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Background To explore the key factors affecting prescription practices of essential medicines in Chinese county hospital. National essential medicine policy (NEMP) plays important roles in health care system, especially in developing countries. As a fundamental component in the Chinese health system reform, NEMP was implemented in primary health care institutions during the first stage of reform. As it is rolled out, priority usage and zero-mark-up policy of essential medicines are to be applied in every government-run healthcare institution. However, the intention and influence factors of physicians on priority selecting essential medicine remains unclear. Methods Based on the theory of planned behavior, a cross-sectional questionnaire survey was conducted to analyze physicians’ intention, attitude, subjective norms (SNs) and perceived behavioral control (PBC) on prescrictions and their actual behavior on selection of essential medicines. Results Two hundred eighty-two physicians participated in the structural questionnaire interview. The final structural equation model reflected influencing factors affecting physicians’ prescribing behavior (χ2/df = 1.32, GFI = 0.99, IFI = 0.99). Structural equation model analysis showed that attitude, other influencers and institutional environment, and PBC significantly affected behavioral intention. However, the control extent of cognition behavior of physicians prescribing had no significant positive effect on the priority usage of essential medicines. Conclusion Investigation results demonstrate physicians are unaware of NEMP design and implementation plans. To help enhance rational use of essential medicines we suggest educating physicians on the value of NEMP, and integrating the drug shortage report into the essential medicine (EM) bidding system seamless communication with pharmaceutical manufacturers’ credit information system.

The article is aimed at studying the main barriers to introduction of the electronic medical card for patient in Ukraine and the readiness of the population to use it. To achieve this goal, the results of a telephone survey of patients at a private medical center in Kharkiv are analyzed. It is defined that a personal medical electronic card is an electronic, life-long resource of health information supported by private persons. Personal medical electronic records that are used or being developed in the world today support a multitude of different functions. To conduct the research on the basis of collection of primary data from the center’s patients’ questionnaire was created a random list of patients, which included both citizens of Ukraine and foreigners who were permanently or short-term present in our country. The study focuses on the reasons for the lack of registration and the identification of benefits of the patient portal for visitors at the studied center. Information about the characteristics of the survey participants - patients of the medical center is provided. Based on the analysis of the responses received, the main reasons that prevented the clients of the medical center to register through the electronic portal are allocated. On the results of the study the main barriers in the perception of the patient’s e-card are identified and analyzed; the results of a telephone survey of patients about registration through the electronic portal are described.

Особливо слід відзначити загальну тенденцію до зниження рівня престижності професії медика в українському соціумі. Це вказує на необхідність розробки заходів, спрямованих на формування позитивної громадської думки щодо важливості та корисності професії медика у суспільстві. Of particular note is the general tendency to reduce the prestige of the medical profession in the Ukrainian society. This indicates the need to develop measures aimed at forming a positive public opinion on the importance and usefulness of the profession of a physician in society.

Cases of next-of-kin veto, i.e., a family refusal to allow organs harvest contrary to donor wishes or when the law presumes consent, is a widespread practice that seriously harms thousands of people. This is a practice settled in many countries Family refusal to donate reduces an already shallow donor pool by approximately 43% in the Americas, 25% in Europe (37,3% in United Kingdom) and 54% in Asia. Some countries, such Argentina, France, Colombia and Wales, current reversed its policy on organ donations to a system that prevents next of kin to dishonoring the donor s wishes restricting the confirm donor status only with the National Donor Registry and unless evidence of their objection is produced. In part I we review the latest amended transplant legislation of those countries that are trying to change this scenario. In part II we question the most frequently cited arguments to uphold the next-of-kin veto right and the countries that successfully changed their legislation banning this practice to encourage organ donation. We conclude that it is imperative to change this practice because the harm caused by promoting the family veto is greater and more serious than the potential harm of not allowing it. Los casos de veto familiar a la donación de órganos es una práctica generalizada que perjudica seriamente a miles de personas. Esta es una práctica establecida en muchos países. La negativa de la familia a donar reduce en un 43% las donaciones bajas de los donantes en las Américas, un 25% en Europa (37,3% en el Reino Unido) y un 54% en Asia. Algunos países como Argentina, Francia, Colombia y Gales han intentado revertir su política de donación de órganos de modo de impedir que los parientes revoquen los deseos del donante. En la primera parte, revisamos las más recientes reformas legislativas de aquellos países que están tratando de cambiar este escenario. En la segunda parte cuestionamos los argumentos más citados para defender el derecho de veto de la familia. Concluimos que es imperativo cambiar esta práctica porque el daño causado por el veto familiar es mayor y más grave que el daño potencial de no permitirlo.

Досліджено еволюцію концептуальних засад державної політики України в галузі охорони здоров’я щодо регіонального аспекту розвитку медсестринства для пошуку шляхів удосконалення механізмів реалізації державної політики, направленої на реформування системи охорони здоров’я. Визначено етапи становлення системи охорони здоров’я в Україні та проаналізовано концептуальні засади основних документів державної політики в цій галузі щодо регіонального аспекту розвитку медсестринства., The evolution of conceptual framework for the state policy in the health care sector of Ukraine concerning the regional aspect of nursing development to find ways to improve the mechanisms for implementing government policies aimed at reforming the health care system is investigated. The stages of the healthcare system formation in Ukraine are defined and the conceptual basis of basic documents of the state policy in this area in regard to regional aspects of nursing development is analyzed.

Питання є досить актуальним. Недостатність фінансування, несвоєчасне надання першої медичної допомоги, формальність у підході до здійснення профілактики захворювання, проблеми з інфраструктурою – усе це призвело до високого рівня захворюваності.

日本の医療保障制度は,国民皆保険制度の下,すべての国民が公的医療保険に加入をする仕組みになっている。その理念は,すべての国民に等しく必要な医療を保障するという生存権保障のための諸政策の一環である。しかしながら,医療費抑制策と経済活性化を目標とする近年の医療制度改革によって,その理念は崩壊の危機にある。無保険者の増加や患者の自己負担の増加によって,経済的理由による医療欠乏者が増えている。その一方で,富裕層を対象とした自由診療による医療機関が増加をしている。すなわち,健康と生命の領域にも所得格差が反映するアメリカ型の医療制度へとなりつつある。国民の生命と健康を守るために健康権に基づく医療制度改革へと転換をするべきである。, Japan has a medical security system whereby the population is requested to enroll in some kind of public health insurance scheme. The idea is part of various policies to assure the entire population of the right to life through health security. However, the idea is in danger of collapse by the recent reform of the health care system, which aims at activating economy and reducing health care costs. As patients' own expenses rise, many people are getting uninsured and medically underserved due to financial reasons. Meanwhile, the number of hospitals giving wealthy people medical treatment not covered by insurance has increased. That is to say, the system is shifting to the U.S.A. model, which projects income differences on health and life. It should be converted into a model based on the right to health in order to protect life and health of the population., 12, KJ00005223129, P, 論説, Article

Неефективність системи охорони здоров’я незалежної України поряд з іншими згубними факторами спричинили глибоку демографічну кризу. В роботі здійснений детальний аналіз основних факторів, що впливають на різке скорочення чисельності населення – рівнів народжуваності та смертності. На основі виявлених основних ризиків смертності встановлено, що збільшення тривалості років життя взагалі та тривалості здорових років життя українців, а також суттєве зниження невиправдано високих показників смертності цілком може бути досягнуто організаційно-економічними реформами системи охорони здоров’я. Внаслідок позитивного досвіду реформування системи охорони здоров’я в країнах Східної Європи запропоновані напрямки розробки стратегічних планів та заходів з метою покращення суспільного здоров’я, а також ключові організаційно-економічні напрямки з профілактики та боротьби з неінфекційними захворюваннями в Україні для різних секторів реформування системи охорони здоров’я. Неэффективность системы здравоохранения независимой Украины наряду с другими губительными факторами стали причиной глубокого демографического кризиса. В работе изложен детальный анализ основных факторов, влияющих на резкое сокращение численности населения – уровней рождаемости и смертности. На основе выявленных основных рисков смертности установлено, что увеличение продолжительности лет жизни вообще и продолжительности здоровых лет жизни украинцев, а также существенное снижение неоправданно высоких показателей смертности вполне может быть достигнуто организационно- экономическими реформами системы здравоохранения. Вследствие позитивного опыта реформирования системы здравоохранения в странах Восточной Европы предложены направления разработки стратегических планов и мероприятий с целью улучшения общественного здоровья, а также ключевые организационно-экономические направления по профилактике и борьбе с неинфекционными заболеваниями в Украине для разных секторов реформирования системы здравоохранения. Not effective health care system of independent Ukraine along with other harmful factors lead to the deep demographic crisis. Authors analyse the fundamental factors, which influence the rapid reduction of population, namely the levels of birth rate and mortality. By identifying mortality risks, we found that increase of the life expectancy at birth, and health life expectancy, as well as significant reduction of unreasonably high mortality rate of Ukrainians, may be achieved by organizational and economic reforms of the health care system. Based on positive experience with reformation of the health care system in Western Europe, we suggest the ways to develop strategic roadmaps and measures in order to improve public health in general, and the key organizational and economic measures to prevent noninflectional diseases for the different sectors of the health care system reform in Ukraine.

This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the “Result Chain” logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio methods. Ultimately, the study established a set of indicators including four grade-1 indicators, 16 grade-2 indicators and 76 grade-3 indicators. The effects of the reforms increased year by year from 2009 to 2011 in Hubei Province. The health status of urban and rural populations and the accessibility, equity and quality of health services in Hubei Province were improved after the reforms. This sub-national case can be considered an example of a useful approach to the evaluation of the effects of health care system reform, one that could potentially be applied in other provinces or nationally.

This paper aims to evaluate the impact of 1998 Chinese health care reform on out-of-pocket expenditure and on saving. Existing evidence on the results achieved by this reform in terms of reduction of out-of-pocket medical expenditures is still mixed and contradictory, and very little is known about the impact of these measures on the consumption and saving behavior of the Chinese population. To shed more light on this issue we use data collected in 1995 and 2002 by the Chinese Household Income Project (CHIP). Contrary to previous evidence, our findings suggest that the effects of the reform have been more articulated and heterogeneous. In fact, we find that once properly accounting for income distribution and unobserved heterogeneity (potentially induced by health status), out-of-pocket medical expenses and saving rate are affected by the reform in a differentiated way. In particular, we find that out-of-pocket expenses decrease only for high income individuals with good health status and the saving rate increases only for low income individuals with good health status. This result is actually worrisome, as it suggests that the public health coverage after the reform provides financial protection only to individuals that are relatively better off (with good health status and/or high income).

During the last decades many European governments have introduced patient payments in their public health care system with the aim to improve efficiency of health care provision, contain overall health care expenditure, and also to generate additional resources. In Poland, since 1999 patients have met formal payment obligations when they use dental services. Though introduction of formal patient payments for primary care services, out-patient specialists’ services and hospital services has been discussed, such payments do not exist. Empirical evidence suggests that the successful implementation of patient payments, to a large extent, depends upon public acceptance and political consensus. The paper presents the results of study on attitudes towards formal patient payments for publicly financed health care services, among different groups of Polish health care system’s stakeholders (health care consumers, providers, insurers and policy makers). The data are collected via focus group discussions and in-depth interviews carried out in Poland in June–October 2009 as part of project ASSPRO CEE 2007. The results are used to out-line policy recommendations.

Purpose and Execution –The purpose of this paper is to seek feasible suggestions and recommendations to the Chinese medical device industry under the new current market situation—Chinese health care system reform. In order to achieve this aim, we will start with introducing the background of current status of related issues. The next part will be the preparation of further analysis, which contains the theory and descriptions of the health care system reform histories of China, Sweden, the USA and UK. We will consequent present the environmental potential influential aspects. The main discussion will take place around medical device market analysis, together with three representative company case studies. After identifying the opportunities and challenges of the industry, we will draw the conclusions which are the recommendations for Chinese health care industry and also some suggestions for the Chinese government. Design/Methodology/Approach – To explore these issues, besides literature reviews on market analysis (five forces, SWOT analysis), this paper applies generic competitive strategy, value-based service and service innovation as well. In addition, it also illustrates with 3 mini cases. We acquired both secondary data from related databases and primary data through questionnaires. Limitation – Due to the restricted access to the specific database, the acquired information is limited to analyze the paper. Furthermore, according to the fact that the data we obtained is mostly on the basis of the whole medical device industry and it is quite difficult to be classified into particular parts, we decided to limit our research to the medical device industry that caters to both medical equipments and disposable tools when doing the analysis. In addition, since the design of questionnaire includes open questions, the research quality is heavily dependent on the individual skills of the researcher. Findings – The new health care system reform will definitely boost the growth of medical device industry, but also create fiercer competition. Chinese Medical device companies need to enhance abilities of marketing, research and development, and aim at meeting customer needs to exploit new profit alternatives.