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。     

我国农村初级卫生保健制度发微

集中梳理和总结有关中国农民初级卫生保健,特别是农村卫生投入和补偿机制、农村公共卫生和预防保健的文献,结合实地调研中发现的问题和矛盾,分析当今中国初级卫生保健的倾向、面临的问题,和当前我国卫生资源科学、合理利用以及可持续发展的滞碍所在,从理论与实证研究的角度提出未来的工作方向和政策建议.     

我国农村初级卫生保健制度发微

集中梳理和总结有关中国农民初级卫生保健,特别是农村卫生投入和补偿机制、农村公共卫生和预防保健的文献,结合实地调研中发现的问题和矛盾,分析当今中国初级卫生保健的倾向、面临的问题,和当前我国卫生资源科学、合理利用以及可持续发展的滞碍所在,从理论与实证研究的角度提出未来的工作方向和政策建议。     

医生是卫生保健改革的关键

来自波士顿哈佛大学医学院阿诺德教授的报告指出：关于美国现今的卫生保健改革应该加强初级保健方面的运作,提高应用于初级保健的资金,使大医院真正拿出人力、物力支持卫生初级保健系统。这样,就要求医生对此项改革给予大力支持,使医生真正成为卫生保健改革的关键。     

20世纪全球卫生发展的回顾与展望

20世纪人类的健康状况发生了革命性的转变,同时也面临着前所未有的挑战。疾病谱的改变及人口寿命的延长以及医疗费用的上涨仍然是困扰各国决策者的难题,卫生发展与改革任重道远。完善健康保障体系最理想的选择方案是政府为居民“购买”基本卫生服务,由国家财政和居民共同承担保险基金,普及初级卫生保健,鼓励多种形式办医,WHO确定的卫生工作目标是各成员国卫生系统改革与发展的指导方针。     

迎接新的卫生挑战

卫生部门和社会各界对卫生挑战的应对通常是缓慢和不充分的。这反映了各国无力动员必需的资源和相关机构进行以初级卫生保健价值观为核心的卫生改革，也无法纠正或实质性地修正那些将卫生机构引入歧途的不良趋势。这些趋势包括对专业医疗的过分重视，不完整的卫生系统和不规范的商业医疗。     

中国卫生改革的公正性和社会责任

世界卫生组织的宪章和有关卫生大会的决议多次指出:"人人享有最高而可获得的健康标准是一项人类的基本权利".中国曾经是发展中国家贯彻世界卫生组织人人享有卫生保健战略目标的楷模.随着社会经济的发展,人口结构及疾病谱的改变,科技的迅速进步,我们需要进行卫生改革,但世界上没有现成的模式.分析了我国的卫生改革中取得的伟大成就,但在医疗卫生改革中缺乏伦理考量:卫生资源分配的不公正和政府在卫生总投入中所占的比例不足,是造成"看病难、看病贵"的主要原因.由世界卫生组织和联合国教科文组织最近所提出的伦理准则:分析了卫生改革的公正性和社会责任.     

国际卫生保健筹资模式的特点与评价

目前 ,卫生保健筹资已成为世界各国共同关注的问题。卫生保健筹资是指卫生保健费用的筹集、分配与利用 ,它从一个侧面反映了一个国家的文化、经济和政治特征 ,体现了每一个国家及其政府是如何解决将稀有的卫生资源配置到全体居民中去这样的难题的。从目前各国卫生保健筹资的模式来看 ,都在通过不同的方式和渠道来筹集卫生资源 ,以解决居民个人和社会所承担的医疗服务费用的风险。就卫生保健服务的性质来看 ,可以从政府、雇主、或个人等三方面来筹集资金 ,形成社会健康保险基金。其筹资渠道 ,可以通过国家税收、薪金税、或者商业保险等形式来…     

卫生保健政策与医学伦理学

卫生保健政策是卫生资源、价值目标和伦理原则三者的结合。医学伦理学是卫生政策的重要基础。当代卫生事业的特点,卫生保健服务面临的挑战以及医学伦理主体与客体的变化,决定了医学伦理学在当代卫生保健政策中的特殊意义。在医学面临全民保健的阶段,一个科学的符合人民健康利益的卫生保健政策是不言而喻的。摆脱当前卫生政策面临的困难,要求必须在医学伦理学方面作出正确的选择。     

卫生保健需要的重要性与意义

卫生保健需要在卫生计划和资源配置中的作用日益受到重视。卫生保健需要是有层次的,相对的,因确定者,不同个体以及时间而异,科学,全面地认识和测量卫生保健需要,分析其与卫生服务需求和提供的关系,是更好的满足整个人群的卫生保健需要,使需要,需求和提供三者相匹配的基本前提,才能确保实现充分利用有发的资源,更经济,有效地提供卫生服务,保障和促进人群健康的宗旨。     

The Primary Care Health System as a Core Resource in Response to Terrorism

Abstract

Living through a terrorist event or under threat of attack affects both mental and physical health. A nation's primary care system plays a critical role under such circumstances. This article reviews the American experience after September 11, 2001 and advocates for integration of mental and physical health services in primary care settings as a key counter-terrorism strategy. Americans put their trust in primary care providers. The nation's healthcare system must develop and implement a strategy that informs and supports primary care providers in meeting the mental health needs of a nation confronted by terrorism.     

Primary health care for women: What is it and who provides it?

Recent federal policy has highlighted historically underrecognized women's health issues. Women comprise the majority of the population, especially the elderly. Women's health care needs, utilization patterns, and outcomes vary from those of men, and often among each other. Primary health care services for women are multidisciplinary and emphasize prevention, education, and early intervention as well as treatment. Psychologists and other primary health care providers can collaborate to provide their services in a cost-effective manner that optimizes quality of care and comprehensive health care.     

Cuban health psychology: A priority is the primary health care system

Cuban health psychology has experienced a great expansion during the last 25 years, both in the number of psychologists and in range of activities in the field. Today, psychologists are integrated at all levels of the national health system, an achievement which is particularly interesting in that Cuba is a developing country. In a position isolated from trends in international psychology, Cuba has developed a role for psychologists within the field of health which is adapted to its situation as a poor and socialistic country. Priority is given to preventive and community-based psychology within primary health care facilities. Psychologists in primary health care serve a composite client-group, with high priority given to pregnant women and to children. The work of these psychologists covers a wide range of health problems—-physical as well as mental—and focuses upon individuals as bio-psycho-social units. Their responsibilities include health promotion, disease prevention, consultation and treatment, rehabilitation, research and education. This report is based on a 2½ month long field study in Cuba, where Cuban health psychology, particularly as it relates to primary health care, was explored.     

Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

Developing more of a local public health focus, and involving local communities in Great Britain in health care decision‐making, are key aspects of the radically changing face of primary care. Community‐oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.     

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.     

Establishing psychological services in a community-based,health care setting: A 3-year case study

Health care practitioners are being challenged to reorganize service delivery and psychology providers are emerging as important participants in shaping the development of primary health care practices. The article outlines the 3-year process of a community/academic/health care center partnership to develop a new model for providing interdisciplinary health care services. The authors describe the process of integrating psychological services into an interdisciplinary, primary care community-based health care center, outline specific planning strategies, and identify the roadblocks and barriers encountered.     

The Challenge of Integrated Care for Mental Health: Leaving the 50 minute hour and Other Sacred Things

A growing body of research has demonstrated the effectiveness of integrating mental/behavioral healthcare with primary care in improving health outcomes. Despite this rich literature, such demonstration programs have proven difficult to maintain once research funding ends. Much of the discussion regarding maintenance of integrated care has been focused on lack of reimbursement. However, provider factors may be just as important, because integrated care systems require providers to adopt a very different role and operate very differently from traditional mental health practice. There is also great variability in definition and operationalization of integrated care. Provider concerns tend to focus on several factors, including a perceived loss of autonomy, discomfort with the hierarchical nature of medical care and primary care settings, and enduring beliefs about what constitutes “good” treatment. Providers may view integrated care models as delivering substandard care and passively or actively resist them. Dissemination of available data regarding effectiveness of these models is essential (e.g. timeliness of treatment, client satisfaction). Increasing exposure and training in these models, while maintaining the necessary training in traditional mental health care is a challenge for training at all levels, yet the challenge clearly opens new opportunities for psychology and psychiatry.     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.