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1、HEALTH CARE REFORMObamas health care reformEverybody should have some basic security when it comes to their health care. Barack Obama Purpose nThe plan will permit millions more to receive free coverage through the Medicaid program for the poor nThe plan aims to make health insurance available to th
2、irty-two million people now without it. nThe plan is expected to raise the insurance coverage to ninety-five percent within several years. Effect of the Health care Reform nIt will make health care more affordablenIt sets up a new competitive health insurance market nIt brings greater accountability
3、 to health carenIt will end discriminationnIt puts our budget and economy on a more stable path Health care 2021 nHealth-care overhaul is up against long campaign across U.S.nEfforts to block a key provision of the new health-care overhaul law are underway in 33 statesPeoples Suggestions & Comments
4、nGovernment should provide health insurance nThe major advantage of this system nGovernment would pay for the insurance nThe other enhancements nWhats the big idea and benefit here ?Health care reform in our countryREPORT ON THE WORK OF THE GOVERNMENT Wen JiabaoProgress In Healthcare Reform in 2021n
5、government spent 127.7 millions on healthcare, an increase of 49.5% nmedical insurance covered 401 million residents nRural medical care reached 8.3million peoplenallocated 42.9 billion yuan for retired workers ndrug system has been implemented in 30% of health care institutions Aim in 2021nmedical
6、insurance rise to 120 yuan per person per year , up 50% over last year ngive 60% of community medical institutions high priority to the use of basic drugs. nraise the quality of service; control medical costs; and improve relations between medical service providers and consumers. Health care systems
7、 are designed to meet the health care needs of target populations. There are a wide variety of health care systems around the world. In some countries, the health care system planning is distributed among market participants, whereas in others planning is made more centrally among governments, trade
8、 unions, charities, religious, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has often been evolutionary rather than revolutionary. What is health care system? the Goals for health system Good healthResponsi
9、veness to the expectations of the populationFair financial contribution.QualityEfficiency Acceptability on one dimension and equity on anotherthe World Health Report 2000 - Health systems: improving performance (WHO, 2000),Duckett (2004) proposed a two dimensional approach to evaluation of health ca
10、re systemsThere are generally five primary methods of funding health care systems:1.direct or out-of-pocket payments 2.general taxation to the state, county or municipality3.social health insurance4.voluntary or private health insurance5.donations or community health insurance.Financing Primary care
11、 Health care was provided in both rural and urban areas through a three-tiered system. The first tier was made up of barefoot doctors working out of village medical centers. At the next level were the township health centers, which functioned primarily as out-patient clinics for about 10,000 to 30,0
12、00 people each. Only the most seriously ill patients were referred to the third and final tier, the county hospitals, which served 200,000 to 600,000 people each and were staffed by senior doctors who held degrees from 5-year medical schools. Health care in urban areas was provided by paramedical pe
13、rsonnel assigned to factories and neighborhood health stations. Public health is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents
14、 (for instance, in the case of a pandemic). Public health is typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral, and occupational health are also important subfields.A child being immunized against polio.What is public health?Management u Vaccin
15、ation policyu Diabetesu HIV/AIDSu Antibiotic resistanceHealth Care in Health Care in ChinaChinaCHINAS PRESENT HEALTH STATUS: FINANCING CHINAS HEALTH SYSTEM: CHINAS PRESENT HEALTH STATUS: China is the most populous nation in the world with a population of approximately 1.33 billion people. The provin
16、ces, which possess a high degree of fiscal independence, are themselves divided into 2182 counties (averaging 400,000 residents), 47,000 townships (averaging 18,000 residents) and 740,000 villages (averaging 1000 residents). The urban population has grown substantially since the 1960s.Population:The
17、 expansion and dynamic, productivity-driven growth of capitalist production in the most industrialized nations has been driven, in part, by the edpimemiological transition from infectious to chronic and degenerative diseases as the major cause of death. This has been critically important in construc
18、ting an economic arrangement based on large-scale cooperation of workers. In China, eighty percent of the population live in areas where this epidemiological transition has already occurred. Nevertheless, there is still a high prevalence of infectious disease in poor rural and urban areas in China,
19、creating an obstacle in the further expansion of large-scale capitalist development (which the pragmatist right leadership in China associates with modernization). The health status of this 15% of the total population is similar to that of the least developed nations.The health statusFINANCING CHINA
20、S HEALTH SYSTEM: Medical services at state expense公费医疗 or Government Employee Health Insurance政府雇员的健康保险), provides coverage for government workers at all political divisional levels (central, provincial, county, township, and village), including officials of labor unions, youths and womens leagues,
21、the staff of cultural, educational, health and research institutes and students at approved colleges and universities. The government is solely responsible for the financing of this system. Health services are mainly provided by public hospitals, but larger organizations with more than 200 employees
22、 usually set up their own clinics. The beneficiaries of medical services at state expense are required to seek health services at appointed hospitals of the organization, and the charge for the services is reimbursed by the medical services at state expense based on the government fee schedule. Medi
23、cal services at state expense公费医疗公费医疗Labor Health Insurance Labor Health Insurance, is a system under which employees in state and collective enterprises and their immediate family members are entitled to full (for the employees themselves) or partial (for immediate family members) benefits. Governm
24、ent mandates that the state enterprises with more than 100 employees must provide labor health insurance Payment is made mainly out of welfare funds of enterprises, a portion of which are designated for medical services. Most large enterprises with more than 1000 employees organize their own hospita
25、ls (inside hospitals) and most medium size enterprises (200-1000 employees) have their own clinics for providing free outpatient services to their employees &Order of the State Council Measures of Shanghai Municipality on the Basic Medical Insurance for Urban Employees Laws and regulations: the rura
26、l cooperative medical system (RCMS)(农村合作医疗制度) The accomplishments of this system were internationally regarded as an unprecedented feat in the creation of a nationwide medical system which effectively met the basic health care needs of the general population, including the widespread use of what is
27、now called preventative medicine, while simultaneously taking major steps toward the eradication of major infectious diseases. private medical insurance private health insurance companies enter into contracts with individuals who exchange premium payments for clearly delineated health coverage, beca
28、use at present this remains relatively rare. There is a negligible segment of the population that is covered by private medical insurance. However, such private insurance systems are a relatively new concept in China and there is some indication that the current pragmatic rightist leadership would f
29、avor seeing this sector expand. Doctoring salesnPharmaceuticals 制药is one of the most profitable industries in north America. But do the drugs industrys sales and marketing strategies go too far?nA recent study analyzed the providers who treat Medicare beneficiaries老年医保受惠人. The startling finding was
30、that the average Medicare patient saw a total of seven doctorstwo primary care physicians and five specialistsin a given year. Contrary to popular belief, the more physicians taking care of you dont guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in
31、cost and medical errors.How did we let primary care slip so far? The key is how doctors are paid. nMost physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better hes reimbursed (返还费用). Moreover, the amount a physician receive
32、s leans heavily toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patients disease. Combine this fact with annual government threats to indiscriminately
33、cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.nWho is responsible for the increase in promotionsDoctors ?or medicine industry?nsalespeople work in an industry highly criticize for its sales and marking practices, but they must make a living.nBusines
34、s would not use strategies that do not work.Answer:nThe industry should pay the most responsibility.Who really pays doctors free gifts ? patients are the ones who payThe positive side of drugs promotion?nSales people provide much needed information and education to physicians.nThey deliver are prima
35、ry sources of drug education for healthcare givers.How do we fix this problem?nIt starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally (最正确地) managing their diseases and practicin
36、g evidence-based medicine. nMake primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.World Health Organizationna specialized agency of th
37、e United Nations (UN) that acts as a coordinating authority on international public health. nEstablished on 7 April 1948, nheadquartered in Geneva, Switzerland, WHO in ChinanThe World Health Organization (WHO) Constitution came into force on April 7, 1948, and China has been a Member since the begin
38、ning.The staff of the WHO Office in China are working with their national counterparts in the following areas:nHealthcare systems development nImmunization nTuberculosis control nHIV/AIDS control nMaternal health and child health nInjury prevention nAvian influenza control nFood safety nTobacco cont
39、rol nNon-communicable diseases control nEnvironment and health nCommunicable diseases surveillance and response Tuberculosis in ChinanTuberculosis is a major public health problem in China, which has the worlds second largest tuberculosis epidemic (after India). Progress in tuberculosis control was
40、slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. Prevalent smoking aggravates its
41、 spread.In China,nthe number 1 cause of death n one of Chinas major public health problems.Control and prevention Tuberculosis control before SARS Efforts to control tuberculosis after SARS 2021-2021 program 2021-2021 programannouned on 1 April 2021, use innovative technologies to improve the detect
42、ion and treatment of tuberculosis (TB) in China. Cutting edge diagnostic tests, drug regimens that reduce the number of pills a patient needs to takeinnovative ways of ensuring patients take their drugs implemented in five designated provinces and one municipalityHIV and AIDSnAcquired immune deficie
43、ncy syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV)Transmission nAnalnvaginal noral sexnblood transfusionncontaminated hypodermic needlesnexchange between mother and baby during pregnancy, childbirth, brea
44、stfeeding nother exposure to one of the above bodily fluids. HIV/AIDS in the Peoples Republic of Chinathe infection rate (incidence) has been rising sharply, in 2021, Chinas leading cause of death among infectious diseases. impact the economies of both China and the world as a whole.Changes in gover
45、nmentIn 2003Panel: Chinese government Four Free and One Care policy for AIDS controlnFree：antiretroviral drugs to AIDS patients who are rural residents or people without insurance living in urban areas.nFree：voluntary counselling and testing.nFree：drugs to HIV-infected pregnant women to prevent moth
46、er-to-child transmission, and HIV testing of newborn babies.nFree：schooling for AIDS orphans.nCare：and economic assistance to the households of people living with HIV/AIDS. In March 2006the AIDS Prevention and Control RegulationsIn February 2021 HIV/AIDS was the leading cause of death in 2021, compa
47、red with other infectious diseases and thought to be the first time this has happened. High risk groups Sex workers/prostitutes Homosexual/bisexual men Intravenous drug users Migrant workers Blood donors Healthcare workers. Hepatitis B in ChinaHepatitis B is endemic in China.Of the 350 million indiv
48、iduals worldwide infected with the hepatitis B virus (HBV), one-third reside in China.As of 2006 China has immunized 11.1 million children in its poorest provinces as part of several programs initiated by the Chinese government and as part of the Global Alliance for Vaccines and Immunization (GAVI).
49、 nTransmissionnThe reason for this increased HBV infection is unknown, because hepatitis B has no clear transmission routes in many people in China, although both neonatal infection and horizontal transmission during early childhood are still the most common routes.Social impactDiscriminationnHepatitis B sufferers in China frequently face discrimination in all aspects of life and work.In the Hepatitis B Camp In the Hepatitis B Camp is a popular website for hepatitis B carriers human rights in China.
