关于农村实行社区卫生服务的思考

1　农村实行社区卫生服务的必要性1.1　可改变目前卫生资源配置不合理的现状我国现行医疗机构不是按区域、人口规划设置,而是按部门、行政隶属关系设置,因而形成了城乡卫生资源反差问题突出。占总人口80%的农村人口仅占有卫生资源总量的20%。众多的卫生机构集中在城市,城市卫生资源浪费严重,而偌大的农村却只有乡镇卫生院、村卫生室,与重点人群需求不相适应,卫生工作应向农村重点倾斜。1.2　可充分利用农村地域分布特点和现有医疗条件农村分布多为自然村落,居民固定,方便建档,易于宣传、教育、组织、管理,以现有乡村卫生院、室为基础,在房屋…     

"看病贵、看病难"的卫生经济浅析

从卫生经济角度论述了“看病难”和“看病贵”的涵义、表现;剖析了其经济实质,分析了“看病难”是城市优质医疗资源提供的基本医疗服务不足与城乡众多患者基本医疗需求之间矛盾的突出表现;“看病贵”是城市优质医疗资源提供的基本医疗服务价格,高于城乡众多患者有支付能力需求之间矛盾的突出反映;提出了治理“看病难”、“看病贵”问题需要标本兼治的一些建议。     

试论卫生改革的“三稳”与“三活”

对已出台的卫生改革重要政策之一的“三保三放”的科学性、相关性及其内涵的探讨，引出一些不同意见，本人认为卫生改革政策中可提出“三稳”与“三活”。即：稳住城乡基本医疗眼务，搞活城乡特殊的医疗需求；稳住卫生防疫与劳动保护事业，搞活特殊的保健、养护需求与服务；稳住药品材料价格与卫生投入，搞活补品价格与卫生“三产”。下面简单分述如下：（一）稳住城乡基本医疗服务，搞活城乡特殊的医疗需求：作为公益性的福利事业，我国城乡基本医疗服务，只能加强不能削弱。目前我国的公费医疗制度、劳保医疗制度及农村的合作医疗制度都不…     

我国医疗卫生服务城乡分割和上下分割的现状分析及解决思路探究

针对我国医疗卫生服务存在城乡分割、上下分割,即农村卫生服务滞后于城市、优质资源过分向大医院集中、基层医疗卫生资源短缺、服务能力不强、不能满足群众基本卫生服务需求等问题,剖析其原因,探索解决思路：通过建立城乡卫生四级网,加大中央财政对农村医疗基础设施的投入,推进城乡医院对口支援工作,健全城乡基本医疗保障体系,以及做好区域卫生规划、建立医疗服务联合体等形式,推进医院与社区一体化、县乡和乡村一体化,引导医疗资源向农村和基层流动,带动基层医疗卫生服务能力和水平的提升,改善基层医疗卫生的便利性和可及性。     

城市和农村医疗卫生服务供给与需求的对比分析

为了解城市和农村医疗卫生服务供给与需求的现状,为决策部门合理分配卫生资源提供参考依据,根据浙江省城市地理位置和经济条件、发展程度,在全省范围内选择有代表性的城市和农村,采用城乡、区县、街村、住户４阶段分层随机抽样调查方法调查了９６２０户家庭。结果表明城市和农村家庭医疗卫生服务需求大于供给,城市医疗卫生服务绝大多数项目需求率和供给率高于农村。城市医疗费用支出占家庭收入的６．２０％,农村为８．２５％。     

城乡卫生资源反差不能颠倒过来

多年来,我国卫生资源在分布上,占人口20％的城市居民拥有80％的份额,面占人口80％的农村居民只占有20％的份额。这个反差确实很大,应该进行适当调整。卫生界有些同志认为,只有把这个反差颠倒过来,才算是合理配置卫生资源,才算是把医疗卫生工作的重点放到了农村。于是就产生了卫生资源“倒三角”变“正三角”之说。城乡卫生资源反差果真能颠倒过来吗?本文对此问题略陈管见。 1 城乡有些方面差距很大,不能把卫生资源反差颠倒过采 我们认为,在现实社会中,城乡有些方面还存在着很大差距。正是这些差距,才把城乡卫生资源反差拉大,也正是     

发展农村医疗卫生事业的思考

一、制约当前农村医疗卫生事业发展的主要因素１、城乡之间医疗卫生资源配置失衡。据统计，目前占全国总人口２０％的城市，拥有４７％以上的大中型医院和４９％以上的卫生技术人员，许多地方８０％以上的高精尖设备集中在城市医院。这种资源分配不公使城市与农村形成极大反差。城市的卫生资源配置和医疗服务供给过剩，造成了卫生资源的极大浪费．农村由于医疗卫生资源配置不足，一方面许多农村尤其是老、少、边、穷地区，缺医少药和看病贵、看病难的问题仍相当突出；另一方面农民对医疗卫生服务的有效需求不足。２、农村的经济状况，制约了…     

农民工集中地区解决卫生服务的建议

农民工是我国改革开放和工业化、城镇化进程中涌现出来的一支新型劳动大军,为城市创造了财富,为农民增加了收入,为城乡发展注入了活力。在城乡二元结构的体制背景下,在城市从事风险高、强度大、劳动条件差的农民工,因医疗服务价格差距、人员流动、文化差异等多种因素,难以纳入城市医疗服务和健康保障体系。在有些劳务集中输出的农村地区,农民工为解决医疗服务需求,私下聘用乡村医生作为“队医”,跟随劳务大军服务。由于执业场所和人员不合法等原因,这些“队医”一到城市就成为“非法行医”,并成为城市卫生监督部门打击、取缔的重点和难点。…     

积极探索全科医疗 提高农村卫生水平

随着社会主义市场经济体制的确立和农村经济的不断发展,逐渐富裕起来的农民对医疗预防保健服务有了更高的要求,迫切需要开展全方位、多层次的卫生服务。传统的“坐堂行医”及“以疾病为中心”的专科化服务模式已难以适应这一新需求。因此,如何合理地调整现有的卫生资源,改变现行被动的坐等病人的服务方式;如何最大限度地满足群众不断增长的生理、心理和社会医学等方面的需求,这是摆在我们各级卫生行政主管部门面前的一项重要任务。江山市在首都医科大学及上级卫生主管部门的指导下,在农村率先开展“以个人为中心,以家庭为单位,以社区为范围”的集预防、保健、医疗、康复为一体的全科医疗服务试点。经过近6年的探     

农村牧区卫生工作面临的主要问题及对策

内蒙古自治区各级党委、政府按照中央卫生工作的方针政策 ,始终把卫生工作的重点放在农村牧区 ,不断加强农村牧区卫生工作。特别是改革开放以来 ,农村牧区卫生事业获得了快速发展 ,取得了令人瞩目的成就。但是 ,随着社会主义市场经济体制的建立 ,农村牧区卫生服务体系存在的经济基础和社会环境的变化 ,农村牧区卫生管理体制、医疗、预防、保健服务体系 ,广大农牧民对医疗卫生服务的需求 ,以及农村牧区卫生工作的各方面都出现了一些新的情况和问题。一、存在的主要问题1.卫生资源短缺 ,配置不合理一是农村牧区卫生资源总量严重不足 ,城乡差距…     

Children's mental health care: differences by race/ethnicity in urban/rural areas

This study examines racial/ethnic disparities in children's mental health and the receipt of mental health services, and whether those disparities differ between urban and rural areas. We find no significant difference between racial/ethnic groups in the prevalence of child mental health problems in either urban or rural areas. However, there are disparities in the use of mental health services. Hispanic children and Black children in urban areas receive less mental health care than their White counterparts, and the disparity persists for Hispanic children in rural areas, even after controlling for other relevant factors. Initiatives to improve access to mental health care for racial/ethnic minorities should recognize these disparities, and address the lack of culturally appropriate services in both urban and rural areas. In addition, outreach should raise awareness among parents, teachers, and other community members concerning the need for mental health services for minority children.     

Characterization of Rural Mental Health Service Systems

This paper explores two mental health systems in rural North Carolina that provide services to people with severe mental disorders. Recent findings show rural people with mental disorders receive less mental health care than their urban counterparts. This study asks whether rural service systems differ from urban systems in the way that their services are coordinated and structured. A popular conception is that public mental health systems in the United States are uncoordinated with many services provided outside the mental health sector. Rural service providers are seen as even more dependent on nonspecialized mental health providers than their urban counterparts. While many rural service barriers are attributed to the rural environment, little is known about rural service systems and how their organization might contribute to or negate barriers to care. Social network methods were used in this study to compare two rural with four urban systems of care. Findings confirm that mental health systems fit the de facto hypothesis, but that rural systems differ in ways not anticipated by the hypothesis. Rather than being more dependent on nonmental health agencies, rural mental health agencies are more interdependent.     

Difference in rural and urban mortality: implications for health education and promotion.

Rural health care delivery is often inferior to that of urban areas. Although health services do not have to be identical in the two settings, quality services appropriate for the needs of rural communities are imperative. Moreover, health education and promotion should be seen as an immediate and viable strategy for (a) reducing risk factors and health care needs, and (b) increasing the cost effectiveness of existing services. The appropriateness and prioritization of health care services and health education/promotion can only be realized if health professionals are aware of rural versus urban needs. To facilitate our knowledge of such differences, the mortality rates of the 10 leading causes of death were compared for each county in Ohio and differences between rural and urban mortality were analyzed. Counties were categorized according to "density" (persons per square mile) and "percent urban" (percent of county area classified as urban). The analysis demonstrated that there were no significant differences between rural and urban counties in mortality due to cancer, pulmonary disease, diabetes mellitus, atherosclerosis, and suicide. Mortality related to cardiovascular disease, cerebrovascular disease, accidents, and influenza/pneumonia was significantly higher in rural counties, while deaths due to chronic liver disease were significantly greater in urban counties.     

Urban versus rural populations' views of health care in Scotland

OBJECTIVES: To compare satisfaction with, and expectations of, health care of people in rural and urban areas of Scotland. METHODS: Questions were included in the 2002 Scottish Social Attitudes Survey (SSAS). The Scottish House-hold Survey urban-rural classification was used to categorize locations. A random sample of 2707 people was contacted to participate in a face-to-face interview and a self-completion questionnaire survey. SPSS (v.10) was used to analyse the data. Relationships between location category and responses were explored using logistic regression analysis. RESULTS: In all, 1665 (61.5%) interviews were conducted and 1507 (56.0%) respondents returned self-completion questionnaires. Satisfaction with local doctors and hospital services was higher in rural locations. While around 40% of those living in remote areas thought A&E services too distant, this did not rank as a top priority for health service improvement. This could be due to expectations that general practitioners would assist in out-of-hours emergencies. Most Scots thought services should be good in rural areas even if this was costly, and that older people should not be discouraged from moving to rural areas because of their likely health care needs. In all, 79% of respondents thought that care should be as good in rural as urban areas. Responses to many questions were independently significantly affected by rural/urban location. CONCLUSIONS: Most Scots want rural health care to continue to be good, but the new UK National Health Service (NHS) general practitioner contract and service redesign will impact on provision. Current high satisfaction, likely to be due to access and expectations about local help, could be affected. This study provides baseline data on attitudes and expectations before potential service redesign, which should be monitored at intervals in future.     

我国城乡居民医疗保健支出现状分析

目的 了解我国城乡居民卫生费用及医疗保健支出情况,为完善卫生系统筹资战略提供客观依据.方法 采用1999年至2007年统计年鉴数据,对我国城乡居民卫生费用及医疗保健支出现状及变化趋势进行分析.结果 城乡卫生费用筹资额定比增长了200%;城乡居民人均医疗保健支出增长幅度差异明显(城市为152.86%,农村为172.77%);居民医疗保健支出随人均收入变化而稳步增长,但健康消费总体水平仍很低,尤其是农村居民;2003年以来农村居民医疗保健支出收入弹性比城镇居民大,相对差距正逐步缩小.结论 应重点增加农村居民收入,提高社会边际医疗保健支出倾向;改善医疗卫生服务条件,扩大医疗保障覆盖面,带动城乡居民医疗保健的合理消费;重视文化因素的作用,提高全民健康投资意识和自我保健能力.     

Patient satisfaction with health care services at a national institute of ophthalmology

Little is known about how patients in developing countries, such as Vietnam, are satisfied with eye care services. The purpose of this study was to assess the satisfaction with health services and its associated factors among patients attending a national institute of ophthalmology in Vietnam. In a cross‐sectional study utilizing quantitative methods, 500 inpatients and their relatives attending a national institute of ophthalmology in Vietnam were approached for data collection. The results indicated that under 50% of the patients were satisfied with eye care services. However, when classified by level of satisfaction, only 6.8% were very satisfied with all domains of care. There was no significant difference in satisfaction by gender and income, while significant differences by department, residence, and education were found. Patients who were from rural areas, were better educated, and used the services of the glaucoma department, were more satisfied with eye care than those from urban areas, were less educated, and used the services of treatment‐on‐demand department. Multivariable regression detected 2 main factors, gender and location, associated with patient satisfaction. Patients who were female and came from rural and remote areas were more likely to be satisfied than patients who were male and living in urban areas. The study suggests that to continue to improve health care quality, it is important to eliminate differences in providing eye care services regardless of whether patients are male or female, and whether they come from a rural or urban area.     

Urban and Rural Differences in Health Insurance and Access to Care

This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub-samples of 400 group-insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies.
Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis.
Rural residents with group insurance have higher out-of-pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment-based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers.     

Rural healthcare needs and solutions

Many rural communities are finding it necessary to create innovative ways to make healthcare more accessible to their residents. Successful rural healthcare delivery systems require the resources of an institution willing to serve the rural healthcare market, a community wanting to improve its healthcare, and dedicated practitioners. Physicians must be willing to see Medicaid and charity care patients. If physicians in the community are too busy or unwilling to accept indigent patients, the community may need more physicians. When the community recruits additional physicians, leaders must clarify that all physicians have a responsibility to serve indigent patients. As a result, a community-wide healthcare planning process is essential. Because residents might not always be aware that they should receive certain routine healthcare services or how to access those services, the community must establish strategies to reduce this knowledge gap. Urban healthcare centers can help by bringing health screening services to the rural community and by providing health education programs. Providers can close another part of the knowledge gap by helping patients fill out the insurance forms required to receive payment and by helping them find and apply for indigent patient coverage. To help solve the physician shortage problem in rural areas, communities can work with urban healthcare providers to purchase or start new practices in rural areas and then supplement the practices with additional primary care physicians or other healthcare practitioners.     

Prenatal care utilization in rural areas and urban areas of Haiti.

OBJECTIVES: This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS: The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS: Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS: A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.     

Biopsychosocial imperatives from the rural perspective

Rural health issues are examined within a biopsychosocial framework by addressing three questions: what is meant by ‘rural’? what are rural health needs? what factors must be considered in understanding and addressing these needs?Probably the single most important characteristic distinguishing rural from urban areas is low population density. This factor is particularly important in terms of its impact on (1) communication and transportation patterns, (2) one's ‘sense of community’ and (3) the availability of specialized services and complex organizations and institutions.For statistical purposes two different definitional dichotomies exist: rural-urban and metropolitan-nonmetropolitan. Although the rural and nonmetropolitan populations are not conterminous, approximately the same percentage of the nation's population is included in each of the two categories. A serious misconception is that of equating agriculture with rurality. While most farmers live and work in rural areas only a small fraction of rural Americans are engaged in agriculture.In terms of health needs, infant mortality tends to be higher in nonmetropolitan than in metropolitan areas; and limitation of activity due to chronic conditions is more likely to occur among the nonmetropolitan than the metropolitan population. Similarly, the percent of people who perceive their health as either ‘fair’ or ‘poor’ is higher for the nonmetropolitan population. On the other hand, the incidence of acute conditions and disability days per person per year are lower for the nonmetropolitan population than for the metropolitan population. Limited data on mental health suggest that the halcyon picture of country life may be grossly distorted.Understanding and addressing rural health needs involves a close look at the social, economic and medical systems operating in rural America. Income and employment levels, and their interrelationship to nutrition, housing and transportation generally find rural areas at a disadvantage. Although attitudes and values between rural and urban populations differ, it is all too easy to exaggerate these differences. The areas of sharpest differences have to do with issues of morality, religion and political philosophy. Problems in the availability and accessibility of medical services—especially specialized services—continue to plague rural areas.Recently, the most important dynamic in rural areas has been the rapid population growth associated with urban-to-rural migration. Another important characteristic of rural America is its diversity. Greater diversity likely exists among rural areas than among urban areas. For example, some rural areas have medical systems that are as sophisticated as those found in most urban areas.Failing to recognize and appreciate the diversity within the rural sector may be the greatest impediment to designing and implementing effective public policies for dealing with rural health needs. Considerable research, recent books, the creation of statewide offices of rural health and the work of national organizations have been helpful in alleviating the misunderstanding which surrounds rural America, its health care needs and the ways to best address those needs.