健康管理外文翻譯 本科畢業(yè)論文(設(shè)計(jì))外文翻譯 題 目 a企業(yè)員工健康管理問題分析及對(duì)策研究學(xué) 院商學(xué)院 專 業(yè)人力資源管理 班 級(jí) 學(xué) 號(hào) 學(xué)生姓名 指導(dǎo)教師 外文題目health management 外文出處 encyclopedia of public health,200805:p618-625 外文作者 wolfgang bocking and diana trojanus原文: health management introduction while health policy focuses on defining health goals and creating the surroundings of a?desired health system, health management focuses on achieving those goals. since there is a?broad variety of health goals which are partly competing against each other, such as reducing cost while improving the quality of health, health management deals primarily with the allocation of limited resources towards health oriented goals. the variety of actors and goals in health care systems leads to a?variety of health management practices being applied. health management can further be defined as a?systematic approach to optimize organization and processes in order to achieve predefined health related goals patients one of the primary targets of health management is to improve public health for individuals patients within a?health system. this target includes, amongst various other targets, the improvement of a?health?induced quality of life and a?growing life expectancy. while life expectancy is easy to measure, it is much more difficult to measure the improvement in the quality of life. various approaches have been made to find a?method of measuring the quality of life. however, no comprehensive system has been established on a?global basis that has been consistently used by countries to manage the outcome of health care on a?comparable basis besides setting goals for health care and health insurance providers, and besides being a?major source of funding for most health systems, patients also have significant control over health?related factors themselves. these areas can be categorized into preventative actions and compliance, which can have a?strong impact on a?patients health status. in the preventative actions area, various measures of caution and healthy life-style can be maintained i.?e. not smoking, exercising regularly, health?oriented diets in order to manage ones personal health risk better. compliance refers to how closely a?patient follows instructions during and after a?treatment or surgery. various studies have shown that a?lack of compliance, especially in the area of medication, can have a?high impact on the recovery rate of a?patient. in this sense, patients play a?role in their own health management which is not neglectable but at present, only few health care systems educate their patients and apply incentives accordingly. besides informing people about their ability to influence their health directly, a?number of incentives could be institutionalized, such as health insurance tariffs that are linked to a?persons manageable risks as opposed to non manageable, chronic disease risks, such as allergies instead, there are multi-layered conflicts that exist between patients and health insurance companies. on the one hand, health insurance companies need patients as customers to raise money for the insurance claims. in that regard, insurance companies need to appeal to the interest of the patients. on the other hand, those patients, i.?e. customers, expect reimbursement for their insurance claims. they expect the payers to offer a?wide variety of options for health coverage according to their individual needs. the payers, however, need to keep payments low, or they will face an increase in overall expenses, which leads to higher tariffs and, therefore, most likely fewer customers in the future. ideally, payers want the patients to seek only needed care, follow providers instructions, and recover quickly. if restrictions become too tight though, a?patient may choose to change insurance providers the mentioned conflicts between patients and insurance companies are only an example of possible conflicts between patients and other stakeholders in a?health care system. this demonstrates that health management has to deal constantly with opposing stakeholder goals and patient goals, although the overall goal remains the achievement of the best health outcome for the individual patient within the financial and organizational restrictions of the health care system health insurance health insurance companies are important stakeholders in the health management context as they are responsible for the payment of health services for individuals in case of sickness or injury. in countries with well developed health care systems there are three forms of health care financing: 1.tax-based health care system, in which individuals contribute to the provision of health services through taxes that are typically pooled across the whole population. the government is in charge of the provision of health care services, usually from a?mix of public and private providers and allocates the existing resources to the different areas of health care. examples of health care systems mainly based on taxation are the united kingdom, ireland, spain and portugal, denmark, sweden and finland.2.social health insurance system, in which contributions from workers, the self-employed, enterprises and the government are pooled into a?single or multiple sickness fund on a?compulsory basis. these so-called statutory sickness funds are either directed by the government or independent non-profit organizations. they typically contract with a?mix of public and private providers for the provision of a?well defined health care benefit package. examples of countries with a?social health insurance system are germany, france, the netherlands and belgium.3.private health insurance system, in which premiums are paid directly by individuals, employers or associations to insurance companies pooling risks across their membership base. private health insurance can be a?complete substitute for social insurance; typicall of a?market-based system such as the us. it can also supplement an existing social insurance system as is the case in france, belgium and the netherlands. private health insurance systems are, in general, voluntary in contrast to social insurance systems that tend to be compulsory. however, in some countries, private insurance may also be compulsory for certain segments of the population. regardless of the specific form of health insurance, all face financial constraints due to medical progress and improvements in technology, expansion of coverage by public health systems and aging populations in the industrial world with higher levels of chronic diseases and disability. however, the funding for the upward spiral of medical expenses is in all health care systems limited: in tax-based health care systems governments are unable to continuously raise taxes. in social insurance based systems the compulsory contribution has to remain bearable for employees and employers. private insurance models depend on individual willingness to spend money on health care, especially if the private insurance comes as a?supplement to compulsory social insurance e.?g. france in this context health insurers are obliged to take measures affecting the balance of demand and supply aiming to reduce medical expenses if a?growth in the contribution rate should become unbearable for the insured demand side measures: the benefit package is restricted by the health insurance. patients are asked for co-payments that may concern drugs, dentistry charges, spectacles and charges for visits to doctors. health insurance improves the cost?awareness of their members by giving incentives not to consume health care e.?g. premium rewards. supply side measures: health insurance sets budgets for hospitals and doctors under direct contract. implementation of disease management programs disease management programs to improve care for chronically ill people while reducing costs through an automatic and streamlined care process. even if a?growing insurance premium is not only in the interest of the health insurer but also in the interest of the patients, who are mostly contributors as well, there are still conflicts between patients and payers of health care that influence health management practices. on the one hand, patients expect payers to offer a?wide variety of options for health coverage that can be customized to their specific needs. on the other hand, payers want to maintain or lower their cost contribution. they want the patient to seek only needed care, follow providers instructions, and recover quickly. patients should also seek to reduce their health risk behaviors through, for example, diet, exercise and smoking cessation government the government plays an important role in health management as it mainly acts as a?decision maker to set the rules for the functioning of a?health care system that fulfills the values and health policy ideals of the country. within the regulatory framework the government may regulate volume and quality of the health care services, is responsible for legislation on health care financing, corporate negotiations, major professional regulations and public health measures such as prevention and health promotion. the government administration of health e.?g. ministry of health formulates and administers the government policy in health, sets standards for the regulation and licensing of health care providers as well as for medical personnel in hospitals. other governmental agencies that set public health standards are the food and drug regulation agencies and agencies regulating occupational health and safety in the workplace in most countries with well developed health care systems the government is in charge of a?number of public health services which are focused on the health status of the whole population. public health programs are typically provided by the ministry of health or other government agencies in order to promote, protect and improve public health. programs encompass disease prevention measures, health education, immunization programs, control of communicable diseases, sanitary measures, and protection against environmental hazards in countries like the uk with a?national health service nhs, the government acts not only as a?decision maker and provider of public health services but also as a?payer and provider of individual health care services health management worldwide in 1998, many countries took a?greater interest in improvement of health management, considering better management of their national health systems to be among their major needs and priorities. during this year, who representatives offices in 16 countries managed who technical cooperation at country level and provided policy support to ministries of health on various aspects of health. desk officers at the regional office continued to provide support for countries without who representatives offices. in addition to serving as an interlocutor and focal point for contacts between who and its countries, the who representatives play an important role in the implementation of the global health policy strategy health for all, liaising with other un agencies as well as bilateral donors and non?governmental organizations. the increasing reliance in recent years on extra?budgetary sources of income due to a?combination of higher demands on who and lower regular budget resources in real terms underline the importance of the who representatives role in resource mobilization. every effort is being made to make use of recent technological advances to establish communication links between who headquarters, its regional offices and country offices as well as countries to permit an efficient flow of information between all parties in most developing countries, health services are weak due to a?lack of responsibility in the government, a?lack of investment in health infrastructure to deliver health services as well as poor training and career structures for medical professionals. in order to respond adequately to national and regional expectations, needs and priorities, great efforts are being made by the regional office to provide necessary support to countries in the development and improvement of health management in the regions. this has been done through a?variety of approaches including contractual services agreements, fellowships, national training activities, consultancy services and regional consultations, particularly on developing and expanding the use of the district team problem?solving dtps technique regional office experts are regularly developing guidelines for restructuring the national health system, proposing possible reasons for restructuring, as well as mechanisms of restructuring, and the resources required to be made available for this process. the regional office collaborates with the ministries of health and develops a?quality management training center for the countries they are in charge of. the center, which enjoys full support from policy?makers, is an innovative strategy to improve the quality of health care and health status through quality orientation, health system development and managerial capacity?building. the center focuses on the core health processes, problem solving and team work. the 12-month modular training program is action?oriented and product?oriented and follows a?learning-by-doing approach designed to build on the knowledge and experience of the trainees the regional office continued its support to a?number of countries in strengthening their planning capabilities at central and district levels. efforts were made to promote strategic planning in ministries of health and to disseminate who literature on health futures. support was provided through who collaborative programs to the national institutes of health management encyclopedia of public health,200805:p618-625譯文:健康管理 前言 健康政策集中在規(guī)定健康目標(biāo)和發(fā)覺周圍對(duì)健康體系的期望,健康管理就集中在實(shí)現(xiàn)這些目標(biāo)上。健康目標(biāo)是非常廣泛的,在這些目標(biāo)中部分目標(biāo)是完全對(duì)立的,就像減少支出要提高健康質(zhì)量之間的對(duì)立,健康管理首先解決的是分配有限的資源來實(shí)現(xiàn)以健康為目的的目標(biāo)。 在健康福利系統(tǒng)中多種多樣的因素和目標(biāo)導(dǎo)致了在健康管理中實(shí)施多種措施。健康管理可以進(jìn)一步被定義為用系統(tǒng)的方法來完善組織和程序來實(shí)現(xiàn)與健康相關(guān)的預(yù)定義目標(biāo)。 患者 健康管理的初級(jí)目標(biāo)之一就是通過健康系統(tǒng)提高患者的公共健康。這個(gè)目標(biāo)包括了幾乎其他所有的目標(biāo),健康的改善?包括生活質(zhì)量的提高和平均壽命的延長。平均壽命的測量比較容易,而對(duì)生活質(zhì)量是否提高的測量則比較困難。然而,還沒有建立一種全世界的國家都可以使用的一致的綜合性系統(tǒng)在可比較的基礎(chǔ)上來衡量健康福利的效果。 除了為健康福利和健康保險(xiǎn)的提供者建立目標(biāo),除了是健康系統(tǒng)資金主要來源,患者自身也在控制與健康相關(guān)的因素上起著重要的作用。這些因素可被劃分為提前預(yù)防的和順從的,這些因素對(duì)患者的健康狀況有的重要的影響。在提前預(yù)防因素方面,包含 了許多關(guān)于告誡和健康生活方式的方法(例如,戒煙,規(guī)律性的鍛煉,健康規(guī)律的飲食)以便于更好的進(jìn)行健康風(fēng)險(xiǎn)管理。(健康風(fēng)險(xiǎn)管理:針對(duì)人群各個(gè)健康狀態(tài)的風(fēng)險(xiǎn)因素,以及發(fā)病率高、危害大,且醫(yī)療費(fèi)用較大的一些慢性非傳染性疾病進(jìn)行風(fēng)險(xiǎn)評(píng)估及干預(yù),以期維持或改善人群的健康水平,降低慢性非傳染性疾病的發(fā)生率、惡化率和并發(fā)癥發(fā)生率,并合理控制人群醫(yī)療費(fèi)用維持在適度范圍。相對(duì)于一般所說的健康管理,健康風(fēng)險(xiǎn)管理更強(qiáng)調(diào)群體健康的整體提升。)服從指的是在治療或者外科手術(shù)之后患者完全的按說明書進(jìn)行治療。很多研究表明缺少服從,尤其是在藥物治療方面,會(huì)嚴(yán)重影響患者的恢復(fù)率。在這種意義上說,患者在他們自己的健康管理中扮演了不可忽視的角色。但是目前,只有少數(shù)的健康福利系統(tǒng)對(duì)他們的患者進(jìn)行相應(yīng)的培養(yǎng)和使用鼓勵(lì)。出了告訴人們他們對(duì)自身健康的直接的影響能力,部分鼓勵(lì)是可以制度化的,例如健康保險(xiǎn)價(jià)目表就聯(lián)系這個(gè)人的可控風(fēng)險(xiǎn)(相對(duì)于不可控制的,慢性的疾病風(fēng)險(xiǎn),如過敏)。 然而,在患者和健康保險(xiǎn)公司之間存在著多層次的沖突。一方面,健康保險(xiǎn)公司需要患者作為消費(fèi)者為保險(xiǎn)賠款籌集資金。在這個(gè)意義上,保險(xiǎn)公司需要引起患者的興趣。另一方面,這些患者,或者說是消費(fèi)者,希望保險(xiǎn)公司報(bào)銷他們的保險(xiǎn)賠款。他們希望付款人根據(jù)患者的個(gè)人需要提供多種多樣的關(guān)于健康保險(xiǎn)項(xiàng)目的選擇。然而付款者要盡量保持付款低,否則他們將面臨總費(fèi)用的增長,這可能導(dǎo)致更高的收費(fèi),因而可能導(dǎo)致在未來消費(fèi)者的減少。理論上,付款者希望患者只尋找他們需要的福利,在提供者的指導(dǎo)下更快的恢復(fù)。如果約束變得太嚴(yán)格,患者就可能選擇變換保險(xiǎn)提供者。 前面提到的關(guān)于患者和保險(xiǎn)公司之間的沖突只是在健康管理系統(tǒng)中患者和其他利益相關(guān)這之間可能存在的例子。這證明了健康管理必須要不斷地解決利益相關(guān)者和患者相反的目標(biāo),盡管總的目標(biāo)是在健康福利系統(tǒng)的財(cái)政和組織性的限制下實(shí)現(xiàn)最好的個(gè)人健康結(jié)果。 健康保險(xiǎn) 在健康管理中健康保險(xiǎn)公司是重要的利益相關(guān)者由于他們?cè)趥€(gè)人發(fā)生疾病或受傷時(shí)負(fù)責(zé)提供賠款服務(wù)。在健康福利系統(tǒng)比較完善的國家有三種健康福利融資方式: 以稅收為基礎(chǔ)的健康福利系統(tǒng),個(gè)人通過納稅成為了健康服務(wù)資金的主要提供者這也是一種全民合伙方式。政府負(fù)責(zé)提供健康福利服務(wù),通常混合公共的和私營的提供者,將現(xiàn)有的資源分配到健康福利的不同領(lǐng)域。健康福利基于稅收的國家有英國,愛爾蘭,西班牙和葡萄牙,丹麥,瑞典和芬蘭。 社會(huì)健康保險(xiǎn)體系,資金貢獻(xiàn)主要來源于在強(qiáng)制的基礎(chǔ)上工人,個(gè)體經(jīng)營者,公司和政府的合伙形成單一的或者復(fù)雜的疾病基金。這些所謂的法定疾病基金不是受政府指導(dǎo)就是依賴于非營利性組織。這種典型的將公共和私營的提供者提供的資金混合起來的方式被定義為健康福利利益包。實(shí)行社會(huì)保險(xiǎn)系統(tǒng)的國家有德國,法國,荷蘭和比利時(shí)。 私營的健康保險(xiǎn)系統(tǒng),保險(xiǎn)費(fèi)直接由個(gè)人雇傭者或者保險(xiǎn)公司的協(xié)會(huì)在會(huì)員關(guān)系的基礎(chǔ)上共同集資。私營健康保險(xiǎn)完全是社會(huì)保險(xiǎn)的代理人,美國是典型的以市場為基礎(chǔ)的保險(xiǎn)體系。私營健康保險(xiǎn)系統(tǒng)也可以蒲沖現(xiàn)存的社會(huì)保險(xiǎn)體系的不足如法國,比利時(shí)和荷蘭。私營健康保險(xiǎn)系統(tǒng),一般來說,和日漸趨于強(qiáng)制的社會(huì)保險(xiǎn)來比是自愿的。然而,在一些國家,私營健康保險(xiǎn)對(duì)某些部分群體仍然是強(qiáng)制的。 不管健康保險(xiǎn)的特殊形式,所有的健康保險(xiǎn)都受到財(cái)政的約束,由于治療在技術(shù)方面的進(jìn)步和提高,公共健康系統(tǒng)覆蓋范圍的擴(kuò)大以及在工業(yè)化國家慢性病和殘疾的數(shù)量不斷劇增。然而,醫(yī)藥費(fèi)用不斷的上升在所有系統(tǒng)中都受到限制:在以稅收為基礎(chǔ)的健康福利體系中,政府不可能持續(xù)提高稅收。在社會(huì)保險(xiǎn)體系中強(qiáng)制的集資必須在雇傭者和受雇者能承受的范圍之內(nèi)。私營保險(xiǎn)依賴于個(gè)人對(duì)健康福利的花費(fèi)意愿,尤其是黨私營保險(xiǎn)成為強(qiáng)制社會(huì)保險(xiǎn)的補(bǔ)充時(shí)(如法國)。 這種情形迫使健康承保人采取措施來以減少醫(yī)藥費(fèi)為目標(biāo)的供給和需求,如果保險(xiǎn)費(fèi)率不斷提高可能