility.     

An evaluation of video-prompting procedures via telehealth to teach first aid skills to children with intellectual and developmental disabilities

Unintentional injuries are one of the leading causes of morbidity and mortality among children with intellectual and developmental disabilities (IDD). First aid training involves teaching critical first aid skills, some of which are designed to treat unintentional injuries. To date, no study has (a) evaluated the effects of a video-prompting procedure to teach first aid skills to children with IDD or (b) attempted to teach these skills to children by using a telehealth delivery format. We used a concurrent multiple-baseline-across-skills design to evaluate the efficacy of a video-prompting procedure via telehealth to teach five children with IDD to perform first aid on themselves for insect stings, minor cuts, and minor burns under simulated conditions. For all participants, our procedure produced large improvements that maintained for a minimum of 4 weeks. Furthermore, the effects of the training generalized to novel confederates for all participants, and these effects maintained for a minimum of 4 weeks.     

糖尿病酮症酸中毒急救措施

辩证思维是最重要的科学思维方法,是指导临床工作的重要科学方法。糖尿病酮症酸中毒（DKA）为糖尿病的急性并发症,是导致糖尿病死亡的主要原因之一。在临床诊治过程中,应科学合理运用辩证思维方法,对DKA快速正确地诊断,积极及时地救治,从而降低糖尿病的病死率,提高患者的生存质量。     

Le consentement du patient aux actes de secours lors d’interventions extrahospitalières

The acquirement of a person's consent to the medical care that is proposed to a patient is an absolute basic principle in rescue health care. This is mandatory for first arrival rescuers ; especially since their actions are, in view of the French Emergency Medical Service call centers, considered as being a medical act. The basic principle of consent to first medical care hence imposes itself as a humanitarian act as well as preventing any potential litigation. Nevertheless there are numerous situations where the management of the consent of the person in need of non-medical assistance will present difficulties. It is the necessary to analyze how the rescue health care system can manage and limit the risks s linked to the different situations when treatment is refused by the person in need of such help ; and this so as to respect the individual's dignity whilst not abandoning the needed health care. A collaboration between rescue personnel and the call center coordinating medical doctor is then mandatory especially when no consent is obtained. This will enable the detection of hypotheses where the individual's lucidity is altered and implement proportionately required and helpful measures. It will also equally enable the transmission of efficient information to the patient, in relation to the matter of patient consent and to ensure that the patient is aware of the consequence of his or her decision and that this decision was fully expressed. It would hence be deemed useful that the referenced work frame and recommendations, pertaining to the emergency rescue of a person, established by the General Management of Public Safety and Crisis Management detail more in detail these difficult and delicate situations so as to ensure that rescue personnel can better anticipate them. To conclude were commend a formalization of procedures that could be implemented in situations where a patient that has full mental capacities refuses the proposed health care, and we give the advantages of such a procedure be discussed.     

Moral Stress in International Humanitarian Aid and Rescue Operations: A Grounded Theory Study

Humanitarian aid professionals frequently encounter situations in which one is conscious of the morally appropriate action but cannot take it because of institutional obstacles. Dilemmas like this are likely to result in a specific kind of stress reaction at the individual level, labeled as moral stress. In our study, 16 individuals working with international humanitarian aid and rescue operations participated in semistructured interviews, analyzed in accordance with a grounded theory approach. A theoretical model of ethical decision making from a moral stress perspective was developed. The practical implications of the study are discussed.