Health care reform in the USA: Recommendations from USA and non-USA radiologists

AIM: To compare the opinions and recommendations of imaging specialists from United States (USA) and non-USA developed nations for USA health care reform. METHODS: A survey was emailed out to 18 imaging specialists from 17 non-USA developed nation countries and 14 radiologists within the USA regarding health care reform. The questionnaire contained the following ques tions: what are the strengths of your health care system, what problems are present in your nation's health care system, and what recommendations do you have for health care reform in the USA. USA and non-USA radiologists received the same questionnaire. RESULTS: Strengths of the USA health care system include high quality care, autonomy, and access to timely care. Twelve of 14 (86%) USA radiologists identified medicolegal action as a major problem in their health care system and felt that medicolegal reform was a critical aspect of health care reform. None of the non-USA radiologists identified medicolegal aspects as a problem in their own country nor identified it as a subject for USA health care reform. Eleven of 14 (79%) USA radiologists and 16/18 (89%) non-USA radiologists identified universal health care coverage as an important recommendation for reform. CONCLUSION: Without full universal coverage, meaningful health care reform will likely require medicolegal reform as an early and important aspect of improved and efficient health care.

A Better Understanding of Reasons for the Failure of the Healthcare Reform in Colombia

The Colombian healthcare crisis is evidenced by obstacles to health service, diminished working conditions and medical autonomy, financial infeasibility, loss of leadership and legitimacy of the healthcare system. In the year 2013 twelve reform projects were presented to Congress, including a statutory law that defines health as a fundamental right which was approved and another ordinary one which sought a complete reform of the system but was rejected and criticized by different opinion leaders. For this study we have made an adaptation to Q methodology, which assigns quantitative values to the most frequent statement variables obtained from secondary sources (norms, articles, media, forums) giving objective information about the diverse positions in the proposals to healthcare reform. We analyzed from the most objective position and from academic independence the different views of the opinion leaders for a better understanding of the reasons for this failure in healthcare reform. There was a great polarization in the diverse statements which made an agreement with the government unlikely and, when added to a political moment in which the presidential election was being held, made the new reform non-viable. Although there is an agreement about the existence of a crisis, this has not been the case about the analysis of its causes or solutions. At the present time, the government is not presenting a new reform proposal and is focusing on some decree to create a model of healthcare in rural zones, define financial conditions for the EPSes (health providers), update norms for membership in a healthcare system and regulate biotechnological drugs. Even though to date there have been no opinions, plus taking into account the previous analysis, it is very possible there will be much criticism from those who demand a structural change in the system.

New Challenges for Occupational Health Services Facing Economic Reform in China

In China, which is facing economic reform and the rapid development of small-scale industries, various occupational hazards are reappearing. The problems are related to the ignorance of the managers and the workers, a lack of capital, the insufficiency of occupational health services, and the transfer of some hazardous work from large factories in the cities to small plants in the towns and villages. The change in life-style, especially in smoking habits, has aggravated occupational hazards. The problems may be solved by renewing the concept of health among the managers and workers, enforcing legislation related to occupational hazards, strengthening health personnel training, and reinforcing health education and self-help. 1989 Academic Press, Inc.

Application of Experiential Teaching in the Reform of College Students' Mental Health Course from the Perspective of Life Education

In recent years,the phenomenon of college students5 indifference to life occurs frequently which seriously damages the healthy growth of college students.Life education should be integrated into mental health education courses in colleges.Experiential teaching is a type of teaching activity that is characterized by students5 personal experiences and initiative,focusing on the participation of practical activities.Compared with traditional lectures,it improves students'interest and enthusiasm.In the mental health course,experiential teaching applies theoretical knowledge to real life and promote the improvement of students9 mental health to shape stable and mature personalities and eventually,promotes the development of life.College students5 mental health course should be integrated with experiential teaching practice in the perspective of life education,so as to better improve the teaching effect and guide students to form a correct outlook of life.

Health reform in China:Developments and future prospects

In 2009,China initiated a new round of health reform to establish a wellfunctioning health system.The 2009 health reform did make some significant achievements in improving affordability and accessibility.In particular,social health insurance has been expanded significantly and various social health insurance plans have covered over 95%of total population in China by 2011.The Chinese government also has significantly increased fiscal input for health financing.However,affordability remains a serious concern as the social health insurers,as purchasers,were not very effective in containing the growth of health expenditure.Accessibility to primary care and public health is another concern.In this context,health governance reforms are necessary to address affordability and accessibility issues.Health governance set rules for key actors of the health system(including service providers,health insurers and government departments)by taking into account the strategies and incentives of these actors in their interactions.In recent years,a series of reforms in health governance have been initiated.Some progresses have been achieved.For the next stage of health reform,issues including how to further reform the governance structure of medical institutions and how to improve resource allocation in the health system are critical.

The politics of the basic benefit package health reforms in Tajikistan

Background:Health reform is a fundamentally political process.Yet,evidence on the interplay between domestic politics,international aid and the technical dimensions of health systems,particularly in the former Soviet Union and Central Asia,remains limited.Little regard has been given to the political dimensions of Tajikistan’s Basic Benefit Package(BBP)reforms that regulate entitlements to a guaranteed set of healthcare services while introducing co-payments.The objective of this paper is therefore to explore the governance constraints to the introduction and implementation of the BBP and associated health management changes.Methods:This qualitative study draws on literature review and key informant interviews.Data analysis was guided by a political economy framework exploring the interplay between structural and institutional features on the one hand and agency dynamics on the other.Building on that the article presents the main themes that emerged on structure-agency dynamics,forming the key governance constraints to the BBP reform and implementation.Results:Policy incoherence,parallel and competing central government mandates,and regulatory fragmentation,have emerged as dominant drivers of most other constraints to effective design and implementation of the BBP and associated health reforms in Tajikistan:overcharging and informal payments,a weak link between budgeting and policymaking,a practice of non-transparent budget bargaining instead of a rationalisation of health expenditure,little donor harmonisation,and weak accountability to citizens.Conclusion:This study suggests that policy incoherence and regulatory fragmentation can be linked to the neopatrimonial character of the regime and donor behaviour,with detrimental consequences for the health system..These findings raise questions on the unintended effects of non-harmonised piloting of health reforms,and the interaction of health financing and management interventions with entrenched power relations.Ultimately these insights serve to underline the relevance of contextualising health programmes and addressing policy incoherence with long horizon planning as a priority.

Evaluation of the Effect of China’s Health Care Reform Based on Prospect Theory

Objective To evaluate the effect of health care reform policy in China comprehensively and provide suggestions for its further implementation.Methods Data on the effect of health care reform were obtained from“China Health Statistics Yearbook”and National Bureau of Statistics of China and the indicators were selected by corrected item total correlation(CITC)and Cronbach’sαreliability coefficient.Then,the selected indicators were calculated through the prospect theory model.Meanwhile,the gray relation analysis method was introduced to enlarge the differences between the advantages and disadvantages to make the comprehensive evaluation result more obvious.Results and Conclusion The implementation of China’s health care reform has a significant impact on China’s medical and health system.However,the effect of the policy will become less with the increase of the total amount.An effective management can ensure that the policy continues to play its role.

Reform of Health System for People's Right to Health——An interview with Gao Qiang,Minister of Health

EDITOR＇S NOTE： In an interview given of late to our staff reporter, Gao Qiang, Chinese Minister of Health, spoke on the achievements made by China in medical and health work during the Tenth Five-Year Plan period （2001-2005）, the soaring medical costs that have invoked much public complaint, ways of carrying to depth the reform of the medical service system, development of the rural cooperative medical system and community-based medical services in cities, as well as prevention and control of AIDS. Following is a transcript of the interview.

Finance Policy for Public Health Disease Prevention: Addressing the Number One Cause of Death in the Western World

Background: The lack of a finance policy to cover heart coronary artery disease CT imaging led to an epidemic of heart disease, the most common cause of death in the United States. The difficulty for many adults to pay $150 for CT heart imaging was the impetus for public health reform through legislative intervention. Methods: The key to finance policy reform was the organization of the medical environment involved in asymptomatic heart disease. Using the ecosystem paradigm for organizational alignment, the legislative goal was financing the $150 heart image to identify and medically prevent symptomatic heart disease, obviating future surgical costs of >$100,000. Results: Assisted by stakeholders for public health reform, a 3-year initiative to pass a legislative bill mandating health insurance coverage of $150 heart imaging was signed into law. Understanding the legislative process was necessary for successful advancement of public health and eliminating unnecessary costs of an established conservative ecosystem. Conclusions: Texas was the first state to achieve this legislative goal and New Mexico soon followed. If political environments, regardless of country following this road map of public health reform, a significant beneficial impact upon heart disease, its cost, and healthier public would result.

基于红色卫生文化资源的思想道德与法治课程教学改革探究

红色卫生文化是中国共产党人精神血脉在医疗卫生领域的重要体现,红色卫生文化资源是新时代思想政治理论课教学的宝贵资源。做好医学院校思想道德与法治课程的教学改革工作,建设更符合医学生需求的思想道德与法治课程,有机融入红色卫生文化资源是其中一项重要举措。红色卫生文化历史悠久,资源丰富,时代价值突出。基于红色卫生文化资源的教学改革可使课程特色更加鲜明、课程体系更加完备、实践教学更加生动。在教学改革推进过程中应注意强原则,站稳立德树人主阵地;新内容,丰富思政教学资源库;活方法,打造沉浸式学习新情景;精评价,收获思政育人真效果。

保障健康权益 促进卫生改革发展

在当前复杂的国际形势下,健康权正受到严重的破环。本文探讨健康权的内涵以及对我国卫生改革的影响,从世界卫生组织对健康的定义出发,提出健康权在10个方面的表现;撰述生命权和健康权在《中华人民共和国宪法》《中华人民共和国民法通则》以及其他法律法规中的立法依据;展示医疗保险、医疗卫生服务和医药产业3个领域高质量发展在维护生命权、健康权方面获得的成果。卫生改革的目标之一是真正实现群众的健康权,应确保人民群众平等获得优质安全的医疗卫生服务,充分发挥政府作用,出台多种惠民政策,从改善政治、经济、立法、环境等条件出发,减轻全社会的疾病经济负担。应以人民健康为中心,不断提高人民群众的健康水平,为护卫人民群众的生命权和健康权而努力。

大健康背景下全球健康课程开设的初步探索

在我国大健康理念背景下,伴随着健康问题全球化进程的加速,世界卫生健康体系面临巨大挑战。伴随着全球健康问题不断升级,通过跨国家、多学科合作开展全球健康课程,加强对全球健康人才的培养,成为医学高校人才教育的一项重点工作。中国医科大学以本博连读临床医学专业(红医班)为试点,开设全球健康必修课程,在教学方案、培养目标、师资建设、教学模式和课程计划等方面进行了初步探索。

The political economy of results-based financing:the experience of the health system in Zimbabwe

Background:Since 2000,results based financing(RBF)has proliferated in health sectors in Africa in particular,including in fragile and conflict affected settings(FCAS)and there is a growing but still contested literature about its relevance and effectiveness.Less examined are the political economy factors behind the adoption of the RBF policy,as well as the shifts in influence and resources which RBF may bring about.In this article,we examine these two topics,focusing on Zimbabwe,which has rolled out RBF nationwide in the health system since 2011,with external support.Methods:The study uses an adapted political economy framework,integrating data from 40 semi-structured interviews with local,national and international experts in 2018 and thematic analysis of 60 policy documents covering the decade between 2008 and 2018.Results:Our findings highlight the role of donors in initiating the RBF policy,but also how the Zimbabwe health system was able to adapt the model to suit its particular circumstances-seeking to maintain a systemic approach,and avoiding fragmentation.Although Zimbabwe was highly resource dependent after the political-economic crisis of the 2000s,it retained managerial and professional capacity,which distinguishes it from many other FCAS settings.This active adaptation has engendered national ownership over time,despite initial resistance to the RBF model and despite the complexity of RBF,which creates dependence on external technical support.Adoption was also aided by ideological retro-fitting into an earlier government performance management policy.The main beneficiaries of RBF were frontline providers,who gained small but critical additional resources,but subject to high degrees of control and sanctions.Conclusions:This study highlights resource-seeking motivations for adopting RBF in some low and middle income settings,especially fragile ones,but also the potential for local health system actors to shape and adapt RBF to suit their needs in some circumstances.This means less structural disruption in the health system and it increases the likelihood of an integrated approach and sustainability.We highlight the mix of autonomy and control which RBF can bring for frontline providers and argue for clearer understanding of the role that RBF commonly plays in these settings.

Universal health coverage and public-private participation: towards a new balance?

This commentary discusses the emergence of a new paradigm to address the health policy issues through Public-Private Participation (PPP).The discussion provides a detailed literature review of PPPs by presenting an initial overview of the ideological shift from state to market intervention,then identifying arguments in support of or against public-private approaches and finally exploring the emergence of this new paradigm of PPP or its hybrid forms.It then discusses the contextual realities of Public-Private Participation in health care,and whether an optimal balance is possible with better government stewardship and private provision.Conceptually,the premise of stewardship in governance is that it is possible to create not only efficient but also effective systems.These ideas may find a receptive audience in many countries,especially in the emerging economies with improving standards.In East Asian societies,the concept of stewardship bears a strong resemblance to Confucian ideals of morality in government,with social expectations of those who govern to be principled and virtuous.Increasingly,a pragmatic theory of development seems to apply in public-private,similarly,through it is expected,that public-private participation in the healthcare system should also achieve the goal of Universal Health Coverage through good governance.

新形势下提升预防医学专业学生实践能力的教学改革探索

文章旨在探讨如何通过改革教育教学体系,提高公共卫生专业学生的实践能力,培养高素质的医学人才。公共卫生教育和人才培养处于关乎国家建设、发展与安全的全局性、基础性和战略性地位。作为公共卫生队伍建设的重要一环,高校承担着公共卫生人才培养的重任。文章结合国家新形势发展的需要和预防医学实践能力的培养现状,提出了特色创新预防医学专业实践能力培养体系框架,并分别从实施改革教学方法、完善教学大纲、重视实践操作以及构建考核方式四个方面提出了具体的举措。这些改革措施能够有效规范学生的实践操作,夯实其工作技能,为国家公共卫生事业输送高素质的医学人才。文章的研究成果将对未来公共卫生教育和人才培养领域的发展和改革具有重要的指导意义。

医保政策与健康伦理的冲突与对策分析

针对现行医保政策与患者健康伦理的冲突现象进行原因分析,汇总原因如下:医保基金的可持续发展状况堪忧、医保管理体系有待完善、医保管理部门与医疗机构协商谈判机制不健全、医疗卫生资源配置和人民群众的卫生服务需求不匹配。针对上述原因,应从调整医保基金筹资机制、构建多层次医疗保障体系、健全医保管理体系、建立医保管理部门与医疗机构协商谈判机制、促进医疗机构精细化管理程度等方面入手,维护医保基金安全,提高患者就医满意度。

综合医疗制度改革对中国家庭财务脆弱性的影响

健康风险作为背景风险的重要组成部分,会给一般家庭造成明显的财务脆弱性。医疗制度作为重要的社会保障基础,可以为家庭提供关键的健康保障,从而有效缓解家庭财务脆弱性。引入2010—2020年中国家庭追踪调查数据(CFPS),构建准自然实验研究体系,采用双重差分法检验了综合医改政策对家庭财务脆弱性的影响特征及其作用机制。研究发现,综合医改政策的实施显著缓解了家庭财务脆弱性,并且这一效应在城镇家庭、有老年人的家庭、儿童健康风险高的家庭、弱社会网络家庭、使用互联网的家庭以及社会信任度高的家庭中表现更加明显。同时,综合医改政策可以通过降低家庭医疗负担、提升家庭劳动参与、改变家庭风险态度等途径缓解家庭财务脆弱性。本文为评估综合医改政策及其对家庭财务影响的有效性提供了新视角,为进一步从微观层面深化医疗卫生体制改革提供了重要的政策启示。

“大健康”视域下环境土壤科学教学改革的一点思考

为全面提升中华民族健康素质、积极参与全球健康治理、切实履行《2030年可持续发展议程》的国际承诺,中共中央、国务院提出全面实施“健康中国战略”。在教育领域尤其是环境科学教育方面,亟需进行改革以适应“大健康”视域下的发展需求,更新教育思想、人才培养模式和视野提升路径成为大势所趋。该文旨在探讨“大健康”理念和土壤环境与健康的融合,分析其对环境土壤科学课程教学的指导作用。在此基础上,提出三位一体的环境土壤科学课程教学改革思路:构建基于“大健康”理念的复合型人才培养知识体系,拓展产学研一体化的应用型人才实践素质,以及融入信息化手段,优化课程考核评价体系。希望通过上述改革方案的实施,达到有效提高教学效果、全面提升学生综合素质和培养符合社会发展需求的高素质环境科学与工程领域人才的目的。