广州市精神科床位及其人员配置的现况调查

目的了解广州市精神科床位及其人员配置的现状。方法采用自编调查表对广州市15家有精神科床位的医疗卫生机构进行调查。结果截至2009年末,广州市精神科定编床位3440张,床位密度为3.33张/万人,实际使用床位5767张,实际使用床位密度为5.58张/万人。增城市、从化市、花都区、海珠区均未设置精神科病床。共有精神科医师421人,精神科护士1050人,每10万人口医师数为4.07名,每10万人口护士数为10.16名。结论广州市精神科床位及医护人员的数量不足,分布不平衡。精神卫生专业机构目前超负荷运作,需要加大投入,增加床位及医护人员。     

灰色预测在新建医院开放床位数预测中的应用

目的探讨灰色预测在新建医院开放床位数预测中的应用。方法以东莞市2004—2010年人口数据为依据建立人口灰色预测模型,对2013—2015年当地常驻人口进行预测。根据当地医疗卫生基本数据测算当地开放床位需求及缺口,对新建医院开放床位进行预测。结果模型预测当地人口2015年达到103.65万人。2015年塘厦新医院的首期开放病床需要达到800张。各类开放病床需呈合理分布。结论数学建模用于新医院开放床位的预测简便、实用,有助于卫生资源规划和配置,值得进一步研究。     

2015 年上海市精神卫生机构与床位资源现状分析

摘要 目的：了解上海市精神卫生医疗机构和床位资源现状,探讨现有资源的数量与特征,为上海市精神卫生工作规划（2016-2020）的制定提供参考。方法：采用描述性分析的方法对上海市精神卫生医疗机构的数量、主办单位、区域分布、床位密度等指标进行分析。结果：2015年末,上海市共有精神卫生医疗机构64家,实际开放床位数14267张,床位密度为5.91张/万人;精神卫生医疗机构以精神专科医院和综合性医院为主,占全部机构数的71.88%;精神科床位主要集中在精神专科医院,占总床位数的93.21%;精神卫生床位资源多集中在静安、徐汇、黄浦、虹口等中心城区。结论：上海市精神卫生资源配置的数量、结构和地区分布不合理,民办精神卫生资源有待进一步发展。     

上海市精神专科医院床位分析和发展建议

运用历史比较、横向比较等方法分析了上海市精神专科医院床位配置和利用情况。结果表明：（1）上海市精神专科医院床位持续增长,2008年每万人核定床位数达到了5.53张,实际开放床位数比核定床位数要高41%,床位使用率在120%左右,床位供给比较紧张。（2）与全国其他省、直辖市、自治区相比,上海精神专科医院床位配置水平最高;与发达国家相比,配置水平则垫底。近50年来,上海持续扩增床位,而西方发达国家持续削减床位,扩增曲线和削减曲线恰好在目前上海床位配置水平上交汇,提示上海正处于扩增床位还是严控床位的十字路口。（3）鉴于上海社区精神康复机构数量较少、建设缓慢的事实,以及这一事实在未来5年内的继续存在,所以分流病人比较困难,建议继续适度增加核定床位来满足日益增长的住院需求。     

上海市老年护理床位配置现状及问题

目的 :论证上海市老年护理床位的配置现状及存在问题。方法 :通过横断面调查获得床位数据,引用卫生统计年鉴、卫生财务年报等资料,通过纵向和横向比较,分析老年护理服务床位数量及构成的合理性。结果 :2012年上海市平均每千65岁及以上老年人口的护理床位数为49.3张,与发达国家齐平。老年护理医疗床位平均每千人口床位数仅6.4张,养老床位则为每千人口42.9张。老年医疗护理床位的使用率近90%,而养老床位入住率仅为70%左右。结论 :上海市老年护理床位总体上基本满足需求,但医疗护理床位相对匮乏与养老床位相对宽裕并存。增加政府重视和协调、明确老年护理机构功能定位和需方需求评估标准,合理引导分流成为当前解决问题之策。     

上海市精神卫生服务床位需要测算和规划

运用世界卫生组织建议的床位需要量测算方法测算了上海精神卫生服务的床位需要,结合上海实际情况,提出了分阶段扩大床位供给的方案,以及优化精神卫生服务提供系统、提高床位使用效率的设想。研究认为,上海精神卫生服务床位存在着供给不足和效率低下双重问题。为解决供给不足问题,针对患有重性精神疾病而可能发生严重危害社会行为的病人应配置床位3518张（每千人口0.25张）,针对患有重性抑郁障碍有自杀倾向的病人应配置床位2259张（每千人口0.16张）,针对患有重性精神疾病可能致残的病人应配置床位10554张（每千人口0.75张）,具体床位配置水平应与经济发展和医疗保障水平相匹配。     

湖北省通山县卫生资源配置现状调查分析

目的:通过对通山县2008年卫生人力资源、卫生物力资源、卫生财力资源及医疗机构卫生服务供给情况等方面卫生资源情况的分析.为制定湖北省卫生规划提供基础性数据.促进卫生体制的改革.方法:采用普查的方法,对通山县卫生资源的各类指标的绝对数、均数及构成比等进行描述性分析,并与全国的总体水平进行对比.结果:2008年通山县共有医疗机构241个,共有床位593张,卫生工作人员1466人,每千名人口卫生专业人员3.2人,全县医护比为1:1.2,每千人口床位为1.32张.结论:各类医疗卫生机构配备不齐全,卫生资源结构配置不合理,卫生专业技术人员配置不合理,防保专业人员配置过少,乡镇卫生技术人员中严重缺乏护理人员.     

2020—2025年广东省医疗机构床位需求预测

目的预测2020—2025年广东省医疗机构的床位需求总量。方法基于卫生服务需求法与Holt双参数指数平滑模型,结合年龄别人口数据预测床位需求。结果 2025年,广东省住院人数为2 425.11万人,床位需求数为70.04万张,每千常住人口床位需求数为5.63张、每千常住人口拥有床位数5.55张,供需比例为98.58%。预测模型的平均百分误差为1.63%(标准差=±1.90%,均方根误差=20.63)。结论结合人口的年龄结构进行预测结果更稳定、误差更小。2020年,广东省的床位配置量基本能满足床位需求,供需较为平衡。但2024年床位需求将超过床位配置总量。未来,广东省应加大床位资源的投入力度,提高基层卫生机构的床位利用率,全面落实分级诊疗制度。     

云南省曲靖市医疗床位配置标准测算方法研究

[目的]测算曲靖市医疗机构的床位配置标准。[方法]采用卫生服务需求法、人口比值法与专家咨询3种方法分别测算出曲靖市医疗床位的配置标准,再将3种方法按照40%,40%和20%的权重比例计算出一个综合标准。[结果]人口比值法和卫生服务需求法的配置标准均为3.04张/千人口,专家咨询法配置标准为2.77~3.33张/千人口,综合配置标准为2.99~3.10张/千人口。[结论]本研究制定的医疗床位配置标准具有科学性并符合曲靖市实际现状和发展需要。     

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　　医疗机构设置规划新指导原则确立
　　近日,国家卫生计生委发布《医疗机构设置规划指导原则（2016-2020年）》,提出县级区域原则上设置1家县办综合医院和1家县办中医类医院;地市级区域,每100万～200万人口设置1～2家地市办综合医院;省级区域划分片区,每1000万人口规划设置1～2家综合医院。新设置的县办综合医院床位数原则上不超过1000张,新设置的地市办综合医院床位数原则上不超过1200张;新设置的省办及以上综合医院床位数原则上不超过1500张。原则上各省（区、市）三级综合医院床位总数不得超过区域医疗机构床位总数的30%,不超过区域医院床位总数的35%。     

The Carter Center Mental Health Program: addressing the public health crisis in the field of mental health through policy change and stigma reduction

Some of the most pervasive and debilitating illnesses are mental illnesses, according to World Health Organization's The World Health Report 2001 — Mental Health: New Understanding, New Hope. Neuropsychiatric conditions account for four of the top five leading causes of years of life lived with disability in people aged 15 to 44 in the Western world. Many barriers prevent people with mental illnesses from seeking care, such as prohibitive costs, lack of insurance, and the stigma and discrimination associated with mental illnesses. The Carter Center Mental Health Program, established in 1991, focuses on mental health policy issues within the United States and internationally. This article examines the public health crisis in the field of mental health and focuses on The Carter Center Mental Health Program's initiatives, which work to increase public knowledge of and decrease the stigma associated with mental illnesses through their four strategic goals: reducing stigma and discrimination against people with mental illnesses; achieving equity of mental health care comparable with other health services; advancing early promotion, prevention, and early intervention services for children and their families; and increasing public awareness about mental illnesses and mental health issues.     

Advocacy for mental health: roles for consumer and family organizations and governments

The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.     

A comparison of health-related quality of life for individuals with mental health disorders and common chronic medical conditions

OBJECTIVES: The purpose of this study was to compare the burden of disease experienced by people with mental health conditions with people who have common medical disorders. Three prevalent medical disorders--the burden of disease of back/neck problems, diabetes, and hypertension--were compared with the mental health category of depression, anxiety, or emotional problem. METHODS: This study used data from the nationally representative 2003-2004 National Health and Nutrition Examination Survey for respondents aged 18 or older (n = 4,833). The measurement of health-related quality of life (HRQOL) used was the Healthy Days Measures developed by the Centers for Disease Control and Prevention. Unadjusted and adjusted HRQOL were compared for individuals reporting each of the four conditions. Adjusted HRQOL was assessed using ordinary least squares regression, which controlled for gender, age, race/ethnicity, education, marital status, comorbidity, and income. RESULTS: Individuals with mental health conditions experienced 17.6 total unhealthy days per month, while those with back and neck problems and those with hypertension experienced 12.2 total unhealthy days per month, and those with diabetes experienced 12.3 total unhealthy days per month. After adjusting for socioeconomic and demographic characteristics as well as comorbid conditions, mental health conditions were responsible for a 6.8-day decrease in healthy days per month compared with average adults (p < 0.001). Mental health conditions resulted in significantly lower HRQOL than back or neck problems (p = 0.053), diabetes, (p = 0.002), and hypertension (p = 0.012). CONCLUSIONS: There were significant differences between the HRQOL found in mental and medical conditions, with mental health conditions being responsible for significantly greater impairment of HRQOL. An efficient health-care system should consider the relative disease burden of specific conditions when allocating public health resources.     

Organization and financing of mental health care in Poland

ORGANIZATION OF CARE: Health care is provided to patients with mental disorders by the state health care facilities as well as by social help agencies. Mental health care services are provided mostly by mental health facilities and partly by primary care units. Outpatient clinics, separate for psychiatric patients and substance abusers, are the most numerous mental health care units, amounting to a total of 1120. Intermediate care facilities include 110 day hospitals, 23 community mobile teams and ten hostels. The number of hospital beds amounts to 31913, i.e. 8.3 beds per 10000 population. 80% of beds are located in mental hospitals. TRENDS OF DEVELOPMENT: The trends in mental health care development are outlined in the Mental Health Programme and accompanying documents accepted by the Minister of Health and Social Welfare. The programme defines specific goals to be achieved by the year 2005 in the primary, secondary and tertiary prevention of mental disorders. In the domain of mental health care accessibility the most important goals are the following: a significant reduction in the number of beds in large mental hospitals, a marked (nearly threefold) rise in the number of beds in psychiatric wards at general hospitals and a significant increase in the number of community-based forms of care (e.g. a fourfold rise in the number of day hospitals). FINANCING OF CARE: Before 1999, the health care system was financed from the state budget and the health care spendings were subject to a political auction each year. Allocation of funds among hospitals and health care centres was based on the total previous year budgetary spendings of particular facilities and did not take into account a detailed cost analysis. Such a financing approach, although giving a feeling of a relative financial safety, did not encourage health care facilities to introduce an organizational flexibility and to expand the scope of their services. In psychiatry, it manifested itself in a very slow development of some community psychiatry forms (mostly day hospitals, mobile community teams and hostels). The Health Care Institutions Act has created a legal framework for the financial management of health care units in their new, independent form. Conditions for health care financing through regional sickness funds were thus created. The financing is currently based on contracts made by sickness funds with health care facilities for specific health services. Both the quantity and price of services should be mutually negotiated. Some simplified measures of services offered were used during the first insurance financing year. In mental hospitals and day hospitals it was a person-day; in out-patient care it was a visit. Both cost indicators were aggregated, including all the components present so far in the functioning a given unit.     

Inclusion of essential components of the World Health Organization palliative care development model in national palliative care plans: A documentary analysis in 31 countries

ContextThe World Health Organization has proposed a new model for the development of palliative care. Whether the current national palliative care plans of Member States are aligned or need to be reformed to meet the new model is unknown.MethodsWe conducted a documentary analysis of national palliative care plans based on an analytic framework structured with the elements recommended by the World Health Organization: (a) building a plan, (b) plan components, and (c) plan implementation. We conducted a categorical analysis of national plans by subgroups according to income and development level of palliative care.FindingsWe identified 112 countries with a palliative care plan, of which 31 were included in the analysis. Of these 31 plans, only 8 had the six components proposed by the World Health Organization, 29 reported an implementation strategy, 23 were aligned with the country's national public health plan, and 15 allocated financial resources for plan implementation. All the national plans assessed included the component provision of palliative care in integrated health services; 93%, education and training; 83%, research; 80%, empowered people and communities; 54%, health policies related to palliative care, and 48% use of essential medicines.ConclusionsNational palliative care plans include the two new development components, but few are fully aligned with the 2021 World Health Organization's model.     

精神卫生资源配置与精神疾病服务供给的关系研究

目的分析2015年中国精神卫生资源配置和重性精神疾病管理相关服务的关系,分析当前中国精神卫生服务存在的缺陷,为精神卫生人力资源配置提供依据。方法使用Excel整理分析《中国卫生统计年鉴2016》和学者相关研究结果中的数据,采用SPSS分析精神卫生资源和服务供给之间的相关性。结果 2015年中国内地每10万人口精神科医师数量的均值为2.19人,每10万人口护理人员数量的均值为5.51人,每万人床位数为3.15张;精神科门急诊总人次为4005.1万人次,出院总人次为1987534人;精神卫生相关医生、床位和护士的数量和精神科门急诊人次、精神科出院人次存在相关关系(p<0.05),与重性精神疾病报告患病率、重性精神疾病患者规范管理率也存在相关关系(p<0.05)。结论不同省份之间精神卫生资源配置与服务供给不平衡,对社区精神疾病的管理和预防投入较少,资源配置与当前精神卫生服务的重点和发展趋势不匹配。     

Rural health around the world: challenges and solutions

Despite the huge differences between developing and developed countries, access is the major issue in rural health around the world. Even in the countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport and communication, and they all face the challenge of shortages of doctors and other health professionals in rural and remote areas. Many rural people are caught in the poverty- ill health-low productivity downward spiral, particularly in developing countries. Since 1992, WONCA, the World Organization of Family Doctors, has developed a specific focus on rural health through the WONCA Working Party on Rural Practice. This Working Party has drawn national and international attention to major rural health issues through World Rural Health Conferences and WONCA Rural Policies. The World Health Organization (WHO) has broadened its focus beyond public health to partnership with family practice, initially through a landmark WHO-WONCA Invitational Conference in Canada. From this has developed the Memorandum of Agreement between WONCA and WHO which emphasizes the important role of family practitioners in primary health care and also includes the Rural Health Initiative. In April 2002, WHO and WONCA held a major WHO-WONCA Invitational Conference on Rural Health. This conference addressed the immense challenges for improving the health of people of rural and remote areas of the world and initiated a specific action plan: The Global Initiative on Rural Health. The "Health for All" vision for rural people is more likely to be achieved through joint concerted efforts of international and national bodies working together with doctors, nurses and other health workers in rural areas around the world.     

Framework and methodology for evaluating mental health policy and plans

The importance of monitoring and evaluation for mental health service planning and delivery is indubitable. Notwithstanding, monitoring and evaluation of mental health policy and plans has received only limited attention. This paper presents an approach developed by the World Health Organization for monitoring mental health policy and plans that can be adapted and utilized for evaluation and monitoring of policy and plans in most other health spheres as well. Four critical areas are outlined i.e., evaluation of the policy document and the plan derived from it; monitoring the implementation of the strategic plan; evaluation of the implementation of the plan; and evaluation of whether the objectives of the policy have been achieved. Overcoming difficulties in objective assessment of policy documents and plans is discussed and two WHO checklists for evaluating the process, content and operational aspects of policies and plans are introduced together with a five step guidance process for conducting policy and plan evaluations. Copyright © 2010 John Wiley & Sons, Ltd.     

安徽省医疗机构精神卫生服务资源和利用现状调查

目的 了解2018年安徽省医疗机构精神卫生服务资源和利用情况，为今后有针对性地开展工作提供依据。方法 采用自行设计的调查表收集全省2018年精神卫生医疗机构的相关数据。结果 （1）全省开设心理门诊或（和）精神科的医疗机构79家，包括56家公立医疗机构和23家民营医疗机构。（2）全省精神科执业（助理）医师共有1 336名，精神科执业（助理）医师密度达到2.11名/10万人，开设床位15 153张，床位密度2.40张/万人。（3）2018年全省精神科门诊及心理门诊量1 477 879人次，急诊量22 094人次，入院患者数量101 638人次，出院患者数量108 282人次，出院患者平均住院日39.78（24.00，64.60） d，床位使用率102.75%。结论 2018年安徽省精神卫生资源与过去相比虽然取得了长足的发展，但是精神卫生服务能力仍达不到社会对精神卫生服务的需求。