0
100% Satisfaction Guarantee
Amazing Value
Fast Shipping
Expert Customer Service
拯救或破坏 : 英国医疗体系缔造者约翰·马克斯
$47.98
●约翰·马克斯医生是英国公共卫生领域的g宝级人物。他为人热情、风趣、富有激情和主见,偶尔也会唱唱反调。他的人生中有40年是与英国国家医疗服务体系(NHS)共同成长的,几乎参与了该体系建设的每次争论和决策。在这些历史事件中,他不是简单的“参与者”,而是舞台上的中心人物。
●他见证了英国20世纪下半叶的医疗改革史堕胎法案修订、医生对医学总会(GMC)的抗议、皇家全科医师学院的建立、NHS的数次重组、NHS床位价格和初级医生工资的斗争,以及艾滋病刚传入英国时医疗界和民众发起的抗争。本书是约翰·马克斯作为医学传奇的亲笔自传,但绝不是枯燥的医疗改革史。书中充满了那个时代的名人轶事,从骇人事件到幽默生活,再到精明的政治操作。
●约翰·马克斯针对其个人生活和所处时代,描述了一段热忱、勇敢、富有人性和偶尔俏皮的往事,让每位读者都乐在其中。医疗体系好像有生命一样,有初生、有成长,也有衰退。约翰·马克斯医生以生动的笔法,记录了他眼中的点点滴滴。相信从他引人入胜的描述中,读者可以看到当时英国医疗体系的蜕变、争议与问题。本书以讲故事的形式讲述了当代严肃的事情。阅读时请大家放眼世界,细品本书妙处,相信你会感受到作者的幽默与坚持。
约翰·马克斯(John Henry Marks)是一名英国医生,他于英国国家医疗服务体系成立的当天(1948 年 7 月 5日)获得医师资格。他长期参与国家层面的医疗政治活动,在 1984—1990 年担任英国医学会主席,任期内广受好评,一直致力于为英国国家医疗服务体系辩护。本书是马克斯的自传,也是一部医疗社会史著作。著者凭借作为家庭医生的长期经历、高层医学政治的深度参与,以及作为全科医学历史学家的细致观察,在本书中深入浅出地呈现了英国国家医疗服务体系的形成和改革进程,其中既有风起云涌的国家大事,又穿插了不少温馨有趣的生活细节,值得医疗体系研究者及对此有兴趣的读者细细品读。
王 岳 法学博士,教授,博士研究生导师,北京大学医学人文学院副院长。中国人体健康科技促进会医学人文与医院管理专委会主任委员,中国卫生法学会学术委员会副主任委员。主要研究方向为卫生政策与卫生法学、医学人文与医患关系、医药政策法制史。
马金平 医学史博士。本硕就读于厦门大学历史系,后于英国华威大学获得医学史博士学位。主要研究方向为医学史、精神健康和中外交流。
第 1 章 1925—1943 年:我的童年和作为避难者的生活 / 001第 2 章 大学和部队生活 / 020第 3 章 从卡车司机到全科诊疗负责人 / 050第 4 章 参与堕胎法改革 / 065第 5 章 进一步参与医疗政治 / 077第 6 章 开始国家层面的医学政治活动 / 087第 7 章 皇家学院、学术取向和博士学位 / 108第 8 章 英国国家医疗服务改革的早期尝试和心脏移植 / 120第 9 章 过时的章程和保罗 · 钱伯斯爵士的报告 / 127第 10 章 我参与了国家谈判 / 138第 11 章 约见纪律机构,失去了一些朋友 / 156第 12 章 我在国内外代表行业 / 168 第 13 章 艾滋病和英国医学会 / 181第 14 章 一个皇家百年纪念年 / 193第 15 章 国际问题和政治猜想 / 205第 16 章 两次危机和一次选举 / 214第 17 章 戴安娜王妃为图书馆揭幕,不愉快的年度代表大会 / 236第 18 章 风暴来临 / 256第 19 章 风暴来临:《白皮书》/ 275第 20 章 行业反对的改革 / 294第 21 章 反对活动继续 / 315第 22 章 法案草案和各种反应 / 328第 23 章 抗议活动继续:神秘传真和牛津辩论 / 334第 24 章 担任主席的Z后几个月 / 345第 25 章 我是一名前任主席 / 358第 26 章 各种活动,包括拳击、讲演和有争议的特别代表大会 / 371第 27 章 被告席上的医生 / 394第 28 章 安静的退休,大选,问号 / 408
译者前言英国《泰晤士报》在世纪之交曾做过一项调查,在回答“你认为政府在 20 世纪影响英国人生活的Z大业绩是什么”时,46% 的人认为是英国国家医疗服务体系(National Health Service,NHS), 可 见 NHS 对英国人民的影响之深。该体系成立于 1948 年 7 月 5 日,是世界上个全民免费医疗系统,是公认的英国名片和国宝,也是很多国家医疗改革的范本。它之所以引人瞩目,在于用相对较小的成本获得了较高的产出 A。取得这一成就的关键,在于完善的初级医疗保障,即社区医疗服务,遍布基层社区的全科医生是该体系的“守门人”,他们用 20% 的医疗资源解决了 80% 的医疗问题。本书的著者既是基层医疗从业者,也是医改参与者,亲证了国家医疗服务体系从艰难成立、不断完善到私有化改革的历程。因此,这部自传,也可以说是英国国家医疗服务体系的侧面描写。著者将其经历娓娓道来,故事环生,既专业又有趣,把国家改革和个人体验完美融合,既见宏大历史进程,又见微妙的权力博弈,可以说是见树又见林,对于想了解英国国家医疗社会史的读者来说,本书不容错过。NHS 的历史,大致可分为三个阶段。阶段是中央政府对地方医院的指挥控制阶段(command andcontrol)。1948 年,英国工党政府在中央税收的支撑下,将免费医疗服务国有化,成立了 NHS,旨在实现公民不论贵贱,都可公平地获得高质量的医疗服务。不过,此时的 NHS 比较艰难,资金支持只有 114 亿英镑 A,医生人手短缺,也缺乏经验,经常要实施未经培训的操作,如插管和麻醉 B。第二阶段是企业化取向(coporateapproach)的协商管理(consensus management)阶段。1974 年,为了解决低薪和合作低效的问题,由英国保守党计划、后来上台的英国工党政府实施,NHS 进行了次大规模重组,将医疗服务划分为地区和区域卫生部门(districts and regional health departments)A,建立了NHS 和地方政府联合委员会,把医院、社区服务和公共卫生职能整合起来,促进横向合作。然而,这一改革造成医疗工作效率低下,灵活度差,因而饱受诟病。第三阶段是综合管理(general management)阶段,主要表现为减少财政压力,进行市场化改革。1987 年,英国保守党首相撒切尔夫人对 NHS 进行了全面评估和改革,在卫生部长肯尼斯·克拉克(Kenneth Clarke)的支持下,于1991 年引进了“内部市场”(internal market)机制,将地方卫生部门(health authorities)与私营医院信托机构(hospital trusts)分离开来,造成竞争,引入全科医生基金,使全科医生有资金为自己的患者购买医疗服务。2000 年,英国工党扩大私人融资计划,建立多家私营医院,雇佣公司提供临床服务,也制定了一些绩效目标和国家指导方针,试图建立统一的医疗标准,还设立了初级医疗信托机构(primary care trust),代表全科医生购买医疗服务。2010 年,英国工党通过重组计划,将初级医疗信托基金排除在核心之外,国家重新掌控科医生的开支权 A。如今,2021—2022 年的 NHS 预算高达 1903亿英镑 B,成为世界上投入Z多的医疗体系之一,资源和人力的相对充足,使得英国在新冠肺炎疫情期间,得以采取比较宽松的控制政策。
Shipping Overview:
• Shipping: Standard Domestic Shipping within the United States charges USD 4.99. Standard International Shipping from United Kingdom, Germany and Japan to the United States charges 14.99.
• Order Processing: Please allow 1-2 business days for order processing and preparation before shipment.
• Domestic Shipping: Orders within the U.S. are shipped via USPS or FedEx, depending on the origin of the product. The average transit time is 3-7 business days.
• International Shipping: Currently, we only ship within the USA.
• Tracking Information: Every order is trackable. You will receive a tracking number once your order has been shipped. Products may be shipped from various global fulfillment centers.
Shipping Delays:
Please note that shipping times may vary due to factors beyond our control, such as weather conditions, natural disasters, or peak holiday periods. While we strive to ensure timely delivery, the exact arrival time cannot be guaranteed and is managed by the shipping carrier.
Shipping Options:
Standard Delivery: Most orders are shipped within 3-7 business days. Larger items may utilize LTL shipping for safe handling.
Handling Time: We handle shipments on business days (Monday - Friday), with a preparation time of 1-2 days.
Additional Charges: Some items require additional shipping charges due to their size, weight, or special handling. These charges are specified on the product pages and are not eligible for shipping discounts.
Exclusions: Gift cards, packaging, taxes, and prior purchases do not count toward the minimum purchase requirement for free shipping. This offer is valid only for shipments to U.S. addresses, including Puerto Rico.
Delivery Details:
Estimates: Standard shipping within the US typically takes 3-7 business days. These are estimates and not guarantees.
Shipping Restrictions: We ship to all 50 states, Washington, DC, U.S. territories, and APO/FPO/DPO addresses. Shipping options vary based on the delivery address.
Remote Areas: Shipments to remote areas may incur additional charges or require pickup from a nearby shipping partner’s location.
Shipping Confirmation:
You will receive a shipping confirmation email with a tracking number as soon as your order is dispatched. If you do not receive this email immediately, please be assured that your items will arrive within the estimated delivery window provided at checkout.
Order Modifications:
If you need to cancel or modify your order, please contact our customer support immediately.
Issues with Delivery:
If your order shows as delivered but you have not received it, please contact the shipping carrier directly to resolve the issue. For persistent problems, contact our customer service at cs@everymarket.com.
Customer Support:
Our team is available 24/7 to assist you with any questions or concerns regarding your order. We are committed to ensuring a smooth shopping experience.
Return & Refund Policy Overview
Please review our return and refund policies below to ensure a smooth transaction process.
Return Policy
Duration: You have 30 days from receiving your item to initiate a return.
Condition: Items must be unworn, unwashed, with original tags and packaging intact.
Shipping Costs: Customers are responsible for return shipping costs.
Packaging: Ensure returned items are well-packaged to avoid damage during transit.
Tracking: Use a trackable and insured shipping method as we are not liable for items lost or damaged on return.
Initiating a Return: Contact us at cs@everymarket.com to start your return. We will provide a return shipping label and instructions upon approval. Returns without prior approval will not be accepted.
How to Return
Method: Returns must be sent back by mail to the address provided in the return instructions.
Return Label
Defective Products: Return labels are provided for defective items.
Non-Defective Returns: Customers are responsible for obtaining their return shipping label.
Product Conditions for Return
Eligible Products: Returns are only accepted for items in new condition.
Nonreturnable Items
Certain items are not eligible for return:
Electronic devices after 30 days (e.g., computers, laptops, Kindles)
Gift cards, prepaid game cards
Perishable goods, live insects, some jewelry, some health and personal care items
Customized or personalized products
Items with special shipping restrictions
Refund Policy
Window: Eligible products may be returned within 30 days of delivery for a refund.
Refund Method: Refunds are processed to the original payment method or as store credit for items purchased with gift cards.
Processing Time: Refunds are processed within 3-5 business days after we receive the return; please allow additional time for shipping and bank processing.
Claims
Inspect your order upon arrival and report any defects, damages, or incorrect items immediately to allow us to address the issue. For claims, contact our support team with details of the issue.
Exchange Policy
For the quickest service, return your original item and place a new order for the desired product once your return is accepted.
Return Address
EveryMarket Customer Service 2101 E Terra Ln, O'Fallon, MO 63366
Customer Support
Available 24/7 for any questions or assistance needed:
Phone: +1 636-312-5925
Email: cs@everymarket.com
Oops!
Sorry, it looks like some products are not available in selected quantity.
OK