健康管理[文献翻译].doc

1、本科毕业论文（设计）外文翻译题目A企业员工健康管理问题分析及对策研究学院商学院专业人力资源管理班级学号学生姓名指导教师外文题目HEALTHMANAGEMENT外文出处ENCYCLOPEDIAOFPUBLICHEALTH,200805P618625外文作者WOLFGANGBOCKINGANDDIANATROJANUS原文HEALTHMANAGEMENTINTRODUCTIONWHILEHEALTHPOLICYFOCUSESONDEFININGHEALTHGOALSANDCREATINGTHESURROUNDINGSOFADESIREDHEALTHSYSTEM,HEALTHMANAGEMENTFO

2、CUSESONACHIEVINGTHOSEGOALSSINCETHEREISABROADVARIETYOFHEALTHGOALSWHICHAREPARTLYCOMPETINGAGAINSTEACHOTHER,SUCHASREDUCINGCOSTWHILEIMPROVINGTHEQUALITYOFHEALTH,HEALTHMANAGEMENTDEALSPRIMARILYWITHTHEALLOCATIONOFLIMITEDRESOURCESTOWARDSHEALTHORIENTEDGOALSTHEVARIETYOFACTORSANDGOALSINHEALTHCARESYSTEMSLEADSTOAV

3、ARIETYOFHEALTHMANAGEMENTPRACTICESBEINGAPPLIEDHEALTHMANAGEMENTCANFURTHERBEDEFINEDASASYSTEMATICAPPROACHTOOPTIMIZEORGANIZATIONANDPROCESSESINORDERTOACHIEVEPREDEFINEDHEALTHRELATEDGOALSPATIENTSONEOFTHEPRIMARYTARGETSOFHEALTHMANAGEMENTISTOIMPROVEPUBLICHEALTHFORINDIVIDUALSPATIENTSWITHINAHEALTHSYSTEMTHISTARGE

4、TINCLUDES,AMONGSTVARIOUSOTHERTARGETS,THEIMPROVEMENTOFAHEALTHINDUCEDQUALITYOFLIFEANDAGROWINGLIFEEXPECTANCYWHILELIFEEXPECTANCYISEASYTOMEASURE,ITISMUCHMOREDIFFICULTTOMEASURETHEIMPROVEMENTINTHEQUALITYOFLIFEVARIOUSAPPROACHESHAVEBEENMADETOFINDAMETHODOFMEASURINGTHEQUALITYOFLIFEHOWEVER,NOCOMPREHENSIVESYSTEM

5、HASBEENESTABLISHEDONAGLOBALBASISTHATHASBEENCONSISTENTLYUSEDBYCOUNTRIESTOMANAGETHEOUTCOMEOFHEALTHCAREONACOMPARABLEBASISBESIDESSETTINGGOALSFORHEALTHCAREANDHEALTHINSURANCEPROVIDERS,ANDBESIDESBEINGAMAJORSOURCEOFFUNDINGFORMOSTHEALTHSYSTEMS,PATIENTSALSOHAVESIGNIFICANTCONTROLOVERHEALTHRELATEDFACTORSTHEMSEL

6、VESTHESEAREASCANBECATEGORIZEDINTOPREVENTATIVEACTIONSANDCOMPLIANCE,WHICHCANHAVEASTRONGIMPACTONAPATIENTSHEALTHSTATUSINTHEPREVENTATIVEACTIONSAREA,VARIOUSMEASURESOFCAUTIONANDHEALTHYLIFESTYLECANBEMAINTAINEDIENOTSMOKING,EXERCISINGREGULARLY,HEALTHORIENTEDDIETSINORDERTOMANAGEONESPERSONALHEALTHRISKBETTERCOMP

7、LIANCEREFERSTOHOWCLOSELYAPATIENTFOLLOWSINSTRUCTIONSDURINGANDAFTERATREATMENTORSURGERYVARIOUSSTUDIESHAVESHOWNTHATALACKOFCOMPLIANCE,ESPECIALLYINTHEAREAOFMEDICATION,CANHAVEAHIGHIMPACTONTHERECOVERYRATEOFAPATIENTINTHISSENSE,PATIENTSPLAYAROLEINTHEIROWNHEALTHMANAGEMENTWHICHISNOTNEGLECTABLEBUTATPRESENT,ONLYF

8、EWHEALTHCARESYSTEMSEDUCATETHEIRPATIENTSANDAPPLYINCENTIVESACCORDINGLYBESIDESINFORMINGPEOPLEABOUTTHEIRABILITYTOINFLUENCETHEIRHEALTHDIRECTLY,ANUMBEROFINCENTIVESCOULDBEINSTITUTIONALIZED,SUCHASHEALTHINSURANCETARIFFSTHATARELINKEDTOAPERSONSMANAGEABLERISKSASOPPOSEDTONONMANAGEABLE,CHRONICDISEASERISKS,SUCHASA

9、LLERGIESINSTEAD,THEREAREMULTILAYEREDCONFLICTSTHATEXISTBETWEENPATIENTSANDHEALTHINSURANCECOMPANIESONTHEONEHAND,HEALTHINSURANCECOMPANIESNEEDPATIENTSASCUSTOMERSTORAISEMONEYFORTHEINSURANCECLAIMSINTHATREGARD,INSURANCECOMPANIESNEEDTOAPPEALTOTHEINTERESTOFTHEPATIENTSONTHEOTHERHAND,THOSEPATIENTS,IECUSTOMERS,E

10、XPECTREIMBURSEMENTFORTHEIRINSURANCECLAIMSTHEYEXPECTTHEPAYERSTOOFFERAWIDEVARIETYOFOPTIONSFORHEALTHCOVERAGEACCORDINGTOTHEIRINDIVIDUALNEEDSTHEPAYERS,HOWEVER,NEEDTOKEEPPAYMENTSLOW,ORTHEYWILLFACEANINCREASEINOVERALLEXPENSES,WHICHLEADSTOHIGHERTARIFFSAND,THEREFORE,MOSTLIKELYFEWERCUSTOMERSINTHEFUTUREIDEALLY,

11、PAYERSWANTTHEPATIENTSTOSEEKONLYNEEDEDCARE,FOLLOWPROVIDERSINSTRUCTIONS,ANDRECOVERQUICKLYIFRESTRICTIONSBECOMETOOTIGHTTHOUGH,APATIENTMAYCHOOSETOCHANGEINSURANCEPROVIDERSTHEMENTIONEDCONFLICTSBETWEENPATIENTSANDINSURANCECOMPANIESAREONLYANEXAMPLEOFPOSSIBLECONFLICTSBETWEENPATIENTSANDOTHERSTAKEHOLDERSINAHEALT

12、HCARESYSTEMTHISDEMONSTRATESTHATHEALTHMANAGEMENTHASTODEALCONSTANTLYWITHOPPOSINGSTAKEHOLDERGOALSANDPATIENTGOALS,ALTHOUGHTHEOVERALLGOALREMAINSTHEACHIEVEMENTOFTHEBESTHEALTHOUTCOMEFORTHEINDIVIDUALPATIENTWITHINTHEFINANCIALANDORGANIZATIONALRESTRICTIONSOFTHEHEALTHCARESYSTEMHEALTHINSURANCEHEALTHINSURANCECOMP

13、ANIESAREIMPORTANTSTAKEHOLDERSINTHEHEALTHMANAGEMENTCONTEXTASTHEYARERESPONSIBLEFORTHEPAYMENTOFHEALTHSERVICESFORINDIVIDUALSINCASEOFSICKNESSORINJURYINCOUNTRIESWITHWELLDEVELOPEDHEALTHCARESYSTEMSTHEREARETHREEFORMSOFHEALTHCAREFINANCING1TAXBASEDHEALTHCARESYSTEM,INWHICHINDIVIDUALSCONTRIBUTETOTHEPROVISIONOFHE

14、ALTHSERVICESTHROUGHTAXESTHATARETYPICALLYPOOLEDACROSSTHEWHOLEPOPULATIONTHEGOVERNMENTISINCHARGEOFTHEPROVISIONOFHEALTHCARESERVICES,USUALLYFROMAMIXOFPUBLICANDPRIVATEPROVIDERSANDALLOCATESTHEEXISTINGRESOURCESTOTHEDIFFERENTAREASOFHEALTHCAREEXAMPLESOFHEALTHCARESYSTEMSMAINLYBASEDONTAXATIONARETHEUNITEDKINGDOM

15、,IRELAND,SPAINANDPORTUGAL,DENMARK,SWEDENANDFINLAND2SOCIALHEALTHINSURANCESYSTEM,INWHICHCONTRIBUTIONSFROMWORKERS,THESELFEMPLOYED,ENTERPRISESANDTHEGOVERNMENTAREPOOLEDINTOASINGLEORMULTIPLESICKNESSFUNDONACOMPULSORYBASISTHESESOCALLEDSTATUTORYSICKNESSFUNDSAREEITHERDIRECTEDBYTHEGOVERNMENTORINDEPENDENTNONPRO

16、FITORGANIZATIONSTHEYTYPICALLYCONTRACTWITHAMIXOFPUBLICANDPRIVATEPROVIDERSFORTHEPROVISIONOFAWELLDEFINEDHEALTHCAREBENEFITPACKAGEEXAMPLESOFCOUNTRIESWITHASOCIALHEALTHINSURANCESYSTEMAREGERMANY,FRANCE,THENETHERLANDSANDBELGIUM3PRIVATEHEALTHINSURANCESYSTEM,INWHICHPREMIUMSAREPAIDDIRECTLYBYINDIVIDUALS,EMPLOYER

17、SORASSOCIATIONSTOINSURANCECOMPANIESPOOLINGRISKSACROSSTHEIRMEMBERSHIPBASEPRIVATEHEALTHINSURANCECANBEACOMPLETESUBSTITUTEFORSOCIALINSURANCETYPICALLOFAMARKETBASEDSYSTEMSUCHASTHEUSITCANALSOSUPPLEMENTANEXISTINGSOCIALINSURANCESYSTEMASISTHECASEINFRANCE,BELGIUMANDTHENETHERLANDSPRIVATEHEALTHINSURANCESYSTEMSAR

18、E,INGENERAL,VOLUNTARYINCONTRASTTOSOCIALINSURANCESYSTEMSTHATTENDTOBECOMPULSORYHOWEVER,INSOMECOUNTRIES,PRIVATEINSURANCEMAYALSOBECOMPULSORYFORCERTAINSEGMENTSOFTHEPOPULATIONREGARDLESSOFTHESPECIFICFORMOFHEALTHINSURANCE,ALLFACEFINANCIALCONSTRAINTSDUETOMEDICALPROGRESSANDIMPROVEMENTSINTECHNOLOGY,EXPANSIONOF

19、COVERAGEBYPUBLICHEALTHSYSTEMSANDAGINGPOPULATIONSINTHEINDUSTRIALWORLDWITHHIGHERLEVELSOFCHRONICDISEASESANDDISABILITYHOWEVER,THEFUNDINGFORTHEUPWARDSPIRALOFMEDICALEXPENSESISINALLHEALTHCARESYSTEMSLIMITEDINTAXBASEDHEALTHCARESYSTEMSGOVERNMENTSAREUNABLETOCONTINUOUSLYRAISETAXESINSOCIALINSURANCEBASEDSYSTEMSTH

20、ECOMPULSORYCONTRIBUTIONHASTOREMAINBEARABLEFOREMPLOYEESANDEMPLOYERSPRIVATEINSURANCEMODELSDEPENDONINDIVIDUALWILLINGNESSTOSPENDMONEYONHEALTHCARE,ESPECIALLYIFTHEPRIVATEINSURANCECOMESASASUPPLEMENTTOCOMPULSORYSOCIALINSURANCEEGFRANCEINTHISCONTEXTHEALTHINSURERSAREOBLIGEDTOTAKEMEASURESAFFECTINGTHEBALANCEOFDE

21、MANDANDSUPPLYAIMINGTOREDUCEMEDICALEXPENSESIFAGROWTHINTHECONTRIBUTIONRATESHOULDBECOMEUNBEARABLEFORTHEINSUREDDEMANDSIDEMEASURESTHEBENEFITPACKAGEISRESTRICTEDBYTHEHEALTHINSURANCEPATIENTSAREASKEDFORCOPAYMENTSTHATMAYCONCERNDRUGS,DENTISTRYCHARGES,SPECTACLESANDCHARGESFORVISITSTODOCTORSHEALTHINSURANCEIMPROVE

22、STHECOSTAWARENESSOFTHEIRMEMBERSBYGIVINGINCENTIVESNOTTOCONSUMEHEALTHCAREEGPREMIUMREWARDSSUPPLYSIDEMEASURESHEALTHINSURANCESETSBUDGETSFORHOSPITALSANDDOCTORSUNDERDIRECTCONTRACTIMPLEMENTATIONOFDISEASEMANAGEMENTPROGRAMSDISEASEMANAGEMENTPROGRAMSTOIMPROVECAREFORCHRONICALLYILLPEOPLEWHILEREDUCINGCOSTSTHROUGHA

23、NAUTOMATICANDSTREAMLINEDCAREPROCESSEVENIFAGROWINGINSURANCEPREMIUMISNOTONLYINTHEINTERESTOFTHEHEALTHINSURERBUTALSOINTHEINTERESTOFTHEPATIENTS,WHOAREMOSTLYCONTRIBUTORSASWELL,THEREARESTILLCONFLICTSBETWEENPATIENTSANDPAYERSOFHEALTHCARETHATINFLUENCEHEALTHMANAGEMENTPRACTICESONTHEONEHAND,PATIENTSEXPECTPAYERST

24、OOFFERAWIDEVARIETYOFOPTIONSFORHEALTHCOVERAGETHATCANBECUSTOMIZEDTOTHEIRSPECIFICNEEDSONTHEOTHERHAND,PAYERSWANTTOMAINTAINORLOWERTHEIRCOSTCONTRIBUTIONTHEYWANTTHEPATIENTTOSEEKONLYNEEDEDCARE,FOLLOWPROVIDERSINSTRUCTIONS,ANDRECOVERQUICKLYPATIENTSSHOULDALSOSEEKTOREDUCETHEIRHEALTHRISKBEHAVIORSTHROUGH,FOREXAMP

25、LE,DIET,EXERCISEANDSMOKINGCESSATIONGOVERNMENTTHEGOVERNMENTPLAYSANIMPORTANTROLEINHEALTHMANAGEMENTASITMAINLYACTSASADECISIONMAKERTOSETTHERULESFORTHEFUNCTIONINGOFAHEALTHCARESYSTEMTHATFULFILLSTHEVALUESANDHEALTHPOLICYIDEALSOFTHECOUNTRYWITHINTHEREGULATORYFRAMEWORKTHEGOVERNMENTMAYREGULATEVOLUMEANDQUALITYOFT

26、HEHEALTHCARESERVICES,ISRESPONSIBLEFORLEGISLATIONONHEALTHCAREFINANCING,CORPORATENEGOTIATIONS,MAJORPROFESSIONALREGULATIONSANDPUBLICHEALTHMEASURESSUCHASPREVENTIONANDHEALTHPROMOTIONTHEGOVERNMENTADMINISTRATIONOFHEALTHEGMINISTRYOFHEALTHFORMULATESANDADMINISTERSTHEGOVERNMENTPOLICYINHEALTH,SETSSTANDARDSFORTH

27、EREGULATIONANDLICENSINGOFHEALTHCAREPROVIDERSASWELLASFORMEDICALPERSONNELINHOSPITALSOTHERGOVERNMENTALAGENCIESTHATSETPUBLICHEALTHSTANDARDSARETHEFOODANDDRUGREGULATIONAGENCIESANDAGENCIESREGULATINGOCCUPATIONALHEALTHANDSAFETYINTHEWORKPLACEINMOSTCOUNTRIESWITHWELLDEVELOPEDHEALTHCARESYSTEMSTHEGOVERNMENTISINCH

28、ARGEOFANUMBEROFPUBLICHEALTHSERVICESWHICHAREFOCUSEDONTHEHEALTHSTATUSOFTHEWHOLEPOPULATIONPUBLICHEALTHPROGRAMSARETYPICALLYPROVIDEDBYTHEMINISTRYOFHEALTHOROTHERGOVERNMENTAGENCIESINORDERTOPROMOTE,PROTECTANDIMPROVEPUBLICHEALTHPROGRAMSENCOMPASSDISEASEPREVENTIONMEASURES,HEALTHEDUCATION,IMMUNIZATIONPROGRAMS,C

29、ONTROLOFCOMMUNICABLEDISEASES,SANITARYMEASURES,ANDPROTECTIONAGAINSTENVIRONMENTALHAZARDSINCOUNTRIESLIKETHEUKWITHANATIONALHEALTHSERVICENHS,THEGOVERNMENTACTSNOTONLYASADECISIONMAKERANDPROVIDEROFPUBLICHEALTHSERVICESBUTALSOASAPAYERANDPROVIDEROFINDIVIDUALHEALTHCARESERVICESHEALTHMANAGEMENTWORLDWIDEIN1998,MAN

30、YCOUNTRIESTOOKAGREATERINTERESTINIMPROVEMENTOFHEALTHMANAGEMENT,CONSIDERINGBETTERMANAGEMENTOFTHEIRNATIONALHEALTHSYSTEMSTOBEAMONGTHEIRMAJORNEEDSANDPRIORITIESDURINGTHISYEAR,WHOREPRESENTATIVESOFFICESIN16COUNTRIESMANAGEDWHOTECHNICALCOOPERATIONATCOUNTRYLEVELANDPROVIDEDPOLICYSUPPORTTOMINISTRIESOFHEALTHONVAR

31、IOUSASPECTSOFHEALTHDESKOFFICERSATTHEREGIONALOFFICECONTINUEDTOPROVIDESUPPORTFORCOUNTRIESWITHOUTWHOREPRESENTATIVESOFFICESINADDITIONTOSERVINGASANINTERLOCUTORANDFOCALPOINTFORCONTACTSBETWEENWHOANDITSCOUNTRIES,THEWHOREPRESENTATIVESPLAYANIMPORTANTROLEINTHEIMPLEMENTATIONOFTHEGLOBALHEALTHPOLICYSTRATEGYHEALTH

32、FORALL,LIAISINGWITHOTHERUNAGENCIESASWELLASBILATERALDONORSANDNONGOVERNMENTALORGANIZATIONSTHEINCREASINGRELIANCEINRECENTYEARSONEXTRABUDGETARYSOURCESOFINCOMEDUETOACOMBINATIONOFHIGHERDEMANDSONWHOANDLOWERREGULARBUDGETRESOURCESINREALTERMSUNDERLINETHEIMPORTANCEOFTHEWHOREPRESENTATIVESROLEINRESOURCEMOBILIZATI

33、ONEVERYEFFORTISBEINGMADETOMAKEUSEOFRECENTTECHNOLOGICALADVANCESTOESTABLISHCOMMUNICATIONLINKSBETWEENWHOHEADQUARTERS,ITSREGIONALOFFICESANDCOUNTRYOFFICESASWELLASCOUNTRIESTOPERMITANEFFICIENTFLOWOFINFORMATIONBETWEENALLPARTIESINMOSTDEVELOPINGCOUNTRIES,HEALTHSERVICESAREWEAKDUETOALACKOFRESPONSIBILITYINTHEGOV

34、ERNMENT,ALACKOFINVESTMENTINHEALTHINFRASTRUCTURETODELIVERHEALTHSERVICESASWELLASPOORTRAININGANDCAREERSTRUCTURESFORMEDICALPROFESSIONALSINORDERTORESPONDADEQUATELYTONATIONALANDREGIONALEXPECTATIONS,NEEDSANDPRIORITIES,GREATEFFORTSAREBEINGMADEBYTHEREGIONALOFFICETOPROVIDENECESSARYSUPPORTTOCOUNTRIESINTHEDEVEL

35、OPMENTANDIMPROVEMENTOFHEALTHMANAGEMENTINTHEREGIONSTHISHASBEENDONETHROUGHAVARIETYOFAPPROACHESINCLUDINGCONTRACTUALSERVICESAGREEMENTS,FELLOWSHIPS,NATIONALTRAININGACTIVITIES,CONSULTANCYSERVICESANDREGIONALCONSULTATIONS,PARTICULARLYONDEVELOPINGANDEXPANDINGTHEUSEOFTHEDISTRICTTEAMPROBLEMSOLVINGDTPSTECHNIQUE

36、REGIONALOFFICEEXPERTSAREREGULARLYDEVELOPINGGUIDELINESFORRESTRUCTURINGTHENATIONALHEALTHSYSTEM,PROPOSINGPOSSIBLEREASONSFORRESTRUCTURING,ASWELLASMECHANISMSOFRESTRUCTURING,ANDTHERESOURCESREQUIREDTOBEMADEAVAILABLEFORTHISPROCESSTHEREGIONALOFFICECOLLABORATESWITHTHEMINISTRIESOFHEALTHANDDEVELOPSAQUALITYMANAG

37、EMENTTRAININGCENTERFORTHECOUNTRIESTHEYAREINCHARGEOFTHECENTER,WHICHENJOYSFULLSUPPORTFROMPOLICYMAKERS,ISANINNOVATIVESTRATEGYTOIMPROVETHEQUALITYOFHEALTHCAREANDHEALTHSTATUSTHROUGHQUALITYORIENTATION,HEALTHSYSTEMDEVELOPMENTANDMANAGERIALCAPACITYBUILDINGTHECENTERFOCUSESONTHECOREHEALTHPROCESSES,PROBLEMSOLVIN

38、GANDTEAMWORKTHE12MONTHMODULARTRAININGPROGRAMISACTIONORIENTEDANDPRODUCTORIENTEDANDFOLLOWSALEARNINGBYDOINGAPPROACHDESIGNEDTOBUILDONTHEKNOWLEDGEANDEXPERIENCEOFTHETRAINEESTHEREGIONALOFFICECONTINUEDITSSUPPORTTOANUMBEROFCOUNTRIESINSTRENGTHENINGTHEIRPLANNINGCAPABILITIESATCENTRALANDDISTRICTLEVELSEFFORTSWERE

39、MADETOPROMOTESTRATEGICPLANNINGINMINISTRIESOFHEALTHANDTODISSEMINATEWHOLITERATUREONHEALTHFUTURESSUPPORTWASPROVIDEDTHROUGHWHOCOLLABORATIVEPROGRAMSTOTHENATIONALINSTITUTESOFHEALTHMANAGEMENTENCYCLOPEDIAOFPUBLICHEALTH,200805P618625译文健康管理前言健康政策集中在规定健康目标和发觉周围对健康体系的期望，健康管理就集中在实现这些目标上。健康目标是非常广泛的，在这些目标中部分目标是完全对

40、立的，就像减少支出要提高健康质量之间的对立，健康管理首先解决的是分配有限的资源来实现以健康为目的的目标。在健康福利系统中多种多样的因素和目标导致了在健康管理中实施多种措施。健康管理可以进一步被定义为用系统的方法来完善组织和程序来实现与健康相关的预定义目标。患者健康管理的初级目标之一就是通过健康系统提高患者的公共健康。这个目标包括了几乎其他所有的目标，健康的改善包括生活质量的提高和平均寿命的延长。平均寿命的测量比较容易，而对生活质量是否提高的测量则比较困难。然而，还没有建立一种全世界的国家都可以使用的一致的综合性系统在可比较的基础上来衡量健康福利的效果。除了为健康福利和健康保险的提供者建立目标，

41、除了是健康系统资金主要来源，患者自身也在控制与健康相关的因素上起着重要的作用。这些因素可被划分为提前预防的和顺从的，这些因素对患者的健康状况有的重要的影响。在提前预防因素方面，包含了许多关于告诫和健康生活方式的方法（例如，戒烟，规律性的锻炼，健康规律的饮食）以便于更好的进行健康风险管理。（健康风险管理针对人群各个健康状态的风险因素，以及发病率高、危害大，且医疗费用较大的一些慢性非传染性疾病进行风险评估及干预，以期维持或改善人群的健康水平，降低慢性非传染性疾病的发生率、恶化率和并发症发生率，并合理控制人群医疗费用维持在适度范围。相对于一般所说的健康管理，健康风险管理更强调群体健康的整体提升。）服

42、从指的是在治疗或者外科手术之后患者完全的按说明书进行治疗。很多研究表明缺少服从，尤其是在药物治疗方面，会严重影响患者的恢复率。在这种意义上说，患者在他们自己的健康管理中扮演了不可忽视的角色。但是目前，只有少数的健康福利系统对他们的患者进行相应的培养和使用鼓励。出了告诉人们他们对自身健康的直接的影响能力，部分鼓励是可以制度化的，例如健康保险价目表就联系这个人的可控风险（相对于不可控制的，慢性的疾病风险，如过敏）。然而，在患者和健康保险公司之间存在着多层次的冲突。一方面，健康保险公司需要患者作为消费者为保险赔款筹集资金。在这个意义上，保险公司需要引起患者的兴趣。另一方面，这些患者，或者说是消费者，

43、希望保险公司报销他们的保险赔款。他们希望付款人根据患者的个人需要提供多种多样的关于健康保险项目的选择。然而付款者要尽量保持付款低，否则他们将面临总费用的增长，这可能导致更高的收费，因而可能导致在未来消费者的减少。理论上，付款者希望患者只寻找他们需要的福利，在提供者的指导下更快的恢复。如果约束变得太严格，患者就可能选择变换保险提供者。前面提到的关于患者和保险公司之间的冲突只是在健康管理系统中患者和其他利益相关这之间可能存在的例子。这证明了健康管理必须要不断地解决利益相关者和患者相反的目标，尽管总的目标是在健康福利系统的财政和组织性的限制下实现最好的个人健康结果。健康保险在健康管理中健康保险公司是

44、重要的利益相关者由于他们在个人发生疾病或受伤时负责提供赔款服务。在健康福利系统比较完善的国家有三种健康福利融资方式1、以税收为基础的健康福利系统，个人通过纳税成为了健康服务资金的主要提供者这也是一种全民合伙方式。政府负责提供健康福利服务，通常混合公共的和私营的提供者，将现有的资源分配到健康福利的不同领域。健康福利基于税收的国家有英国，爱尔兰，西班牙和葡萄牙，丹麦，瑞典和芬兰。2、社会健康保险体系，资金贡献主要来源于在强制的基础上工人，个体经营者，公司和政府的合伙形成单一的或者复杂的疾病基金。这些所谓的法定疾病基金不是受政府指导就是依赖于非营利性组织。这种典型的将公共和私营的提供者提供的资金混合

45、起来的方式被定义为健康福利利益包。实行社会保险系统的国家有德国，法国，荷兰和比利时。3、私营的健康保险系统，保险费直接由个人雇佣者或者保险公司的协会在会员关系的基础上共同集资。私营健康保险完全是社会保险的代理人，美国是典型的以市场为基础的保险体系。私营健康保险系统也可以蒲冲现存的社会保险体系的不足如法国，比利时和荷兰。私营健康保险系统，一般来说，和日渐趋于强制的社会保险来比是自愿的。然而，在一些国家，私营健康保险对某些部分群体仍然是强制的。不管健康保险的特殊形式，所有的健康保险都受到财政的约束，由于治疗在技术方面的进步和提高，公共健康系统覆盖范围的扩大以及在工业化国家慢性病和残疾的数量不断剧增

46、。然而，医药费用不断的上升在所有系统中都受到限制在以税收为基础的健康福利体系中，政府不可能持续提高税收。在社会保险体系中强制的集资必须在雇佣者和受雇者能承受的范围之内。私营保险依赖于个人对健康福利的花费意愿，尤其是党私营保险成为强制社会保险的补充时（如法国）。这种情形迫使健康承保人采取措施来以减少医药费为目标的供给和需求，如果保险费率不断提高可能会使投保人无法接受。需求供给方面的措施利益是受健康保险限制的。要求患者合作支付费用可能关于药物，牙科的费用，眼镜盒看医生的费用健康保险通过激励手段提高其成员的费用意识使成员意识到他们并不只是在健康福利上消费（如津贴，奖金）供给方面的措施在合同的指导下健

47、康保险机构为医院和医生作预算。疾病管理实施方案（疾病管理方案）通过自动的流线型福利项目减少费用来提高慢性病患者的福利水平。虽然不断增长的保险津贴不仅对健康承保人是一种吸引对保险金的主要贡献者患者同样是一种吸引，但是在患者和付款者之间仍然存在的影响健康管理实施的矛盾。一方面，患者期望付款者针对健康福利范围提供更大的选择并按客户要求满足患者的特殊需求。另一方面，付款者想尽量降低其费用支出，他们希望患者只要求他们必须的福利，服从提供者的命令，并可以快速恢复。患者也应该寻求减少健康风险的行为，如饮食，锻炼和戒烟。政府政府在健康管理中扮演着重要角色，由于政府是健康管理系统规定的制定者并实现国家健康管理政

48、策的组织。根据规章化的计划政府可以规定健康福利服务的容量和质量，政府也负责关于健康福利融资财政的立法，合作谈判，主要的专业性规定和公共健康措施如防治和健康质量的提高。政府健康管理部门（卫生部）是政府关于健康政策的规划者和管理者，为健康福利提供者和医院的内科的规定和许可设定了规范。其他制定公共健康规范的政府部门是食品和药品规范部门和规范工作地职业健康和安全的部门。在很多健康福利系统完善的国家中政府负责一些公共健康服务集中关注全民的健康水平。为了提高和保护公共健康水平，公共健康项目主要是由卫生部和其他政府机构提供的。这些项目包含疾病预防措施，健康教育，免疫项目，传染病的控制，公共卫生措施，以及避免

49、来自环境的危险。在拥有全民健康服务的国家中如英国，政府扮演的不仅是公共健康服务的决策者和提供者的角色同时也是付款者和个人健康福利服务的提供者。世界范围内的健康管理1998年，更多的国家对健康管理产生了兴趣，更好的健康管理体系被看做是他们的主要需要和优先考虑的。经过了这些年，世界卫生组织代表办公室在16国展开国家水平的技术合作和提供能够支持卫生部关于健康管理的多方面政策。地区的办公室是世界卫生组织代表办公室之外的提供支持的组织。除了作为世界卫生组织和其他国家联系的对话者和焦点，世界卫生组织代表在全球健康政策策略“为了所有人的健康”中扮演了重要的角色，和其他联合国取得联系以及双方的捐赠者和非政府组织。健康水平的增长依赖于这些年来额外的收入，额外的收入来源于结合了世界卫生组织的更高要求和实践中的低预算，这也强调了世界卫生组织代表在资源整合中的重要作用。每项努力都充分运用了近期技术的进步来建立于世界卫生组织总部的联系，世界卫生组织的区域代表、国家官员以及各国都被允许在其之间进行有效的信息交流。在很多发展中国家，健康服务还是个薄弱环节主要是由于政府缺乏责任，缺少对于传递健康服务的公共健康设施的投入，也缺少对于职业医院工作者的培训和职业规划。为了适当地响应国际和地区的号召、需要和优先权，地区代表在支持发展中国家发展和提高区域健康水平中作了很大