城乡医疗保障制度一体化研究

公平和正义是社会保障制度价值的核心理念,也是衡量一个国家或地区社会保障制度能否充分和真正发挥作用的重要衡量因素。在新医改背景下,"人人公平享有健康保障"成为医疗保障制度建设进程中的一个重要目标,而推动城乡医疗保障制度一体化,进而实现三项医保制度整合衔接是实现这一目标的途径。下一步要重点完善社会医疗保障制度的运行环境;努力保障流动参保人员的就医权益,完善基本医疗保险关系转移接续;整合经办资源,强化管理体制统一化;确定合理的筹资补偿机制,强化财政补贴机制。     

论民国初期北京地区的行医管理和医病关系

本文以北京为研究个案,说明民国初期国家相关机构对于行医实行规范管理,医生只有通过考试获得相应资格后方可行医。由于这一变革,病家认识到国家在医病关系中的作用,因医疗不满而发生的告医现象开始涌现。为规避责任,无论是正式的医生还是私自行医者均不得不采取策略加以应对。     

Models of Disability, Work and Welfare in Australia

In discourse around disability there has been a shift away from a ‘medical model’, which perceives disability as an individual problem to be ‘cured’ or contained, towards a ‘social model’. The latter focuses on the relationship between people with disabilities and their social environment, locating the required interventions within the realm of social policy and institutional practice. Drawing upon a small qualitative study conducted in Melbourne, this article argues that recent plans by the Australian government to introduce mutual obligation requirements for recipients of the Disability Support Pension (DSP) sit in tension with this shift from the medical to the social models of disability. Mutual obligation is based on the assumption that income support recipients need to be taught how to be more ‘self‐reliant’, to ‘participate’ in society more fully and to become ‘active’, rather than ‘passive’, citizens. This language appears to overlap with that used to articulate a social model, which places emphasis on participation in the community and attempts a shift away from reliance on the medical profession. However, examples from interviews conducted with current and former DSP recipients demonstrate that, in practice, mutual obligation is likely to reinforce a medical model of disability, frame DSP recipients as ‘conditional’ citizens and ignore the obligations of the state and society regarding access and inclusiveness for people with disabilities.     

Managing Communication: Appropriate Behaviour in Medical Consultations

The interaction process between doctors and their patients represents a relatively infrequently explored strand of medical sociology. This paper is primarily concerned with one aspect of the attitudes and expectations which both doctors and patients bring to their interaction—the role which the patient is expected to play in the medical consultation. The data provide a detailed picture of the sorts of things which it was felt that patients should and should not do. Furthermore, the data indicate a high degree of overlap between doctors' and patients' views on what characteristics are representative of ‘good’ and ‘bad’ patients. Finally, some consideration is given to the implications of what is seen to be ‘appropriate’ behaviour in medical consultations for broader health care outcomes.     

Euthanasia and the medical profession: an Australian study

Advances in medical knowledge and technology are enabling more people to live longer in modern societies. This situation has also created dilemmas for medical practitioners in treating severely or chronically ill patients where the harm caused to them by treatment appears to outweigh the benefits. After reviewing some of the major legal and ethical issues confronting medical practitioners in Australia, this paper reports findings of a survey of Australian doctors' attitudes towards euthanasia. The findings show that a significant number of doctors receive requests from either the patients or their families to hasten death through active or passive euthanasia. A large majority of them also regard some form of passive euthanasia as an acceptable medical decision concerning the end of life. Twenty per cent of general practitioners and 17 per cent of specialists surveyed have taken active steps in the past to hasten the death of a patient. This paper explores the circumstances in which doctors are prepared to perform euthanasia and concludes with a discussion of the legal, ethical and professional issues raised by the survey's findings.     

Social Antecedents of Medical Fraud and Over-Servicing: What Makes A Doctor Criminal?

Medical fraud and overservicing are estimated to cost the Australian community between $130 and $200 million per annum, a figure far greater than the national cost of burglary and almost the same as the total property loss from all conventional crime. An examination of the social antecedents of medical fraud and overservicing suggests that the predisposition of some doctors to engage in these practices occurs because of the following: (1) medical training and professional socialization that orientate student doctors away from altruistic health issues towards narrower self-interested professional concerns; (2) career expectations of a high pattern of material consumption that are often frustrated by an increasingly competitive medical market place; and (3) professional medical organizations that lobby for national health policies which reflect the mercenary self-interest of doctors rather than the health interest of the nation.     

Sensory Work of Diagnosis: A Crisis of Legitimacy

Sensory judgments have always been a part of medical practice, as sensory studies scholars have emphasized. However, in current regulatory, management and technological contexts, there is a push toward rational decision-making procedures and test-based evidence over clinical diagnosis. Sociological scholarship highlights that in focusing on explicit medical knowledge and disembodied data we take for granted aspects of healthcare work, including the ways in which health and illness is sensed. Research in sociologies of diagnosis and social studies of science and technology has captured that while the senses continue to play a role in medical work, the status and practice of this sensory work is not straightforward as evidenced by dual use of the senses and tests and the delegation of sensory work. Based on semi-structured interviews with expert doctors in diverse specialties, this article examines the sensory work of medical decision-making, with attention to its legitimacy. It examines applications of the senses from auscultation to ongoing sensing of patients’ bodies unmediated and via technological outputs. While critical to clinical judgments, there is discomfort with this sensory work in light of medico-legal pressures. I argue that the sensory work of diagnosis is vital, to the extent that gaps in sensory information imply gaps in understanding.     

Student Projects in Medicine: A Lesson in Science and Ethics

Regulation of biomedical research is the subject of considerable debate in the bioethics and health policy worlds. The ethics and governance of medical student projects is becoming an increasingly important topic in its own right, especially in the U.K., where there are periodic calls to change it. My main claim is that there seems to be no good reason for treating student projects differently from projects led by qualified and more experienced scientists and hence no good grounds for changing the current system of ethics review. I first suggest that the educational objectives cannot be met without laying down standards of good science, whatever they may be. Weak science is unnecessary for educational purposes, and it is, in any case, unlikely to produce good researchers in the future. Furthermore, it is curious to want to change the system of ethics review specifically for students when it is the science that is at stake, and when the science now falls largely outside the ethics remit. I further show that ethics review is nevertheless important since students carry a new potential conflict of interests that warrants independent oversight which supervisory support does not offer. This potential conflict may become more morally troublesome the greater the risks to the subjects of the research, and students may impose greater risks on their subjects (relative to professional researchers) by virtue of being inexperienced, whatever the nature of the project. Pragmatic concerns may finally be allayed by organizing the current system more efficiently at critical times of the university calendar.     

论人权国际法保护的逻辑基础——以米尔恩“低限人权说”展开

米尔恩的人权哲学认为,人权并不是西方竭力宣扬的理想标准概念,而是最低限度道德标准所要求尊重的一些基本权利。虽然人类生活具有多样性,但最低限度的道德标准是共有的,因此是普遍意义上的人权。米尔恩＂低限人权说＂的积极意义在于,其有效协调了＂主权优于人权＂和＂人权优于主权＂的争论,为不同文明圈关于人权国际保护的对话提供理论平台。唯有各国完善人权保障法律体系,尤其是作为国家根本大法的宪法,才能承载人权国际保护重任。     

对城市医疗救助制度的思考

实施城市医疗救助制度是贯彻党的十七大关于社会保障的精神、维护医疗保健公平、完善我国社会保障体系的需要。当前城市医疗救助制度存在以下问题：救助对象的确定不够灵活,大病医疗救助模式影响了医疗救助制度功能的发挥,医疗救助资金存在绝对不足与相对过剩的矛盾,法律制度本身不完善,管理体制没有理顺。为了完善城市医疗救助制度,需要更加准确地确定救助对象,逐步推行综合救助模式,解决好医疗救助资金绝对不足与相对过剩的矛盾,逐步完善医疗救助法律制度,理顺医疗救助的管理体制。     

略论医疗保险政策的公平性选择

在现阶段经济转型时期,卫生事业的公平性是和谐社会建设的重要基础之一。而目前,我国医疗保险政策存在公平性缺失的问题,医疗保险政策的公平性选择就是建立强制性城乡一体化的医疗保险体制;在加大政府投入的同时,建立收支两条线的资金控制系统;建立医疗保险再分配机制和医疗救助体系。     

我国民法基本制度生态化探究

生态文明时代要求法律制度进行不同程度的生态化.在各种法律制度生态化历程中,民法制度的生态化起着相当重要的作用.民法基本制度的生态化是民法生态化的重要内容,它包括人格权制度的生态化、物权制度的生态化、合同制度的生态化、侵权责任制度的生态化.这其中,环境人格权是人格权制度生态化的主要内容；生态性用益物权是物权制度生态化的重要组成部分；环境物权交易合同是合同制度生态化的主要方面.以损害风险预防、现实损害救济赔偿、恢复责任承担为切入点,采用无过错责任与过错加重责任并用的原则,贯彻环境损害全程监管与责任追究的理念,对环境污染与生态破坏的源头与过程实行全面的控制与追责是侵权责任制度生态化的基本要素.     

Mental & Social Diagnosis and the English Prison Commission 1914–1939

In this article the author argues that there was a strengthening optimism about the value of psychological treatment between 1914 and 1939 amongst medical personnel employed by the English Prison Commission. This optimism contrasted with the pessimistic eugenic notion that there was an increasing and unreformable underclass which transmitted its inferior mental and physical characteristics biologically. Prison Commission medical staff became openly critical of eugenic proposals during the interwar years and, advised by a number of its medical personnel such as medical inspector and later Medical Commissioner William Norwood East, the Prison Commission was influenced towards the mental hygienism advocated by a growing number of American and British clinicians. Fherefore the Commission initiated a number of experiments in psychological treatment and psychoanalysis in English prisons.     

Research ethics review for the use of anonymized samples and data: A systematic review of normative documents

While the anonymization of biological samples and data may help protect participant privacy, there is still debate over whether this alone is a sufficient safeguard to ensure the ethical conduct of research. The purpose of this systematic review is to examine whether the review of an ethics committee is necessary in the context of anonymized research, and what the considerations in said ethics review would be. The review of normative documents issued by both national and international level organizations reveals a growing concern over the ability of anonymization procedures to prevent against reidentification. This is particularly true in the context of genomic research where genetic material’s uniquely identifying nature along with advances in technology have complicated previous standards of identifiability. Even where individual identities may not be identifiable, there is the risk of group harm that may not be protected by anonymization alone. We conclude that the majority of normative documents support that the review of an ethics committee is necessary to address the concerns associated with the use of anonymized samples and data for research.     

医务社会工作在医疗服务中的运用——以肾透析病人为例

肾透析病人在承受肾功能衰竭及治疗带来痛苦的同时,面对巨额医药费和健康（工作）丧失、成为家庭负担的压力。现行医疗体制下的医护很难关注影响肾透析病人康复的社会心理、经济、行为、文化因素,其需求与感受可能在诊断和治疗中被忽略。本文从医务社会工作的视角,用个案工作方法对该人群做出社会诊断,并就医务社工在协助病人及家属解决相关社会、经济、家庭、职业、心理问题,提高生活质量、促进社会回归方面提出建议。     

Europeanization of Social Inclusion Policy in Macedonia – Trends,Challenges and Potential Benefits

The article explores policies, trends and challenges related to social inclusion in Macedonia, and assesses the contribution of EU strategic frameworks and instruments towards the country's greater inclusive growth. In this respect, the article starts by exploring existing instruments for pre‐accession (IPAs) which are relevant for the achievement of the EU 2020 goals. Then the article offers a country analysis related to issues such as poverty, material deprivation, as well as exclusion from the labour market, accompanied by an overview of policies and measures undertaken by the current government in the respective domains. Unfavourable socio‐economic trends, such as undeclared work, jobless growth, high unemployment and poverty rates, present serious challenges to the creation of an effective social inclusion policy. On the other hand, the ‘delayed’ negotiation process with the EU, which in social policy results in a lack of Joint Inclusion Memorandum (JIM) and Joint Assessment Paper (JAP) processes even after seven years of candidate status, slows down the adoption of more strategic policy approach towards sensitive issues, such as social inclusion and anti‐discrimination. The main aim of the article is to assess whether there is a significant difference between current social inclusion policies, measures, indicators and trends with the similar EU standards and practices. In addition, the article explores the potential benefits of the process of Europeanization for Macedonian social inclusion policy.     

The Child Under Five in Canberra

An outline is given of the changing attitude of the Australian community towards its responsibility for the care of young children vis á vis the rights of the parents. Canberra's various provisions for the day care of the under-fives is reviewed and the distinction is made between education facilities for the children and ‘child care’ for the benefit of the parents. Because there is no literature in the field of family day care—‘child minding’—a small survey was conducted. Data are presented covering the ages of the children, the composition of the minders' families, charges made, and the minders' and working mothers' attitudes towards the arrangements. In conclusion, some indication is given as to desirable standards for both day care and group care, and suggestions are made about areas for which community responsibility should be taken in the future.     

生态补偿与横向财政转移支付的理论与对策研究

过去的分税制改革确立的财政转移支付制度不能适应人口、资源、环境的协调发展,探讨适应限制类和禁止类主体功能区建设所需的基于生态补偿的横向财政转移支付制度设计,认为应该根据这两类区域进行生态保护建设的直接成本和放弃发展经济的机会成本,以及受益区域的支付意愿来共同确定横向财政转移支付的规模,最后提出了改革现有以纵向为主的财政转移支付体系,逐渐完善以生态补偿为主的横向财政转移支付制度的政策建议。     

The twin deficit hypothesis in Egypt

We employ a new approach to the twin deficit hypothesis aimed at enhancing policy making in Egypt. In contrast to the conventional twin deficit hypothesis between the current account, which comprises many items out of governments’ scope of maneuvering, and the budget deficit, we track the causal link between Egypt’s merchandise trade deficit and the budget deficit. We begin first by examining the conventional twin deficit hypothesis using a VAR model, which implies short run reverse causation running from the current account deficit to the budget deficit. Second, as cointegration exists between the budget deficit and the merchandise trade deficit, we run a multivariate VECM model which refutes the twin deficit hypothesis in favor of the current account targeting hypothesis. In policy terms, ameliorating Egypt’s trade balance would ultimately improve its fiscal balance as well.