基本公共卫生服务均等化研究综述

随着医改的深入开展,基本公共卫生服务均等化正由理论到实践,由局部向整体全面推进.文章试图从基本公共卫生服务及均等化的内涵、发展逻辑、测量评价、财政转移支付、市场化供给、主要问题等方面研究梳理及述评,提出推进基本公共卫生服务均等法制化建设,探索卫生资源公平分配与有效利用的新路径,构建基本公共卫生服务均等热化评价指标体系以及加快城乡卫生综合配套改革衔接的思考建议.     

武汉市基本公共卫生服务均等化评价指标体系实证研究

目的构建适合武汉市基本公共卫生服务均等化评价的指标体系,并通过实证研究评价指标体系的信度和效度。方法 2015年,采用Delphi法构建指标体系,选择24名基层工作人员开展实证研究,并对指标体系的信度、效度和指标权重设置的合理性进行评价。结果基本公共卫生服务均等化评价指标体系总的克朗巴哈α系数为0.966,指标体系现场调研的总评分与一级指标的Spearman相关系数分别为0.439、0.788、0.966和0.839,体系现场实证调研的总评分指标体系综合评分与重要性评分呈正相关(ICC=0.458,P=0.000)。结论基本公共卫生服务均等化评价指标体系具有较好的信度与效度,指标权重系数设置合理,适合武汉基本公共卫生服务指标均等化的考核。     

基于三角模糊层次分析法的基本公共卫生服务均等化效果评价研究

指标体系是评价基本公共卫生服务均等化的基础工具。文章针对基本公共卫生服务均等化评价中指标众多且专家打分不确定性等问题,提出了一种基于三角模糊层次分析法的均等化评价方法。首先,建立基本公共卫生服务均等化递阶层次结构;其次,运用三角模糊层次分析法计算得出目标层、准则层及指标层综合权重;最后,以我国中部A市某区基本公共卫生服务为例,对其均等化效果进行评价。     

基本公共卫生服务均等化绩效考核指标体系信度和效度分析

目的评价基本公共卫生服务均等化绩效考核指标体系的信度和效度。方法主要采用德尔菲专家咨询法,通过克朗巴赫系数（Cronbach’sα系数）、因子分析（factoranalysis）等方法检验指标体系的信度和效度。结果基本公共卫生服务均等化绩效考核指标体系条目总的Cronbach’sα系数为0．875,因子分析90．16％的总方差可以由6个潜在因子解释。通过四次方最大旋转对因子载荷起到了明显分离作用,使前5个公因子具有较明确的专业意义。结论基本公共卫生服务均等化绩效考核指标体系具有较好的信度与效度,适合作为基层医疗卫生机构绩效考核的测评工具。     

西北五省基本公共卫生服务均等化水平测量研究*

基本公共卫生服务均等化,作为当前深化医药卫生体制改革的一项重要制度和工作重点之一,是保证公共卫生资源优化配置和实现2020年达到"人人享有基本医疗卫生服务"目标的前提条件。本文首先通过以往研究,结合专家咨询法与层次分析法构建基本公共卫生服务均等化指标体系,并计算指标权重,运用西北五省的相关数据,在对原始数据进行标化的基础上,计算各省份的最终结果并进行排名,对进一步优化基本公共卫生均等化提出合理化建议。     

我国基本公共卫生服务“均等化”程度评价体系研究综述

对国内基本公共卫生服务“均等化”程度测量评价体系研究及实施效果方面的文献进行梳理研究,分析基本公共卫生服务项目在区域、城乡和人群之间的均等化效果评价体系研究存在的问题,建议加快从均等化角度评价实施基本公共卫生服务项目的效果评价体系研究。     

以公平正义的视角审视我国基本公共卫生服务均等化

从公平正义的视角阐释基本公共卫生服务均等化提出的必要性,并用公平正义思想指导基本公共卫生服务均等化的实践。基本公共卫生服务均等化的实施不强求绝对平均,但要做到相对均等,须保证起点公平、过程公平、结果公平。这需要加强卫生领域法制化建设,加大政府对偏远地区和农村地区的公共卫生投入力度,创新公共卫生人才机制,建立一个适合国情的基本公共卫生服务均等化绩效评价体系等。促进基本公共卫生服务均等化是实现社会公平正义的具体举措,也只有保证公平正义才能在真正意义上实现基本公共卫生服务的均等化。     

我国基本公共卫生服务均等化建设与发展内涵的思考

本文就我国基本公共卫生服务逐步均等化建设与发展的内涵展开较系统的理论思考,研究并讨论了基本公共卫生服务均等化的核心、属性、目标和特征等主要理论问题。认为:基本公共卫生服务均等化的核心内容是公共卫生服务,根本属性是保障"底线均等"的公平性,主要目标是逐步实现"均等化",基本特征是均等化过程的长期性、渐进性和发展性。应全面理解和准确把握基本公共卫生服务均等化的概念和内涵,完善理论认识,以适应基本公共卫生服务均等化建设与发展的需要。     

青州市实施基本公共卫生服务均等化存在问题及对策探讨

基本公共卫生服务均等化是我国基本公共服务均等化的重要组成部分.本文从基本公共卫生服务均等化的相关概念和内涵等方面,分析当前我市公共卫生服务存在的主要问题,并提出了实现均等化的相关政策建议,旨在促进我市基本公共卫生服务健康、持续发展.     

基本公共卫生服务均等化评价的实证研究

正本研究以前期构建的基本公共卫生服务均等化评价指标体系为基础,结合山东省2015年数据,采用TOPSIS和模糊综合评判两种方法验证指标体系的稳定性,并以此为结果评价山东省各地市基本公共卫生服务均等化水平。TOPSIS法对样本资料无特殊要求~([1]),模糊综合评判法是定性分析转化为定量分析的方法,运用该法进行综合评价更合理可靠~([2])。两种方法相结合能更科学验证指标体系的稳定性。前期构建     

Sex Differences in Personality Traits and Gender-Related Occupational Preferences across 53 Nations: Testing Evolutionary and Social-Environmental Theories

Using data from over 200,000 participants from 53 nations, I examined the cross-cultural consistency of sex differences for four traits: extraversion, agreeableness, neuroticism, and male-versus-female-typical occupational preferences. Across nations, men and women differed significantly on all four traits (mean ds = −.15, −.56, −.41, and 1.40, respectively, with negative values indicating women scoring higher). The strongest evidence for sex differences in SDs was for extraversion (women more variable) and for agreeableness (men more variable). United Nations indices of gender equality and economic development were associated with larger sex differences in agreeableness, but not with sex differences in other traits. Gender equality and economic development were negatively associated with mean national levels of neuroticism, suggesting that economic stress was associated with higher neuroticism. Regression analyses explored the power of sex, gender equality, and their interaction to predict men’s and women’s 106 national trait means for each of the four traits. Only sex predicted means for all four traits, and sex predicted trait means much more strongly than did gender equality or the interaction between sex and gender equality. These results suggest that biological factors may contribute to sex differences in personality and that culture plays a negligible to small role in moderating sex differences in personality.     

Sex Differences in Mental Rotation and Line Angle Judgments Are Positively Associated with Gender Equality and Economic Development Across 53 Nations

Mental rotation and line angle judgment performance were assessed in more than 90,000 women and 111,000 men from 53 nations. In all nations, men’s mean performance exceeded women’s on these two visuospatial tasks. Gender equality (as assessed by United Nations indices) and economic development (as assessed by per capita income and life expectancy) were significantly associated, across nations, with larger sex differences, contrary to the predictions of social role theory. For both men and women, across nations, gender equality and economic development were significantly associated with better performance on the two visuospatial tasks. However, these associations were stronger for the mental rotation task than for the line angle judgment task, and they were stronger for men than for women. Results were discussed in terms of evolutionary, social role, and stereotype threat theories of sex differences.     

Measures of goal attainment and performance in the World Health Report 2000: a brief, critical consumer guide

The World Health Report 2000 presents a set of indicators and global indices by which different countries' goal attainment and performance in health care may be compared. The paper explains the methods employed in some detail and raises a number of critical points. The WHO has gone too far in compressing the results of potentially useful primary measurements in summary indices with unclear meaning, dubious validity and little practical relevance to decision makers facing specific tasks and problems. The WHO has also gone too far in applying the same measuring rods to countries with different histories and values and different stages of development, and in encouraging international comparisons that are of little use to policy makers. The WHO needs to add an indicator of equality in access to its present indicator of fairness in financing.     

Inequality trends in the demographic and geographic distribution of health care professionals in China: Data from 2002 to 2016

China has long been negatively affected by a shortage and maldistribution of health workers. This study aimed to examine the national and regional trends in the demographic and geographic distribution inequality of health care professionals in China from 2002 to 2016. Based on data from the China Health and Family Planning Statistical and China Statistical Yearbooks, we calculated the Gini coefficient and the Theil T and Theil L indices based on the number of health care professionals per capita and per geographic area to measure the inequalities in their demographic and geographic distribution, respectively. The contributions by intra‐regional and inter‐regional differences on total inequality were explored within and among East, Central, and West China via Theil index decomposition. We found that the national demographic distribution of health care professionals maintained in an absolute equality level, and the inequality indices decreased gradually, whereas the corresponding geographic inequalities were severe and presented a worsening trend. Compared with nurses, physicians not only maintained higher densities but also maintained a more equal distribution. Intra‐regional disparities within the east, central, and western regions were the main cause for overall demographic inequality, whereas both intra‐regional and inter‐regional disparities significantly contributed to overall geographic inequality. To conclude, the distribution equality of health care professionals by population was satisfactory, whereas the corresponding distribution inequality by area was severe. Different types of distribution inequality of health care professionals existed regionally and nationally despite their increasing quantities and densities. Factors beyond population size should be considered when the government introduces health workforce allocation policies.     

The impact of filipino micro health-insurance units on income-related equality of access to healthcare

BACKGROUND: This study aims to assess the impact of being insured by micro-health insurance units (MIUs) on equality of access to health care among groups with inequitable income distribution. We measure equality by relating income with access to healthcare. The analysis is based on a household survey conducted in five regions in the Philippines in 2002. METHODS: We generated concentration curves and indices (CI) for insured and uninsured households (150 for each cohort in each region). We also elaborated a method to retain the relative income rank of households when data were aggregated across regions, as the regions had quite different nominal income levels. RESULTS: We found a significant effect of household income on access to hospitalizations among the uninsured households (a positive CI), but no such effect among the insured households (CI close to zero). As regards professionally attended deliveries, an increased tendency of poorer households to deliver at home (CI slightly negative) and a lower rate of deliveries in hospital (CI slightly positive and statistically significant) were reported by both uninsured and insured households. Access to consultations was unrelated to income among the insured (CI close to 0), but negatively correlated with income among the uninsured (a positive and significant CI). CONCLUSION: We conclude that MIUs in Philippines improve income-related equality of access to hospitalization and medical consultation in cases of illness. The findings of this study strengthen a claim for government support for the operation of MIUs as successful (albeit micro) suppliers of health insurance.     

A simple logical solution to eliminate the limitations of using the number needed to treat

Because it can be easily understood by clinicians, the "number needed to treat" (NNT) has recently received considerable attention in the clinical sciences. When the NNT is applied to summarize findings, it is important to understand the limitations of its use. First, the important confusion and criticisms found in the past on using the confidence interval of the NNT are summarized. To eliminate the confusion and criticisms, the NNT should be used only when there is some prior knowledge to rank the order of the response rates under comparison. An example is included to illustrate the use of the proposed approach and show how a number of the criticisms, limitations, and undesirable properties of the interval estimator for the NNT can be avoided. To test the equality of two response rates, the use of test statistics based on other well-established indices is recommended in lieu of the NNT.     

卫生经济学视阈中卫生服务公平与效率的关系研究

卫生服务的公平与效率是卫生事业发展的核心问题。卫生服务公平是机会公平、过程公平和质量公平的有机统一;卫生服务效率包括制度效率、经济效率两个方面。基于卫生经济学的视阈,卫生服务中应该坚持"公平优先,兼顾效率"的原则。在宏观上政府要合理的配置卫生资源,积极推进区域卫生计划,提供公平、有效和经济的卫生服务;在微观上加强对医疗机构的经济管理。进而实现公平与效率的和谐统一。     

我国中医人力资源配置公平性分析

目的 探讨我国2012年中医人力资源配置的公平性问题.方法 运用洛伦兹曲线与基尼系数、泰尔指数对全国各省区市中医类医院的中医类执业医师(含执业助理医师)、中药师以及护士等指标进行人口公平性分析.结果 31个省区市中医人力资源配置的人口公平性良好,基尼系数均在0.1以内.泰尔指数贡献率显示地区内差异是引起目前不公平的主要原因.结论 中医人力资源现阶段面临的主要任务是在解决人力资源总量不足的同时,注重配置公平性.     

Macro-level gender equality and alcohol consumption: a multi-level analysis across U.S. States

Higher levels of women's alcohol consumption have long been attributed to increases in gender equality. However, only limited research examines the relationship between gender equality and alcohol consumption. This study examined associations between five measures of state-level gender equality and five alcohol consumption measures in the United States. Survey data regarding men's and women's alcohol consumption from the 2005 Behavioral Risk Factor Surveillance System were linked to state-level indicators of gender equality. Gender equality indicators included state-level women's socioeconomic status, gender equality in socioeconomic status, reproductive rights, policies relating to violence against women, and women's political participation. Alcohol consumption measures included past 30-day drinker status, drinking frequency, binge drinking, volume, and risky drinking. Other than drinker status, consumption is measured for drinkers only. Multi-level linear and logistic regression models adjusted for individual demographics as well as state-level income inequality, median income, and % Evangelical Protestant/Mormon. All gender equality indicators were positively associated with both women's and men's drinker status in models adjusting only for individual-level covariates; associations were not significant in models adjusting for other state-level characteristics. All other associations between gender equality and alcohol consumption were either negative or non-significant for both women and men in models adjusting for other state-level factors. Findings do not support the hypothesis that higher levels of gender equality are associated with higher levels of alcohol consumption by women or by men. In fact, most significant findings suggest that higher levels of equality are associated with less alcohol consumption overall.     

国内公共卫生服务均等化的理论探讨及研究现状

公共卫生服务均等化是当前社会经济生活中的热点,也是新医改方案明确提出的今后三年的五项重点工作之一。本文主要从对公共服务均等化时代内涵的理解入手,分析和总结我国公共卫生服务均等化的现状、存在的问题及公共财政体制对均等化的影响,认为实现公共卫生服务均等化,政府公共财政需承担更大的责任,同时要加快公共财政立法保证均等化的实现。