RESUMEN
The unclear connotation and fragmented governance of the multi-tiered medical security system pose challenges to its high-quality development.This article redefines the concept and connotation of the multi-tiered medical security system using holistic governance theory.It distinguishes the bottom layer,basic layer,and supplementary layer from the perspective of the essential attributes and direct functions of each system.Furthermore,from the perspective of holistic governance,the article analyzes the current reform practice and finds that fragmented management thinking,unclear positioning of sub-system functions,insufficient policy coordination,single participation subject,and lack of equal negotiation mechanisms are constraints on the overall effectiveness of the multi-tiered medical security system.Therefore,it is necessary to adopt systematic and targeted reform measures from the perspective of holistic governance to improve the system.
RESUMEN
Objective:To quantitatively analyze the policy of maternal and child health talents in Yangtze River Delta,and to provide reference for optimizing the policy.Methods:The three-dimensional framework of policy tools,policy objectives and policy objects was constructed,and the policy texts retrieved from the official websites of people's governments of three provinces and one city,health Commission,Human resources and Social Security Department were analyzed by quantitative policy analysis method.Results:A total of 239 documents were included.The main policy tools were supply tools(47.7%)and demand tools(32.1%).The main policy goal is to cultivate talents(53.2%);The main policy objects were universal(61.1%)and high-level talents(18.9%).Conclusion:The importance of maternal and child health talent policy in the Yangtze River Delta is increasing day by day,and the regional coordination is improving,but the coordination of the combination and collocation of policies still needs to be optimized,and there is strong convergence among different regions.It is necessary to promote the construction of talent highland and information platform,improve the operability of policies and carry out incentive and evaluation trials,increase the talent training and evaluation policies and introduction and publicity policies,train and make good use of middle-level talents,and create their own characteristics under the framework of regional cooperation.
RESUMEN
Objective:To establish a set of evaluation indicator system of policy coordination of integrated county healthcare consortium based on the construction practice of integrated county healthcare consortium in Zhejiang province.Methods:Based on the guiding opinions and relevant supporting policy documents issued by Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis, and the indicator system was modified and perfected in two rounds by Delphi method. The weight value of the indicators was calculated by the priority chart method.Results:The indicator system included 4 first-level indicators, 10 second-level indicators and 35 third-level indicators. Among the first-level indicators, the weight values of health insurance payment, personnel salary, price reform, fiscal and finance were 0.406, 0.281, 0.141 and 0.172, respectively.Conclusions:The indicator system established in this study has certain rationality and feasibility, which can provide reference for promoting the construction of integrated county healthcare consortium in China from the perspective of policy coordination, and provide reference for relevant scholars to carry out follow-up research.
RESUMEN
Objective:To analyze the physical geography and social and economic geography of Huairou District, Beijing, from the perspective of health geography and based on the science of health policy, and study the implementation effects and existing problems of village-level health resource allocation policy based on household registration system and population number, then put forward relevant countermeasures.Methods:From December 2020 to May 2021, 14 rural townships in Huairou district of Beijing were investigated on the basis of literature review, on the basis of information saturation, through typical case analysis, semi-structured interview and other methods. According to the distribution of physical geography and social economic geography, 15 administrative villages of 3 townships were selected to carry out field observation and in-depth interviews with key insiders on the basic information of village clinics and rural doctors, basic medical and health services, management system and operation mechanism.Results:The characteristics of geographical environment, population change and population density of village-level health institutions in Huairou district made the current situation of village-level health resources allocation highlight the current situation of insufficient policy coordination and supervision, and showed the reality of unbalanced distribution of village-level health institutions. There was a big gap between the geographical distribution of villager health institutions and the allocation of health human resources and the health needs of villagers, and the current situation was worrying. The lack of analysis of health geographical factors in the policy formulation and implementation was an important factor.Conclusions:To realize village-level health allocation, it is necessary to fully consider health geographic factors, break institutional boundaries through policy coordination and differentiation, and gradually optimize village-level health resource allocation starting from optimizing the layout of village-level health institutions.
RESUMEN
RESUMO Este artigo investiga um tema quase completamente inexplorado da formação de governo e da construção de burocracias e capacidades em âmbito local no Brasil: a existência de uma rede de decisores e burocratas de alto nível que se deslocam entre posições de comando de diferentes agências no governo de uma grande cidade. Redes desse tipo costuram agências, áreas de política pública e administrações e são responsáveis por uma parte substancial das práticas e processos informais que constroem governança por detrás dos procedimentos administrativos formais. Partindo de um banco de dados inédito, o artigo analisa a rede construída pela migração de decisores entre departamentos e agências da prefeitura de São Paulo entre 1985 e 2012, envolvendo dezenas de secretarias e aproximadamente cinco mil indivíduos em mais de uma centena de diferentes posições administrativas. Os resultados indicam a existência de um denso e complexo tecido relacional que conecta o interior de cada governo, costura áreas temáticas internamente entre agências e governos e liga governos com afinidades políticas. Os dados indicam que a estrutura da rede é um resultado ao mesmo tempo de processos de especialização temática e de clivagens políticas, criando importantes elementos de coordenação entre agências e governos.
ABSTRACT This paper investigates an almost completely unexplored facet of government formation and of the construction of bureaucracies and capabilities at the local level: the existence of a network of decision makers and senior bureaucrats who move over time between positions at different agencies in the administration of a big city. Networks of this kind weave agencies, policy areas and administrations together and are responsible for a substantial part of the informal practices and processes that construct governance and underlie formal governmental procedures. Setting out from a newly constructed database, the article analyses the network built by the migration of top officials between departments and agencies in São Paulo city from 1985 to 2012, involving dozens of secretaries and approximately five thousand individuals in more than one hundred different government positions. The results indicate the existence of a dense and complex relational fabric that connects the interior of each government, weaves thematic areas internally between agencies and governments, and links governments with the same political affinities. The data indicates that the network structure is an outcome of processes associated simultaneously with political cleavages and policy field specialization, providing important elements for coordination between agencies and administrations.
RÉSUMÉ Cet article s'intéresse à une facette encore assez peu étudiée de la formation des gouvernements et de la construction de bureaucraties et de capacités locales au Brésil: l'existence d'un réseau de décideurs et de bureaucrates de haut niveau qui naviguent entre différents postes de direction au sein de divers organismes liés au gouvernement d'une grande ville. Ces réseaux pénètrent organismes, secteurs politiques et administrations publiques et sont responsables d'une partie substantielle des pratiques et processus informels qui construisent la gouvernance en arrière-plan des procédures administratives formelles. En nous fondant sur une base de données inédite, cet article analyse le réseau construit par la migration des décideurs entre différents départements et autres agences de la Mairie de São Paulo entre 1985 et 2012, qui a impliqué des dizaines de départements et environ 5.000 personnes occupant plus d'une centaine de positions administratives différentes. Les résultats indiquent l'existence d'un tissu relationnel dense et complexe qui occupe le cœur des gouvernements, conforme des domaines thématiques partagés entre organismes et gouvernements, et lient ces derniers en fonction des affinités politiques. Les données indiquent que la structure du réseau est le résultat simultané de processus de spécialisation thématique et de clivages politiques permettant de créer d'importants éléments de coordination entre agences et gouvernements.
RESUMEN Este artículo investiga un tema casi completamente inexplorado de la formación de gobiernos y de la construcción de burocracias y capacidades en el ámbito local en Brasil: la existencia de una red de decisores y burócratas de alto nivel que transitan entre posiciones de mando de diferentes agencias en el gobierno de una gran ciudad. Las redes de este tipo anexan agencias, áreas de política pública y administraciones, y son las responsables de una parte sustancial de las prácticas y procesos informales que construyen gobernanza por detrás de los procedimientos administrativos formales. Partiendo de un banco de datos inédito, el artículo analiza la red construida por la migración de decisores entre departamentos y agencias del ayuntamiento de São Paulo entre 1985 y 2012, que incluía a decenas de secretarias y a aproximadamente cinco mil personas en más de un centenar de cargos administrativos diferentes. Los resultados indican la existencia de un denso y complejo tejido relacional que conecta el interior de cada gobierno, vincula áreas temáticas internamente entre agencias y gobiernos, y asocia gobiernos con afinidades políticas. Los datos apuntan que la estructura de la red es el resultado de procesos de especialización temática y, al mismo tiempo, de fracturas políticas, creando importantes elementos de coordinación entre agencias y gobiernos.
RESUMEN
Los problemas ambientales actuales demandan acciones y respuestas por parte de las instituciones que tienen a su cargo la ejecución de la política ambiental y que gestionan el ambiente en el territorio que les compete. La dinámica propia de la temática ambiental ha impuesto un ritmo de respuesta institucional, política, administrativa y jurídica de tal naturaleza que la construcción teórica desde el derecho ambiental se ha visto, al menos, rezagada. Es en este sentido que, ante los escasos antecedentes en Argentina referidos a estudios jurídico-institucionales relacionados con la cuestión ambiental o ecológica entendida como problema político acuciante, nos propusimos intentar diferentes desarrollos teóricos y relevamientos de datos capaces de echar algo de luz a la situación en nuestro territorio. En este trabajo precisaremos, en primer término, nociones como gestión pública del ambiente e institucionalidad ambiental. En segundo término, nos ocuparemos de aquello que denominamos "nuevo orden ambiental Nacional". En ese marco abordaremos lo que aparece como sus impactos directos en la sanción legislativa nacional y provincial, pero principalmente en las instituciones ambientales nacionales y de las diferentes jurisdicciones provinciales². A los fines de este último punto, explicitaremos los diferentes modelos institucionales elaborados que nos permitieron caracterizar los organismos públicos estatales y su desarrollo. Por último, efectuamos algunas referencias a la trascendencia de la coordinación interjurisdiccional en materia ambiental. Asimismo, cabe destacar que el presente se inscribe en el marco del desarrollo de una novedosa línea de investigación entre los estudios jurídico-ambientales en Argentina. La misma intenta abordar los problemas ecológicos desde el derecho pero sin descuidar la especificidad y complejidad de lo ambiental.
The current environmental problems demand action and answers from the institutions that are responsible for implementing the environmental policy and managing the environment in the territory of their competence. The typical dynamics of the environmental subject matter has set an institutional, political, administrative and legal answer rhythm of such nature that the theoretical construction from the Environmental Law has been, to say the least, left behind. It is in this sense that, in view of the scarce background referred to legal-institutional studies in Argentina in relation with the environmental or ecological matter -understood as an urgent political problem,- we decided to intend different theoretical developments and data surveys capable to throw a light upon this situation in our territory. In this work we will specify, in first place, ideas such as public environmental management and environmental institutionalism. Secondly, we will see to what we call "new environmental National order." In this framework we will deal with what appears as its direct impact in the national and provincial legislative sanction, but mainly in the national environmental institutions and the different provincial jurisdictions². For the purposes of this last point, we will explain the different institutional models developed which allowed us to characterize the state-owned public organisms and their development. Finally, we will make a reference to the importance of the interjurisdictional coordination in environmental matters. By the same token, it is worth noting that this work is registered within the framework of an innovative research line in the Judicial-Environmental Studies in Argentina. It intends to deal with ecological problems from the Law but without neglecting the specificity and complexity of the environmental issues.