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卫生区域:实现正确治理.pdf

上传人: Fl****zo 编号:724400 2025-07-01 9页 1.08MB

1、Health Regions:Getting governance rightA case study of the design and implementation of new decentralised health regions in Ireland,2018-2023Prof Sara Burke,Dr Carlos Bruen,Dr Sarah Parker,Dr Rikke Siersbaek,Luisne Mac Conghail&Dr Katharine SchulmannHealth Summit Croke Park 6 February 2025 Trinity C

2、ollege Dublin,The University of DublinKey reform context&component:Decentralised Health RegionsContextMixed,fragmented system of public-private financing and deliveryOnly European country without universal healthcare systemSlintecare 10-year programme of healthcare reform in 2018 overarching aim of

3、universal healthcareRationale for decentralising health services to six regions:i.Integration of careii.Clinical Governanceiii.Corporate Governance and Accountabilityiv.Population-Based Approach to Service PlanningTrinity College Dublin,The University of DublinDraws on research we did in 2003To use

4、governance of the design and implementation of the regions as focus of our policy analysis To inform design and implementation of the Health Regions To shed light on broader Slintecare reforms through a governance lensTo contribute to international academic research on centralisation/decentralisatio

5、n3Trinity College Dublin,The University of DublinMethodology Qualitative multi-method approach to explore how aspects of governance have shaped the design and implementation of theHSE Health Regions(2018-2023)Two methods employed,enabling the triangulation of information:1.Document analysis:Systemat

6、ic examination of policy documents,government reports,white papers,and official statements between 2018 and 20232.Key informant interviews:12 semi-structured interviews conducted with policymakers and health system leaders between Nov 2022 and Aug 2023 Thematic analysis of data,applying deductive/in

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本文研究了爱尔兰2018-2023年新分散卫生区域的设计和实施情况。关键点如下: 1. 背景:爱尔兰拥有混合、碎片化的公私融资和医疗服务体系,缺乏全民健康保险制度,2018年开始实施为期10年的Sláintecare医疗改革计划。 2. 改革理由:将卫生服务分散到六个区域,以实现医疗服务整合、临床治理、企业治理和问责制以及基于人口的医疗服务规划。 3. 研究方法:采用定性的多方法研究,包括文件分析和关键信息访谈。 4. 治理框架:使用TAPIC治理框架,包含透明度、问责、参与、诚信和能力的五个维度。 - 设计和实施卫生区域的情况对非直接参与政策设计的利益相关者不明确。 - 问责方面存在缺陷,缺乏对高级领导决策的奖励/惩罚机制。 - 利益相关者参与度低,咨询过程流于形式。 - 角色和责任分配不清晰,存在政策实施过程中的模糊地带。 - 政策制定能力充足,但实施能力和所需资源不足。 结论:卫生区域设计和实施过程中的治理存在跨五个相互关联的TAPIC领域的缺陷,需要加强信任和沟通,明确区域职责,为实施改革提供足够资源和能力。
"爱尔兰医疗改革亮点有哪些?" "如何衡量区域医疗治理成效?" "医疗改革中的治理挑战是什么?"
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