医院图书馆为社区卫生服务的方式

建立以社区卫生服务为基础的城市医疗卫生服务体系，切实解决群众看病难、看病贵的问题，是当前卫生改革的重点。面对新的发展形势，各级医院图书馆应根据自身功能和实际情况，调整职能，面向社区医疗和社区公众开展服务。我们认为医院图书馆为社区卫生服务可采取以下方式。     

美国的医疗服务体制及其对我国社区医疗工作的启示

美国的医疗服务体制以民间的私营医疗与保险为主，政府辅以对特殊群体的社会医疗保险与补助。美国的社区诊所是医疗服务体制的基础，设备先进，服务周到。我国应构建以社区卫生服务为基础、社区卫生服务机构与医院和预防保健机构分工合理、协作密切的新型城市卫生服务体系，形成小病在社区、大病到医院的医疗服务格局，切实解决群众看病难、看病贵的问题。     

开展社区医疗服务的思考与建议

1社区医疗服务概况 为方便群众就医，解决“看病难，看病贵”问题，1997年，党中央、国务院明确提出要积极发展社区卫生服务事业。到2005年，我国大中型城市已基本形成以卫生服务中心为主，卫生服务站为辅，医疗诊所、医务室为补充的社区卫生服务体系。目前全国已设置卫生服务中心3400多个，卫生服务站近12000个，社区医疗服务机构的数量多，网络布局也合理，[第一段]     

充分利用医疗资源降低基本医疗费用

看病难、看病贵的关键不是医疗资源贫乏,而是医疗资源的利用不充分、不合理.解决看病难、看病贵的关键是要按区域卫生规划规范药品经营、控制药品价格,建立医院以医补医的良性补偿机制,充分合理利用医疗资源,提高医院工作效率,降低医疗服务成本.     

城乡医疗联合体调查

城市医院与基层卫生院建立医疗联合体或实行医疗协作,是卫生工作在改革不断深入发展中出现的一种新的办医形式。笔者对鄂州市第二医院与鄂州市燕矶卫生院实行医疗联合体的情况进行了调查。结果表明,城乡医院实行医疗联合体是缓和在城市医院看病难、住院难的矛盾,解决基层卫生院的医疗现状与富裕起来的农民对医疗保健条件日益提高的要求不相适应的有效途径。通过这种形式,不仅能够互相取长补短,发挥优势,有助于解决大     

农民基本医疗费用由卫生站包干的形式与可行性研究

探索解决群众"看病贵、看病难"这一社会热点问题的方法。我院通过裕民村卫生站以医疗费用包干的形式对裕民村村民试行"免费医疗"服务半年,引导患者改变就医模式,促使医院改变经营理念。实现了村民"有病及时看、小病及时医、大病转医院"的目标,同时也使医疗机构树立了"花小钱、治好病"的理念。农民基本医疗费用由卫生站包干的方法为缓解农村村民"看病难、看病贵"问题提供了一个参考模式。     

“医疗直通车”进社区

为坚决贯彻落实上级关于医疗服务进社区，切实解决老百姓看病难、看病贵，探索二级综合性医院如何参与、重点加强农村三级卫生服务网络和以社区卫生服务为基础的新型城市卫生服务体系建设之中，充分发挥我院在人力、物力、财力等方面的资源优势，与社区卫生服务中心相衔接，做好社区医疗服务，我院决定以“医疗”为前提，采取“医疗直通车”的形式，即：专家社区巡回医疗服务-免费接送车-院内全程陪伴医疗服务为形式的一站式便民惠民利民医疗服务，开展社区医疗。我们的“医疗直通车”完全有别于以往作为交通工具的“病人接送车”，其关键是“突出医疗、排忧解难、便民惠民利民”。     

谁来为社区医疗抗航？

“小病不出社区，大病才上医院”。这是“十一五”规划中所提出的有关构建以社区为基础的新型城市医疗卫生服务体系的目标。 “看病难，看病贵”这个问题困扰我国百姓多年，国家为解决这个问题，采取了多种措施，其中发展社区医疗机构服务是最为人们所关注的。几年来，政府一直在大力推广社区医疗卫生服务，那社区医疗机构到底是个什么概念？目前在我国各城市的发展情况又如何呢？[编者按]     

社区卫生与医疗救助迎来新的春天 UHPP 总结经验 继往开来 加快发展 再创辉煌

2005年3月，国务院转了《民政部等部门关于建立城市医疗救助制度试点工作意见的通知》，提出进行医疗救助试点。2006年2月，国务院下发了《关于发展城市社区卫生服务的指导意见》，要求“将发展社区卫生服务作为深化城市医疗卫生体制改革，有效解决城市居民看病难，看病贵问题的重要举措，作为构建新型城市卫生服务体系的基础”。     

解决看病难看病贵的制度性对策探讨

看病难主要体现在到城市大医院看病和乡村农民看病,看病贵主要贵在药价虚高、开大处方和大型医疗设备滥用.文章试图在探究原因的基础上,从制度构建入手探讨解决看病难看病贵问题.     

Being rural in rural health research

This paper explores ways that being from a rural background might influence the health research process and why this might occur. It draws on the research experiences of three 'generations' of rural health researchers to suggest rural background affects how researchers approach and conduct study, and how they interpret findings. Concepts of positionality, habitus, performance and 'othering' are explored to suggest how existing sociological and philosophical ideas can explain why rural researchers possess a particular worldview that may influence their research outputs.     

Culture and rural health

This paper considers the role of culture in rural health, suggesting that the concept and its impacts are insufficiently understood and studied. It reviews some of the ways that culture has been considered in (rural) health, and states that culture is either used ambiguously and broadly – for example, suggesting that there is a rural culture, or narrowly – indeed perhaps interchangeably with ethnicity, for example Aboriginal culture as a unity. The paper notes that, although culture is a dynamic social concept, it has been adopted into a biomedical research paradigm as though it is fixed. Culture is often treated as though it is something that can be addressed simplistically, for example, through cultural sensitivity education. Authors suggest that culture is an unaddressed ‘elephant in the room’ in rural health, and that exploring cultural differences and beliefs and facing up to cultural differences are vital in understanding and addressing rural health and health system challenges.     

Doctors in vocational training: rural background and rural practice intentions

Objective: To report the findings of a national survey of Australian doctors in vocational training about their rural practice intentions and their plans to work full time or part time. Design: A self‐administered mailed survey. Setting: Vocational training: general practice and other medical college training programs. Subjects: Australian doctors (i.e. Australian citizens and permanent residents) registered with one of Australia's 17 medical college vocational training programs in September 2002. Main outcome measures: Intention to practise in a rural area on completion of vocational training; full‐time or part‐time practice plans; views about rural practice. Results: Of the 7899 doctors who met the criteria for inclusion in the study, 4259 (54%) responded. In total:14% indicated a preference for rural practice on completion of vocational training; 17% were GP trainees of which 31% preferred rural practice; 83% were registered with one of the other 16 specialist training programs (e.g. adult medicine, paediatric medicine and surgery) of which 10% preferred rural practice; 50% of general practice trainees and 23% of trainees in other specialist training programs with a rural background indicated a preference for rural practice in the long term, compared with 25% and 7%, respectively, of doctors with an urban background; 46% of general practice trainees with intentions to practise in a rural area plan to practise part time. A positive association was observed between rural background and preference for rural practice (odds ratio (OR) 2.9) and between preference for rural practice and enrolment in the rural general practice training pathway (OR 3.1) and involvement in rural education and training activities (OR 5.1). Conclusions: The findings of this study support initiatives to increase the number of rural background students entering medical school and rural education and vocational training initiatives. Australia's rural doctor shortage is not likely to be addressed by this cohort of doctors in vocational training. General practice workforce plans, rural and urban, need to take note of the high proportion of doctors who plan to practise part time.     

新型农村合作医疗和农村社区卫生服务的关系研究

桐庐县于2004年实施新型农村合作医疗试点，并同期开始乡镇卫生院向社区卫生服务转型，发展农村社区卫生服务，结合工作实践，文章就新型农村合作医疗与社区卫生服务关系进行了论述。     

实施"农民健康工程"推进农村社区卫生服务

2001年以来 ,保定市卫生局按照《关于农村卫生改革与发展的指导意见》 (以下简称《指导意见》)和省卫生厅关于实施“农民健康工程”的部署 ,坚持“政府主导 ,统一管理 ,多元投入 ,分类指导 ,全面推进”的原则 ,在总结涿洲市码头镇向阳卫生院实施农村社区卫生服务经验的基础上 ,选择6个县市 ,12个乡镇先行推开 ,收到明显成效。一、充分调动三个积极性 ,做好农民健康工作保定市是个农业大市 ,卫生工作突出问题有两个 :一是全市1072万人 ,85%的人口在农村 ;二是卫生资源相对丰富 ,但85%集中在城镇。要落实好“三个代表”和《指导意见》的要求 ,…     

The planning of rural health research: rurality and rural population issues

Rurality and rural population issues require special consideration when planning both qualitative and quantitative health research in rural areas. The objective of this article was to explore the issues that require attention when planning the research. This is the first of two articles and focus on issues that require consideration when undertaking rural health research. The diversity of study populations, the feasibility of a research topic, the selection of a research team, and the cultural traditions of Indigenous communities, are all aspects of rural health research planning that require attention. Procedures such as identifying the characteristics of the population, the selection of measures of rurality appropriate for the research topic, the use of local liaison persons, decisions on the use of 'insider' or 'outsider' researchers, and the identification of skills resources available, increase the quality of the research outcomes. These issues are relevant to both qualitative and quantitative research. Procedures are available to address issues of particular concern in developing appropriate methods for rural health research. While we have concentrated on Australian issues and solutions, rural localities in other countries may face similar issues. Attention to rurality and rural situations when planning rural health research, results in studies that support the continued improvement of health in rural communities.     

论农村医疗救助与新型农村合作医疗的有机衔接

新一轮医药卫生体制改革提出了近期着力抓好的五个方面重点工作,其中包括加快推进覆盖城乡的基本医疗保障制度建设。新型农村合作医疗（以下简称“新农合”）和农村医疗救助是农村基本医疗保障体系的重要内容,在新形势下研究两者的有机衔接,无疑具有重大的现实意义。