卫生系统反应性——概念与测量

卫生系统反应性是卫生系统的产出之一，它是指医疗卫生机构对个体普遍合理期望的认知和适当的反应。卫生系统的反应性由七个方面组成，分为两个部分。第一部分为对个人的尊重，包括尊严、保密性和自主性三个方面；第二部分为以病人为中心，包括及时性、社会支持、基本设施质量和选择性四个方面，反应性一词往往被等同与病人满意度，反应性与病人的满意度和服务质量是有区别的，尽管它们之间有许多相同之处，它们的主要区别有：（1）范畴：病人的满意度主要体现在特定卫生服务环境下对医疗活动的反应，而反应性则是对整修卫生系统的评价。（2）范围：病人的满意度包括医疗和非医疗两个方面，而反应性仅指卫生系统的非医疗方面。（3）原理：病人的满意度是根据个人的期望和医疗活动经历，对已接受的服务进行的评价。测量卫生系统反应性的重要性主要表现在：（1）了解公众的合理期望是卫生系统管理的核心。（2）反应性是基础。因为它涉及到基本人权，反应性目标的核心就是保护和提高基本人权。（3）卫生系统不需要大量的投入即可改善反应性的部分指标。（4）在卫生系统的三个目标中，反应性的改善可能是最快捷的，因为他不需要大量投入，同时，干预措施的结果可立即显现，反应性的改善比健康的改善要快得多。

The Concept and Measurement of Responsiueness of Health System

Responsiveness in the context of a system can be defined as the outcome that can be achieved when institutions and institutional relationships are designed in such a way that they are cognisant and respond appropriately to the universally legitimate expectations of individuals. Responsiveness is composed of dignity, autonomy, confidentiality, prompt attention, social support networks, quality of basic amenities, and choice of providers. It is different from patient satisfaction and quality of care in three main aspects. (1) Scope: patient satisfaction focuses on clinical interaction in specific health care settings whereas responsiveness evaluates the health system as a whole. (2)Range: patient satisfaction generally covers both medical and non - medical aspects of care while responsiveness focuses only on the non -health enhancing aspects of the health system. (3) Rationale: patient satisfaction represents a complex mixture of perceived need, individually determined expectations and experience of care. Responsiveness evaluates individual's perceptions of the health system against 'legitimate' universal expectations. The measurement of Responsiveness is very important because, a. Addressing the legitimate expectations of people is at the heart of the stewardship function of health systems, b. Responsiveness is fundamental, because it relates to basic human rights, c. A health system can improve some of the elements of responsiveness without large investments, d. Improvements in responsiveness may come before changes in performance on either of the other two intrinsic goals.