scholarly journals 衛生保健體制改革: 理性與現實的選擇

1999 ◽  
Vol 2 (1) ◽  
pp. 5-26
Author(s):  
Zhizheng DU
Keyword(s):  
Public Health ◽  
Health Care ◽  
Medical Care ◽  
Small Group ◽  
Health Care Reform ◽  
Health Care Costs ◽  
High Technology ◽  
Public Health Care ◽  
Basic Health ◽  
Care Costs

LANGUAGE NOTE | Document text in Chinese; abstract also in English.衛生保健制度改革之艱難，主要在於要在諸多因素發展勢頭的相互硑撞中維持衛生保健工作的良性發展。衛生保健改革目標的設定，應當着眼於現實，但又必須顧及長遠。為此，它應當是首先有利於為更多的人群提供最基本的保健服務，同時又 能有力地控制保健費用的增長，有利於控制疾病的發生。只着眼於開源或節流，或者只強調衛生服務組織自身的營運，都可能使衛生保健產生更多的麻煩。多方位的雙層或多層的體制是使衞生保健工作適應各方需要的理想構思，它包含多種雙層或多種多層的內涵。在衛生資源有限的情況下，配給是保證為更多的人群提供保健的有效措施，救援則是其重要的補充。現行的醫療服務體系與為最廣大的人群提供基本的醫療保健服務不適應，也與抑制醫療費用上漲的要求不適應，必需有較大力度的改革。衛生保健改革的選擇，必須是道德的，同時又是理性而現實的。Health care costs soar and become unbearable everywhere in the world. This is not only a problem faced by developed Western countries. It is also a difficult issue for the third world countries such as China. China's health care system needs reform. On the one hand, a great number of people have not been covered by any basic health insurance. On the other hand, however, critical care medicine in high-technology hospitals in urban areas consumes tremendous public health care resources for a very small group of patients. This essay argues that China should appropriately establish multiple goals for its health care reform, based on ethical and reasonable deliberations on China's actual health care situation.First, rationing is crucial in containing health care costs. Public health care resources are limited. It is impossible to satisfy all medical needs for all people at all times. This is especially the case for mainland China, where public resources that can be invested in medical care are scarce. An appropriate goal of China's health care reform should be to provide basic, not luxury, health care for the people. Some luxury medical procedures must be left to individuals for purchase through their own resources.Second, a basic level of health care must be ensured to most people, even if it is impossible to ensure to everyone. It is important for everyone to understand that providing the best care for everyone is practically impossible. The best a government can do is to provide some level of basic care. However, the goal here must be the basic health of all or most people, rather than total care for a small group of people.Third, an appropriate pattern of China's health care should be prevention-oriented and ordinary-treatment-oriented, rather than high-technology-medicine-oriented. Since the early 1980s, many hospitals have relied on high-technology medicine to deal with diseases and to earn more income for themselves at the same time. But high-technology medicine is not panacea, though it is extremely costly. Inexpensive medical prevention is often more effective than high-technology medical procedures.Finally, a rule of rescue should be established in society. Society ought to provide some help for those who need special expensive medical care (such as organ transplantation) and are not able to afford it. The rule of rescue guides our efforts in this direction. Society should organize and establish special foundations to help people in this regard.DOWNLOAD HISTORY | This article has been downloaded 21 times in Digital Commons before migrating into this platform.

scholarly journals Financing of medical services: experience of foreign countries and Ukraine

2020 ◽  
pp. 9-13
Author(s):  
Nataliia KARPYSHYN ◽  
Iryna SYDOR
Keyword(s):  
Health Care ◽  
Health Services ◽  
Medical Care ◽  
Health Care Reform ◽  
Health Care System ◽  
Health Care Costs ◽  
Medical Services ◽  
Foreign Countries ◽  
Care Costs ◽  
Care System

Introduction. Research into the sources of health care funding is necessary to develop an effective policy to improve the domestic health care system and improve the accessibility and quality of medical care. The purpose of the article is to assess the sources of funding of medical services in foreign countries and in Ukraine in order to identify and analise current trends and prospects for financing the domestic health care system in the implementation of health care reform. Results. An analysis of trends in the financing of health services in foreign countries has shown that there is a certain imbalance between the country's economic growth and its health care expenditures. The share of health services expenditures in GDP averaged 8.8 % or almost $ 4,000 per OECD citizen in 2018 y . This cost figure is 24 times higher than the per capita health care costs in Ukraine and can be a guide to the amount of funding for medicine in the world community. Citizens of OECD countries, unlike Ukrainians, pay an average of 21 % of all health care costs. The priority sources of funding for one group of countries are budget funds (Norway, Denmark, Sweden, Great Britain, Canada), and for another – compulsory health insurance (Germany, Japan, France, etc.). Сonclusion. Funds of the population are the main source of funding for medical services in Ukraine – 53 %. This indicator is critical for the country, as low-income citizens are unable to pay for medical care and the number of chronic diseases, disability and mortality are increased. The transformational reform of the health care system in Ukraine was started in 2015 and according to international experts is successful and meets international practices of accessibility, quality and efficiency of medical services. Further consistent implementation of health care reform can provide financial protection for the population from excessive out-of-pocket spending, improve access to health care, and improve public health.

Les Nouveaux Miserables: Modem Victims of Social Asphyxia

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 851-857
Author(s):  
David R. Smith
Keyword(s):  
Health Care ◽  
Health Status ◽  
Medical Care ◽  
Health Care Costs ◽  
Health Care Services ◽  
Preventive Services ◽  
Medical Care System ◽  
Care Services ◽  
Care Costs ◽  
Care System

During the past 30 years, social and economic barriers to health care services have increased for many Americans, especially for the nation's most vulnerable populations. Health status actually has declined for certain populations during this time. Meanwhile, national attention has been focused primarily on containing health care costs and on devising strategies for reforming the financing of health care rather than strategies for achieving improvements in the health status of the population. Existing methods of financing health care services, health research priorities, the increasing centralization and compartmentalization of health care services, and the recent failure of national health reform all serve to hinder this nation's progress towards developing a comprehensive and accountable health care system focused on promoting and achieving improved health as well as treating sickness. Recent changes in the health care marketplace, however, including a growing movement toward measuring the outcomes of medical treatments and an emphasis on improving the quality of services, have increased interest among payers and providers of health care services in investing in preventive services. Health maintenance organizations and other integrated health care delivery systems are beginning to devise incentives for increasing preventive care as well as for containing costs. The transformation of the nation's current medical care system into a true health care system will require innovative strategies designed to merge the existing fragmented array of services into coordinated and comprehensive systems for delivering primary and preventive health care services in community settings. The community-Oriented Primary Care concept successfully blends these functions and has achieved measurable results in reducing health care costs and improving access to preventive services for identified populations. There is flexibility in existing funding sources to promote preventive services in various public and private health care settings and to assist in the transformation from a disease-oriented medical care system to one focused on health.

User Fees for Health Care: Why a Bad Idea Keeps Coming Back (Or, What's Health Got to Do With It?)

1995 ◽  
Vol 14 (2) ◽  
pp. 360-390 ◽  
Author(s):  
Robert G. Evans ◽  
Morris L. Barer ◽  
Greg L. Stoddart
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Final Analysis ◽  
User Fees ◽  
Care Providers ◽  
Positive Effects ◽  
The Face ◽  
Care Costs

ABSTRACTCalls for user fees in Canadian health care go back as far as the debate leading up to the establishment of Canada's national hospital insurance program in the late 1950s. Although the rationales have shifted around somewhat, some of the more consistent claims have been that user fees are necessary as a source of additional revenue for a badly underfunded system, that they are necessary to control runaway health care costs, and that they will deter unnecessary use (read abuse) of the system. But the real reasons that user fees have been such hardy survivors of the health policy wars, bear little relation to the claims commonly made for them. Their introduction in the financing of hospital or medical care in Canada would be to the benefit of a number of groups, and not just those one usually thinks of. We show that those who are healthy, and wealthy, would join health care providers (and possibly insurers) as net beneficiaries of a reintroduction of user fees for hospital and medical care in Canada. The flip side of this is that those who are indigent and ill will bear the brunt of the redistribution (for that is really what user fees are all about), and seniors feature prominently in those latter groups. Claims of other positive effects of user fees, such as reducing total health care costs, or improving appropriateness or accessibility, simply do not stand up in the face of the available evidence. In the final analysis, therefore, whether one is for or against user fees reduces to whether one is for or against the resulting income redistribution.

Use, cost, and digital divide in online public health care: lessons from Denmark

2019 ◽  
Vol 13 (2) ◽  
pp. 197-211 ◽  
Author(s):  
Kim Normann Andersen ◽  
Jeppe Agger Nielsen ◽  
Soonhee Kim
Keyword(s):  
Health Care ◽  
Digital Divide ◽  
Health Care Costs ◽  
Online Communication ◽  
Population Data ◽  
Public Health Care ◽  
Content Type ◽  
Health Related ◽  
Use Of The Internet ◽  
Care Costs

Purpose The purpose of this paper is to enhance the knowledge about the use of online communication between patients and health-care professionals in public health care. The study explores digital divide gaps and the impacts of online communication on the overall costs of health care. Design/methodology/approach This study focuses on online health care in Denmark. The authors rely on population data from 3,500 e-visits (e-mail consultations) between patients and general practitioners (GPs) from 2009 to 2015. Additionally, they include survey data on the use of the internet to search for health-related information. Findings The analysis of the Danish data reveals a rapid uptake in the use of the internet to search for health-related information and a three-fold increase in e-visits from 2009 to 2015. The results show that the digital divide gaps exist also in the online health-care communication. Further, the study findings suggest that enforced supply of online communication between GPs and patients does not alleviate the costs. Rather, the number of visits to GPs has not been decreased significantly and health-care costs showing a marginal increase. Research limitations/implications Further data should be collected and analyzed to explore the impacts of other institutional factors and population cohort on the digital divide and healthcare costs. Also, it is difficult to estimate whether the increased use of online health care in the long run lead to lowering overall health-care costs. While the internal validity of the study is high due to the use of population data, the external validity is lower as the study results are based on the data collected in Denmark only. Practical implications The study offers important input for practice. First, leaders in government might reconsider how they can control the health-care costs when opening online channels for communication between patients and doctors. Second, concerns about digital divide issues remains, but the study suggests that the uptake of e-visits does not widen the socio-economic, gender or age gaps. For health policy concern, this is encouraging news to lead to an increasing push of online communication. Social implications The dynamics of online health-care communication may lead to mixed results and unexpected impacts on overall health-care costs. Originality/value The paper offers new insights in the impacts of mandatory supply of digital services. The Danish push-strategy has led to an enforced supply of e-visits and a rapid growing use of the online health care without widening digital divide but at the risk of potential increasing the overall costs.

Sign in / Sign up

Export Citation Format

Share Document