Quantitative Analysis on Economic Contribution of Community Health Service in China

In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan pertime. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service.     

Construction of HMI Network System for Individualized Maternity Intervention Service against Birth Defects in Community

The paper expounds the community maternity service system against birth defects, from the viewpoint of individualized service in family planning. We have utilized modern information technology to develop health management information （HMI） network with individualized maternity, and to establish the community service system for intervention of birth dejects. The service system applied the concept of modern health management information to implementing informational management for screening, treatment, following up, outcome monitoring, so as to provide a base for promotion of health, diagnosis, treatment as well as scientific research, with the prenatal screening of Down＇s syndrome as a model. The introduction to informational network during the processes of service has been carried out with regards to its composition, function and application, while introducing the effects of computerized case record individualized in prevention, management and research of Down＇s syndrome.     

Impacts of Clinic-based Informed Choice Program on Quality of Individualized Counseling Service in China

Objective To evaluate the impacts of clinic-based informed choice program on quality of individualized service in family planning clinics in China。Methods During the program, family planning service staff in intervention clinics were trained on counseling skills and key points of individualized counseling service.Questionnaire surveys were conducted pre- and post-informed choice program to evaluate the impacts of the program.Results Informed choice program had significantly improved the quality of individualized counseling service. The multivariate regression analysis showed that clients of the clinic were more likely to give the better evaluation of the service, the OR of evaluation score of individualized service is 1. 712 (95% CI is 1. 146 to 2. 564) in Experiment Group of post-program in contrast with pre-program. The program also could satisfy individual needs of clients and increase the satisfaction degree of the service.Conclusions Informed choice program is helpful for the improvement of the quality of individualized counseling service. It is necessary and imperative to improve the skills of counseling service provided in family planning clinics.     

Assessment of community health needs of Chongqing residents： a qualitative study

Objective： The aim of this preliminary qualitative study was to gain insight into community health needs in order to develop health program for community in Chongqing. Methods： Totally 40 participants were assigned into 6 focus group discussions. All groups were led by local language speakers, and their talking was recorded after gaining informed consent. Transcribed data were coded and subjected to thematic analysis. Results： The main obtained themes were that community health problems were chronic noncommunicable disease, main health service needs included regularly free check-up and health education, and perceived health risk factors were unhealthy lifestyle and behavior as well as environment problems. Conclusion： Our community health needs assessment （CHNA） with FGDs indicate that residents realize the importance of prevention of disease. Our study identifies that primarily community health promotion is one of the priorities of community health service needs, including reorienting health service, health education, guiding behavior or lifestyle. and creating healthy environments. The findings of this study can provide guidance to the development of more effective and pertinent health program in this community.     

IMPROVING ACCESS TO HEALTH SERVICES IS STRATEGIC PRIORITY OF PRODUCTIVITY DEVELOPMENT

As one of the basic human rights, health is an important guarantee for productivity. The authors introduce the Andersen's behavioral model of health service use,as well as the conception and classification of access to health services based on the model. Meanwhile,the relative guidelines and the impact on the health reform of China are discussed, compared with America's and China's. This paper propounds three strategic priority of productivity development.     

HIV/AIDS Related Discrimination in Health Care Service： a Cross-sectional Study in Gejiu City, Yunnan Province

Objectives To investigate discrimination against people living with HIV （PLWH） and its impacts. Methods Forty people who were either HIV positive （7/40） or had high risk behavior （33/40） were interviewed. Focus group discussion was held in the interview with people who were suspected to be infected with HIV, and in-depth interview was conducted in the survey of HIV positive persons whose privacy was strictly protected to ensure the confidentiality of the collected information. Results It was identified that six forms of discrimination against people living with HIV occurred in health care service in Gejiu, including speaking to patients in an insulting manner, refusing to provide health care service, delaying treatment, treating differently, uncovering patients＇ privacy, and over-protecting themselves against patients. Discrimination against people living with HIV greatly affected their health conditions. Conclusions Discrimination against people living with HIV in health service has negative impact on their physical and mental health.     

Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System:A Cross-sectional Study in Nanjing,China

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service(CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor‐patient relationships, information and support, organization of care, and accessibility(P 0.001). One or more factors such as gender and self‐perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy.     

The Evaluation of the East,Central ＆ Southern Africa Health Community Surgical Camp

Background： Lesotho experiences human resources for health crisis, thus creating challenges in accessing specialist surgical services. In 2008, doctor-patient ratio was 1：16298. In mitigation, the ECSA Health Community initiated a south to south collaborative strategy by mobilizing a surgical camp team of 25 specialists from ECSA virtual colleges that conducted an inaugural regional surgical camp. Sixty-five complex surgeries were performed. Objectives： Our aim was to evaluate the camp and document lessons for application in future camps on planning, organization, roles of stakeholders and determine immediate patient outcomes. Methods： We used quantitative and qualitative methods to evaluate the adequacy of planning, organizing, coordinating and executing the camp. We collected data through self-administered questionnaires and focus group discussions. We used qualitative and quantitative methods for data analysis. For qualitative data, we used a multilayered approach of triangulation, data coding and categorizing based on emerging themes. Results： We found that camp objectives were met. Participants were satisfied with organization and coordination of the camp although 91% preferred advance notification of 6-12 months. All patients had successful outcomes. 61.9% rated partners/donors involvement as inadequate. Majority （90.5%） reported adequacy of equipment. Mobilizing participants from various countries ensured a highly qualified experienced surgical team. Conclusion： The ECSA camp was a best practice for fostering south to south cooperation in bridging knowledge and skills gap through pooling of regional expertise. The camp has potential for replication and sustainability. The high calibre and experience of the team may have contributed to the 100% success rate.     

Reverse Gear： Cairo＇s Dependence on a Disappearing Paradigm

In the 1960s and 1970 s, attention was focused on rapid population growth and large scale family planning programs were launched in many developing countries. However, the paradigm for understanding fertility decline assumed that exogenous socioeconomic changes were necessary to reduce family size. By the mid-1990s, the standard model of the demographic transition had been all but discarded, partly there were numerous country experiences inconsistent with the model. The 1994 International Conference on Population and Development （ICPD） emphasized women＇s broader needs, which were important but were promoted by reducing attention to population and the need for family planning. The timing of this shift was peculiar, because the Cairo proponents were depending on an already discredited model of reproductive behavior. The policy shift at Cairo undermined the political coalition that had supported international family planning since the 1960s. As a result of declining financial support, the health of women has deteriorated seriously in the past decade. Meantime, the countries that have been successful in lifting unprecedented numbers of people out of abject poverty were acting independently of the Cairo consensus.     

Reproductive Health and Family Planning

I am honoured to have the opportunity to speak about an issue, which lies at the heart of the Cairo agenda, and that is reproductive health. In the specialized sessions of this Forum, we are focusing on reproductive health and family planning, HIV/AIDS and maternal death, for example. Therefore, my statement aims to remind us all of what has been agreed upon in Cairo on reproductive health and family planning so that the case studies that will be presented can be examined within the contex…     

社区卫生服务项目流程化管理研究(二)--制定社区卫生服务基本项目

目的 对社区卫生服务的需要项目和发展状态进行研究，奠定流程化管理基础。方法 采用现场调查和座谈会法。结果 社区医疗服务内容较多，康复保健等服务项目需要进一步发展。结论 目前社区卫生服务组织提供的服务项目在一些方面和国外社区卫生服务组织以及卫生部要求提供的项目基本一致，但进一步发展服务项目一定要不断完善。     

慢性病健康管理模式在社区居家养老服务中的应用

目的：通过把慢性病健康管理模式应用于社区居家养老服务中心的养老服务实践中,为探索一条老年慢性病健康管理的新模式提供参考。方法建立慢性病健康管理小组,利用社区居家养老服务中心的管理平台实施慢性病健康管理服务。对比慢性病健康管理实施前、后社区老年人慢性病管理和服务情况,以及慢性病健康管理实施后与社区卫生服务中心在服务上的差异。结果社区居家养老服务中心在老年慢性病健康管理前、后比较,服务内容实施得到明显提高（P＜0．01）,慢性病管理的满意度增加39．66％;在慢性病管理率和控制率上均优于社区卫生服务中心（ P＜0．01）。结论慢性病健康管理模式应用在社区居家养老服务中心的平台上,可为社区老年人提供更全面、具体、高效的慢性病健康管理服务,探索出一条老年人慢性病健康管理应用的新模式。     

广东省城市社区卫生服务机构功能完善情况调查

目的 调查广东省不同组织形式的社区卫生服务机构功能完善情况。方法 采用问卷和现场检查的方式。结果 广东省城市社区卫生服务机构功能完善情况总体较好，但对某些服务功能如上级医院向下转诊、计划免疫工作的开展、配合计划生育工作等在不同组织形式中完善程度差异很大。结论 在社区卫生服务中，要进一步加强和完善健康教育进入社区、上级医院向下转诊、机构内计划免疫服务、家庭健康档案的建立等工作。     

社区卫生服务质量管理的探索

目的：探索社区卫生服务质量管理模式。方法：建立质量监控体系，强化全员质量意识，制定质量管理方案，从组织机构，卫生技术、人员队伍与信息资料等方面实施质量管理。结果：社区卫生服务支持管理组织与技术服务网络覆盖率分别达到１００％和９１％。社区卫生服务站提高综合服务技能，基本实现“四化”、“五统一”；卫生服务向家庭延伸，建立了家庭健康档案１５．８万份，家庭卫生保健服务合同２万余份；与１９９６年相比，１９９     

社区卫生服务机构全科医师胜任力实证研究

目的 构建我国社区卫生服务机构的全科医师胜任力模型.方法 通过文献查阅分析及相关专家的深度访谈,初步建立包含16项因子的全科医师胜任力模型,并设计包含16项胜任特征的调查量表.选择江苏省镇江市7个区的社区卫生服务机构的部分医务人员进行全科医师胜任力问卷预调查(n=55)和实证研究(n=201).采用Likert五级量表进行度量,要求调查对象判断各个胜任特征的重要程度,并根据重要程度从5～1进行记分;采用SPSS和LISREL软件对调查量表收集的数据进行探索性因子分析和验证性因子分析.结果 探索性因子分析显示:各胜任力特征项的载荷系数均达到0.5以上,总体α系数在0.9以上,人力资本、心理资本和关系资本3个因子的方差解释量为84.876％,说明最表具有良好的信度和效度.实证性因子分析显示:人力资本是全科医师最为主要的胜任力特征,其中非专业知识的修养、综合管理能力和分析判断能力更为重要;事业心是心理资本最为重要的胜任特征;在关系资本方面,最为影响全科医师绩效的胜任特征是与签约的社区居民的关系.结论 构建的全科医师胜任力模型得到了验证,具有较高的拟合度和稳定性.     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系.由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线.从效果看降低了医疗和药品费用,提高r居民满意度.但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制.     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系.由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线.从效果看降低了医疗和药品费用,提高r居民满意度.但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制.     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系.由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线.从效果看降低了医疗和药品费用,提高r居民满意度.但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制.     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系.由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线.从效果看降低了医疗和药品费用,提高r居民满意度.但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制.     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系。由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线。从效果看降低了医疗和药品费用,提高了居民满意度。但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制。