江西省宜春地区城乡医疗服务情况调查

了解居民健康水平、医疗需求、患者对卫生服务的看法以及当地的卫生资源和医疗卫生服务资源的利用程度等情况是评价和管理卫生工作的基础 ,也是制订卫生计划的依据。在市场经济条件下 ,各医疗服务机构如何更好地满足患者的医疗需求有赖于对当前的医疗服务状况进行客观评价和预测。为此 ,我们于 1998年 10月 ,对江西省宜春地区城乡居民的医疗卫生服务情况进行了调查。基本情况1 调查内容　参照 1992年全国农村医疗卫生服务调查内容 ,重点是医疗卫生服务的需求、资源及其利用、城乡居民。2 调查方法　采用多级随机抽样方法、从本地区10个市、…     

大数据理念下居民医疗服务利用监测研究

居民医疗服务利用监测是卫生政策管理与研究的重要内容之一。国家卫生服务调查、居民医保就诊数据等传统的服务利用监测存在成本高、偏倚大,监测指标更新缓慢,无法满足新时期的卫生管理决策等问题。多数据源的数据衔接与再构架为居民服务利用监测提供了新的思路,通过Access数据库管理与Excel的编程技术能够实现不同数据源的对接,同时构架出居民年度医疗服务利用等具体问题的新数据库,从而反映居民的年度服务利用、居民就诊偏好、不合理的服务利用行为等,推动居民医疗服务利用监测研究的发展。     

改善卫生服务的公平性:任重而道远

提高卫生服务可及和公平,确保居民人人享有所需的基本医疗服务既是近年来国际热点问题,也是我国此次卫生改革的主要目标之一。当前的挑战主要体现为地区资源配置不公平、保险待遇差异引起的风险分担水平差异,以及服务供给中价格机制僵化。改善公平需要从加大偏远地区资源配置以提高其服务提供能力、缩小人群保险待遇差异、调整价格机制等方面入手,结合实际情况,科学决策,同时也需要多部门的协作。     

处方信息的分析和利用

处方是医疗活动中医疗信息的重要载体,是进行卫生服务调查研究的依据之一.一张完整的处方包含有患者的个人情况、医生的诊断印象、治疗方案、给药途径以及本次医疗活动中所发生的药品费用等信息[1].通过对处方内容的分析可以了解用药合理性、医生的技术水平、处方费用水平、当地疾病的罹患情况等信息,为卫生行政部门制定和规划卫生服务方案,分配卫生服务经费,采取行政干预措施提供理论依据.     

澳大利亚的医疗保障制度及实践

澳大利亚政府部门和私人企业在医疗保健服务中各自承担着不同的职责。分别起着不同的作用。联邦政府制订政策法规，进行宏观调控，州政府负责医疗计划，运行和管理医疗服务体系。私人医生和服务机构则是澳大利亚医疗服务的主要执行，在医疗费用方面、联邦政府，州政府和私人各出的份额大致相当，澳大利亚政府要求所有收入超过最低限的人都交纳医疗税，同时为绝大多数居民提供医疗保障福利。澳大利亚公立和私立医疗机构并存，医生，     

广东省卫生人力供需现状评价

卫生资源的配置是否合理 ,关系到能否使有限的投入达到最大的产出。卫生人力 (本文专指从事医疗工作的医生 )作为卫生资源的重要组成成分之一 ,近些年得到长足发展 ,达到一定的规模 ,但卫生人力的供需状态到底如何则不得而知。为了了解全省卫生人力的供需平衡状况 ,同时也为制定全省区域卫生规划服务 ,本文根据卫生服务调查资料和常规卫生统计年报资料 ,力求从供给与需求两方面评价全省及各地区的卫生人力供需平衡状况 ,并对今后的卫生人力的发展提出合理化建议。资料与方法居民健康状况、居民卫生服务需求与利用等资料来自 1998年全省卫生…     

卫生经济学在临床应用的价值综述

卫生经济学是关注有效分配医疗资源的经济学科,主要是通过可用的资源使社会对健康的收益最大化。在对医疗服务需求不断增加和医疗资源配置有限的情况下,卫生经济学在临床的应用越来越被重视,甚至在临床决策方面也逐渐发挥重要作用。通过介绍卫生经济学,并讨论其与临床应用的相关性,有助于临床医生理解卫生经济学与其医疗实践之间的联系,以及临床决策如何反映医疗资源配置。     

1980-2000年新疆卫生资源发展状况分析

对1980—2000年20年间新疆卫生资源拥有量的发展变化及卫生服务利用的变化进行分析。新疆卫生人力及医院床位的增长速度逐年下降，尤其是床位数近5年已是负增长。医生工作负荷减少，卫生资源利用效率下降，居民医疗负担加重。卫生资源配置应综合考虑当地经济、卫生资源发展及现状及居民的健康需求，合理规划卫生资源的布局和结构，提高卫生资源的利用效率。     

我国卫生服务资源的互动与整合

本文围绕我国医院与社区医疗资源互动与整合的实际,从宏观、中观和微观三个层次以及制度、医疗机构和居民行为三个方面对卫生资源的互动与整合进行分析;在阐述建立互动整合机制所需条件的基础上,介绍了卫生资源互动与整合的基本模式及特点,这对我国卫生服务的发展具有一定的指导意义.     

心血管专科卫生资源的优化配置研究

研究的目的是提出威海市二级以上医院心血管疾病专科建设的适度规模，为政府决策和区域卫生规划提供参考依据。方法：使用居民卫生服务调查数据计算心血管疾病的两周就诊率和住院率，利用人口资料得到居民的就诊人次和住院例数。通过医生评价的方法分析心血管疾病患者对各级医疗服务的需求结构。使用专家咨询法和文献法确定病床和医生的理想工作效率以及各类卫生人力资源之间的适宜配置比例，使用年增长率法预测人口规模以及需求的变化，进而计算现在和 ２００５ 年对各类卫生资源的需求数量。     

家庭医生签约服务的政策知晓及服务利用研究——基于杭州主城区签约居民调查

目的:了解杭州主城区家庭医生签约服务的现状。方法:通过分层随机抽样,抽取杭州主城区共397名签约居民,调查其对家庭医生签约服务的政策知晓及服务利用情况。结果:签约居民以门诊签约为主(占85.5%),61.9%为老年人,反映最多的问题是“缺少上门服务”“缺少个性化健康管理服务”“医保报销力度有限”和“转诊手续麻烦”。结论:家庭医生签约服务提高了社区卫生服务资源的使用效率;但要提升签约居民的服务获得感,有赖于强化基本公共卫生服务能力,并普惠家庭病床、远程健康监测及健康评估等服务项目。     

Disadvantage and discontent: a review of issues relevant to the mental health of rural and remote Indigenous Australians

OBJECTIVE: To provide an overview of the mental health of Aboriginal and Torres Strait Islander residents of rural and remote Australia and to identify associated factors. FINDINGS: Indigenous Australians have higher rates of serious mental disorders and of mental health problems associated with social disadvantage. This disadvantage is greater for Indigenous Australians living outside metropolitan centres. Contrary to romanticised constructions of remote Aboriginal Australia, those living in such settings are not immune to such hardship - which is often unrelenting. The psychological and behavioural problems that emerge as a result are compounded by narrowly focused and inadequate mental health services, with children being particularly vulnerable. CONCLUSION: Indigenous residents of rural and remote Australia experience high levels of mental disorder. Although addressing the predisposing social disadvantage will demand significant whole-of-government investment, ensuring equitable access to effective mental health services is an immediate priority.     

Medical e-commerce for regional Australia

The residents of rural and regional Australia have less access to health care services than in capital cities. There is a reluctance of General Practitioners to practice in the country. New information technology and government initiatives are now addressing this problem. High bandwidth videoconferencing is now being routinely used to provide psychiatric consultations to areas without this service. But this (like many other implementations of telecommunication technologies to health) has resulted in loss of revenue to regional Australia while benefiting capital cities. Thus, the current implementation of telecommunication technology to health has resulted in loss of revenue of the regions while increasing the bias towards the cities. Further, the system is not economically viable and requires the Government to inject funds for the smooth operation of the system. This paper proposes the use of telecommunication technology for enabling the communities of regional Australia to access health facilities via physical and virtual clinics. The proposed technique is self supporting and is based in the country with the intent to prevent the drain of resources from regional Australia. The technique attempts to eradicate the problem at the root level by providing a business opportunity that is based in and to cater for the needs of the remote communities. The proposed system would provide health services by physical and virtual clinics and while serving the communities would be profit centres- and thus attracting doctors and other resources to the remote communities.     

我国家庭医生签约服务现状研究——基于四省份的实地调研

目的:了解我国部分典型地区家庭医生签约服务状况,为提升家庭医生服务供给能力提出政策建议。方法:采用典型抽样法在青海、甘肃、安徽、浙江共选取7家基层医疗卫生机构,对13名机构负责人、23名家庭医生服务团队成员进行面对面半结构式访谈,运用主题框架法对访谈资料进行分析。结果:不同地区在家庭医生服务团队组建、服务模式上存在差异。基本医疗、公共卫生、健康管理、资源协调、政策宣传等服务是家庭医生的主要工作内容。当前,家庭医生签约服务面临职责不清、工作量大、物质激励不足、职业发展受限、居民主动性不强等共性问题。中西部地区在人力资源、技术支撑、服务条件等方面面临更大挑战。结论:建议优先明确家庭医生职责要求和签约服务规范,并优化薪酬待遇、职业发展等方面的保障机制。对于中西部地区,还需进一步加大家庭医生培养力度,提高家庭医生服务能力,强化签约服务技术支撑。     

Doctors and nurses in outback Australia: living with bush initiatives

This qualitative in-depth study investigates the work and life experiences of 18 female doctors and nurses in remote Australia. The study begins to unravel some of the events and relationships in the women's lives that keep them working and living in remote areas. The study also examines social and working conditions that cause the women to leave, and concludes that action must be taken at both government and local levels to support female health professionals who work in remote locations. This may be achieved by the means of a health promotion action model to underpin such initiatives as the 1999 Commonwealth Government 'fly-in-fly-out' initiative, in which sessional female doctors provide women's health services in remote areas.     

Does health service utilisation vary by remoteness? South Australian population data and the Accessibility and Remoteness Index of Australia

OBJECTIVE: To compare rates of self-reported use of health services between rural, remote and urban South Australians. METHODS: Secondary data analysis from a population-based survey to assess health and well-being, conducted in South Australia in 2000. In all, 2,454 adults were randomly selected and interviewed using the computer-assisted telephone interview (CATI) system. We analysed health service use by Accessibility and Remoteness Index of Australia (ARIA) category. RESULTS: There was no statistically significant difference in the median number of uses of the four types of health services studied across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use (> or =6 visits, 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was not statistically significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (e.g. 5.9% for highly accessible areas). CONCLUSION: The self-reported frequency of use of a range of health services in South Australia was broadly similar across ARIA categories. However, use of primary care services was higher among residents of highly accessible areas and public hospital use increased with increasing remoteness. There is no evidence for systematic rural disadvantage in terms of self-reported health service utilisation in this State.     

从嘉定区乡村医生队伍培养与建设思考我国乡村医生队伍的发展

乡村医生在我国农村卫生事业的发展中起着重要的作用,他们为广大农村居民提供了基本医疗和公共卫生等服务。但是,如何使这支队伍可持续地、健康地发展下去一直是政府、管理者和学者们思考的问题。嘉定区根据社区卫生服务综合改革和新医改的要求,对乡村医生队伍的培养与建设,研究和制定出了一些适应农村社会实际、可操作的政策和措施,初步解决了乡村医生培养、管理与发展的关键问题,这些成效不乏可以成为我国乡村医生队伍今后发展的范例和参考之处。     

天津市医疗机构精神卫生服务资源和利用状况调查

目的了解天津市医疗机构精神卫生服务资源和利用情况,为制定天津市精神卫生服务规划提供基础数据。方法使用《天津市医疗机构精神卫生服务状况调查问卷》调查并分析天津市18个区县365家医疗机构2006年精神卫生资源分布情况及精神卫生服务提供和利用情况。结果 2006年天津市有60家医疗机构提供精神卫生服务,共拥有精神科医生561人,精神科护士885人,精神科床位4281张,按人口密度计算分别为5.4/10万、8.5/10万、4.1张/万。全年总住院10449人次,门诊为434120人次。精神卫生资源相对集中于市内六区和其他六区,精神专科医院较综合医院的精神卫生资源更为丰富,三级医院所拥有的资源又明显多于一、二级医院。住院服务的利用主要在市内六区和精神专科医院,门诊服务利用主要在市内六区和非精神专科医院。结论天津市精神卫生资源处于国内较高水平,但是资源的分布和服务的利用极为不均衡,存在资源相对短缺和利用不足。     

Resource requirements to develop a large,remote Aboriginal health service: whose responsibility?

Abstract: In 1994 the Commonwealth funded studies to establish and develop Aboriginal health services. One such study was undertaken in 1995 at Maningrida, Northern Territory: to identify the health-service needs of the population and consider community management structures; to identify Northern Territory expenditure for primary health care; and to provide a three-to five–year development budget. Approximately 2100 Aboriginal residents in the region used the service, including 750 living on 24 outstations within 75 km. Nearly 40 per cent were aged under 15 years. Childhood morbidity was high, with children under two averaging 1.4 hospital admissions per year. The age pyramid reflected premature adult mortality from the third decade of life. Service providers identified inadequate staffing and infrastructure as barriers to service development. Community consultations emphasised the need for resident doctors, improved outstation services and aged and respite care, local training for Aboriginal health workers and housing for staff. These developments would require per capita primary health care expenditure ($872) to be doubled. Aboriginal people in remote areas are disadvantaged through Commonwealth Grants Commission funding formulae and lack of Medicare access. As the sole funding source, the Northern Territory spends over $1.83 million per year providing health services at Maningrida. Additionally, the study proposed that the Commonwealth spend $1.96 million a year over five years on staffing and infrastructure. Local Aboriginal organisations also agreed to allocate resources for health service development. Ineffective implementation, lack of clarification of government responsibilities and funding shortfalls remain barriers to developing remote Aboriginal health services. (Aust N Z IPublic Health 1998; 22: 133–9)     

Practical strategies for working with indigenous people living in Queensland,Australia

Internationally, occupational therapists have recognized the need to provide culturally appropriate services for indigenous people. This study explored experiences, perspectives and practical strategies of occupational therapists working with Aboriginal and Torres Strait Islander people living in rural and remote areas of Queensland, Australia. Semi-structured interviews were conducted with eight occupational therapists who had at least 12 months' experience providing services to Aboriginal and Torres Strait Islander people in health, rehabilitation or education services. Key themes identified in the data focused on strategies for facilitating effective communication with individuals and families, and collaborating with other service providers. The role of Aboriginal Liaison Officers or Indigenous Health Workers was emphasized by participating therapists. Participants identified resources that they perceived as useful in their practice, such as cross-cultural training and access to indigenous health workers. Other resources suggested for further development included information about learning styles of indigenous people and information about cultural variations between specific Aboriginal and Torres Strait Islander communities. The small number of participants limits generalizability of the findings. However, therapists can decide on the relevance of strategies to their own workplaces. Suggestions for further research focused on improving occupational therapy services for indigenous people in Australia. These include an investigation of therapy goals with indigenous people, and interviews with indigenous Australians and indigenous health workers about their experiences and perceptions of occupational therapy.