Measuring client-perceived quality of maternity services in rural Vietnam.

OBJECTIVE: To examine the feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternity services provided at commune health centres in rural Vietnam. DESIGN: A survey of 200 women who gave birth in July-August 2000 and 196 pregnant women in 34 communes in Quang Xuong District, Thanh Hoa Province, Vietnam. MAIN OUTCOME MEASURES: Inter-rater reliability, internal consistency and factor structure of the scale were examined. The associations between perceived quality and client characteristics were also investigated. RESULTS: The instrument had relatively good inter-rater reliability and internal consistency. Except for two items: 'good clinical examination' and 'adequacy of health workers for women's health', the scale exhibited good agreement between the two raters, with kappa values ranging from 0.54 to 0.84. The Cronbach's alpha coefficients for the dimensions 'health care delivery', 'health facility', 'interpersonal aspects of care' and 'access to services' were 0.72, 0.64, 0.72 and 0.33, respectively. Respondents were positive on items related to the dimensions 'interpersonal aspects of care' and 'access to services', but negative on the dimensions 'health care delivery' and 'health facility'. The maternity status of clients was found to influence the perceived quality of maternity services. CONCLUSIONS: The feasibility, reliability and validity of the instrument were established in the context of rural Vietnam. Its application in evaluating other health care programmes should be an important follow-up action for the Vietnamese government.     

城乡基层医疗卫生机构基本公共卫生服务居民满意度研究:以湖北省为例

目的:分析湖北省城乡居民对基本公共卫生服务的满意度及影响因素,为改善我国基本公共卫生服务质量提供政策依据。方法:根据经济发展情况选取湖北省武汉、黄冈、荆州地区共12家基层医疗卫生机构,对就诊居民进行满意度问卷调查,测量居民对基本公共卫生服务的可及性、舒适性、安全性和有效性的满意状况。结果:城乡居民对基本公共卫生服务的满意度得分为71.62分,总满意率为73.44%。城乡居民对基本公共卫生服务具体指标满意度最高的为就诊方便性(83.03%)和隐私保护(80.25%),满意度最低的指标为医疗技术(61.61%)和设备设施(64.53%)。Logistic回归分析结果显示,基本公共卫生服务的可及性、舒适性、安全性对社区居民满意度影响较大,性别及年医疗支出对居民满意度也有一定的影响。结论:城乡居民对基本公共卫生服务总体满意度处于一般水平,有待提升;城市平均满意度高于农村,农村地区存在较大的提升空间;基本公共卫生服务应进一步强化质量建设,促进城乡基本公共卫生服务均等化发展。     

Utilization of delivery services at the primary health care level in rural Vietnam

The objective of this study is to investigate factors that influence the utilization of delivery services at the primary health care level in rural Vietnam. A quantitative survey was conducted amongst 200 women who had given birth within the past 3 months. Focus group discussions and in-depth-interviews were then undertaken using the attitudes--social influence--self-efficacy model to obtain complementary information on the delivery decision. The results show that client-perceived quality of services and socio-cultural and economic factors, rather than geographical access, can affect the utilization of delivery services. It is therefore important to improve the cost-efficiency of the health care network, and delivery services should be provided in a client-oriented manner taking into account economic, social and cultural factors.     

对农村基本公共卫生服务工作的探讨

通过对福建省四个区县乡镇卫生院的调查,对农村基本公共卫生服务存在的问题进行了分析,就实现农村基本公共卫生服务均等化提出了建议,如改革卫生人才的培养和引进机制,确保农村基本公共卫生的经费投入,与新型农村合作医疗工作相结合,强化乡村卫生组织一体化管理等。     

公共卫生保障体系的建立与农村卫生改革

SARS的肆虐,使我们看到了建立公共卫生保障体系的迫切性;“三农”问题的日益突出,使农村卫生改革变得更加刻不容缓。把公共卫生保障体系的建立与农村卫生的改革有机地融合在一起,是一个新的思路,也是一个新的课题。本文试图对此作初步的探讨。     

我国农村卫生服务存在的质量问题分析及解决对策

随着我国卫生服务水平的发展，农村卫生状况已经有了极大的改善，然而农村卫生服务质量还是存在相当多的问题。本文针对农村卫生的特点，指出农村卫生服务机构中存在的质量问题，并分析其原因，提出解决问题的对策。     

The changing public/private mix in dentistry in the UK--a supply-side perspective

This paper examines the factors beyond NHS dentists' remuneration which may explain the variations in the public/private mix in general dental practitioners' workload in the UK. Given that NHS dentistry is subject to a fixed price system, the study focused mainly on non-income supply-side factors. Using data from a postal survey of a national random sample of dentists practising in the NHS in England in 1997, the study found that the strategies adopted by dentists in the management of NHS lists and the evidence that dentists spent significantly more time in private consultations compared with NHS consultations support concerns over equity of access to dental care and the quality of NHS dentistry. Dentists' attitudes to NHS and private dentistry revealed considerable ambiguity towards the NHS. While, on the one hand, the lack of sufficient demand for private dentistry emerged as a strong reason for remaining in the NHS, on the other, there was evidence that equity in access to dental treatment is still seen as an important principle. The implications of these findings in the context of recent discussion of the future of NHS dentistry are considered.     

浙江省农村公共卫生服务投入调查报告

选取9个县（市）27个乡（镇）为样本，对浙江省农村公共卫生服务投入进行深入调查。调查发现，浙江省农村公共卫生服务投入与经济发展不相适应，农村防保经费严重不足，乡镇卫生院负担较重，农村卫生服务开展随意性较强。为此，笔者提出了增加公共卫生投入，保证重点公共卫生服务项目，加强村卫生室管理，完善社会保证制度等建议。     

中国农村基本公共卫生服务研究的系统评价

目的：全面总结和分析2009年医疗改革以来,全国农村地区基本公共卫生服务的现状及其问题。方法：通过电子检索CBM、VIP、CNKI和万方数据库,查找2009年1月至2013年11月期间发表的所有研究中国农村基本公共卫生服务的文献,采用定性方法系统总结纳入文献的研究结果。结果：最终共纳入85篇文献,其中横断面研究占55篇,涉及最多的项目是高血压患者健康管理。结论：我国现有基本公共卫生服务的研究项目比重差异大,同时缺乏综合性研究和高质量的研究设计。提示各研究单位需要在后续的研究中,加强横向研究的交流,包括各地高校资源的利用,从更高的角度准确分析农村基本公共卫生的发展趋势,从而为农村基本公共卫生服务政策的制定提供更科学、客观的依据。     

Patterns of health service utilization and perceptions of needs and services in rural Orissa

Despite emphasis on strengthening local health care provision, concern remains regarding the rates of utilization of state-provided services within Orissa. The reported study examined patterns of service utilization across the rural population of four districts of Orissa, with special reference to perceptions of the availability and quality of state services at the primary care level. Within the selected districts, 219 interviews were conducted across 66 villages. Households reported utilizing a wide range of health care providers, although hospitals constituted the most frequently--and primary health care centres (PHCs) the least frequently--accessed services. Private practitioners (qualified and unqualified) represented a major sector of provision. This included high rates of access by scheduled tribes and castes (running at approximately twice the rate of access to both local and PHC provision). Key factors guiding patterns of utilization were reputation of the provider, cost and physical accessibility. Local health provision through assistant nurse midwives and male health workers was generally perceived of poor quality, with the lowest rates of resolution of health problems of all service providers. The location of a sub-centre base for assistant nurse midwives within a village had no demonstrable impact on access to services. Acknowledging constraints on broader generalization, the implications of the findings for informing health policy and programming within Orissa are noted. This includes support for current efforts to strengthen the capacity of PHC and sub-centre level provision within the state, and acknowledgement of the potentially growing role of effectively regulated private provision in meeting the needs of the rural poor.     

Household utilization and expenditure on private and public health services in Vietnam

The private provision of health services in Vietnam was legalized in 1989 as one of the country's means to mobilize resources and improve efficiency in the health system. Ten years after its legalization, the private sector has widely expanded its activities and become an important provider of health services for the Vietnamese people. However, little is known about its contribution to the overall objectives of the health system in Vietnam. This paper assesses the role of the private health care provider by examining utilization patterns and financial burden for households of private, as compared with public, services. We found that the private sector provided 60% of all outpatient contacts in Vietnam. There was no difference by education, sex or place of residence in the use of private ambulatory health care. Although there was evidence suggesting that rich people use private care more than the poor, this finding was not consistent across all income groups. The private sector served young children in particular. Also, people in households with several sick members at the same time relied more on private than public care, while those with severe illnesses tended to use less private care than public. The financial burden for households from private health care services was roughly a half of that imposed by the public providers. Expenditure on drugs accounted for a substantial percentage of household expenditure in general and health care expenditure in particular. These findings call for a prompt recognition of the private sector as a key player in Vietnam's health system. Health system policies should mobilize positive private sector contributions to health system goals where possible and reduce the negative effects of private provision development.     

泰安市不同性质学校中学生心理健康状况调查

目的 了解山东省泰安市公立学校与私立学校中学生心理健康状况之间的差异.方法 采用便利整群抽样方法,抽取泰安市2所公立学校和2所私立学校的中学生,采用症状自评量表 (SCL-90)进行匿名自填式问卷调查.结果 共发放问卷1232份,收回1232份,有效问卷1221份;公立学校学生579人,私立学校学生642人;公立学校、私立学校中学生轻度心理健康问题检出率分别为27.8%,53.4%,差异有统计学意义 (P<0.01);公立学校、私立学校学生中度以上的心理健康问题检出率分别为5.2%,15.4%,差异有统计学意义 (P<0.01);除了恐怖因子外,私立学校女生在其余8个因子得分均高于公立学校女生,且差异均有统计学意义 (P<0.01);私立与公立学校男生仅在抑郁因子分上差异有统计学意义 (P<0.01).结论 与公立学校比较,私立学校中学生心理问题更加突出,尤其是女生的心理问题更明显.     

经济欠发达地区农村社区卫生服务模式探索

目的:介绍经济欠发达地区农村社区卫生服务模式并评价该模式对促进农村卫生工作和初级卫生保健的有效性。方法:通过开发领导、培训卫生人员、制定标准及完善制度、开发激励政策等方面对试点进行干预。选取江西省崇义县作为干预组,江西省芦溪县作为对照组。2009年6月和2010年6月分别对两地进行基线调查和追踪调查,评价其实施效果。结果:通过开展社区卫生服务,崇义县卫生机构公共卫生服务数量增加,村卫生机构在3岁以下儿童系统管理、孕产妇产后访视、慢性病人管理等方面开展比例分别由53.1%、51.2%、46.9%上升到77.8%,73.3%、71.1%,居民对医疗服务(就诊、住院)满意度提高;芦溪县没有明显变化。结论:建立了一种通过服务理念、服务模式的改变和激励政策的开发促进农村初级卫生保健工作的工作模式,这种模式适合于经济欠发达地区,政府投入不会太大,也不需涉及机构的转型和太多的体制问题,给欠发达地区农村卫生改革提供了启示和借鉴。     

民营医院与公立医疗机构经济运行现状对比分析

文章以北京市丰台区民营医院为调查对象,根据丰台区2007—2009年统计数据,对民营和公立医疗机构的卫生资源、经济运行现状等方面进行对比分析,并提出加强对民营医院非营利性监管等措施。     

质量控制图在农村互助医疗保险项目监测中的应用

以中国农村互助医疗保险项目试点乡铁厂镇的门诊服务利用人次和门诊补偿费用的监测为例，介绍了质量控制图的制作方法以及质量控制图在项目运行监测中的应用，旨在探索我国的医疗保险制度的监测管理方法。     

婚前医学检查医师的基本素质与健康教育的关系

目的：探讨健康教育作为婚前技术服务的法定内容和重要策略，在实施婚前保健工作中的作用。方法：利用现代促进型健康教育模式。开展目标人群的健康教育。结果：健康教育有利于保障母婴健康，有利于帮助人们转变不良健康行为，有利于提高婚前保健服务质量。结论：健康教育已成为母婴保健服务的重要组成部份，在婚前保健中显得尤为突出，并提出从事这项工作的婚检医师应在伦理道德，业务能力等素质方面加强自身的提高。     

北京城乡基本公共卫生服务均等化现状评价及其对策

基本公共卫生服务均等化是国家"新医改"方案中近期实施的一项重要内容,其难点在于实现城乡基本公共卫生服务的"均等化"。北京作为国家的首都,提出要在全国"率先形成城乡经济社会发展一体化新格局"的目标。因此,评价北京城乡基本公共卫生服务均等化的现状,对北京市贯彻落实"新医改"方案和实现城乡一体化的目标具有非常重要的意义。     

提高福建省农村医疗卫生服务质量的探讨

调查表明,目前农村医疗卫生服务体系在不同地区发展不平衡;农民年医疗费用个体间差别很大,患重病的村民可能造成历病致贫现象。建议采取措施健全以乡镇卫生院为龙头的农村医疗医疗卫生服务体系网络,通过乡村一体化管理方式,不断提高服务质量,因地制宜建立农村社会医疗卫生服务保障制度。