南宁市妇幼保健机构资源配置与运营现状分析

目的:分析南宁市妇幼保健机构资源配置与运营现状,为规范建设和科学决策提供指导。方法:利用国家妇幼卫生综合信息平台网络直报系统,分析全市妇幼保健机构上报的2010年度基本情况、人力资源、设备拥有、服务提供、群体保健及科研教学等信息。结果:妇幼保健机构面临政府重视不够、财政投入不足、人员偏少及素质偏低、业务发展不平衡、科研教学弱等问题。结论:坚持政府主导,加大财政投入;强化公卫职能,注重群体保健;加强人员培养,增强队伍素质;提高临床水平,促进群体保健。     

Understanding the central-local relationship in health care: a new approach

One of the basic assumptions of governmental health planning policy is that the government can effectively take final responsibility for the development of the health care system. Failure to reach policy goals is explained in terms of inadequate planning technology and instruments to control implementation. In this article an alternative explanation is offered, based on the theory of strategic organizational behavior. According to this theory, the government must be seen as but one actor in a complex interorganizational network. From this, a different perspective on effective health planning policy is developed. Policies will fail if they are not based on a valid analysis of the policy space of health care institutions and the interdependencies between government and health care organizations. This article starts with an outline of the nature of the central-local relationship as seen from the perspective of strategic organizational behavior theory. Next, this theory is used to frame two cases in which Dutch health care institutions successfully pursued their own strategies that ran counter to the existing health planning policies. The article ends with a discussion of the implications of the theory of strategic organizational behavior for the development of effective central health care policies. This development starts with a thorough analysis of the policy space and interdependencies of all relevant actors in the health system, the government included. Following, policy makers can set the governmental goals and then have to start negotiations with health care institutions about mutual adaptation of their strategies and the governmental goals. The result is a negotiated health care order.     

基于泰尔指数和集中指数的我国妇幼保健资源配置 公平性评价

摘要:目的　分析评价我国妇幼保健资源分布情况及其公平性。方法　主要利用集中指数、集中曲线和泰尔指数进行测算。结果　妇幼保健机构数、妇幼保健机构床位数、妇幼保健机构卫生技术人员数的集中指数CI分别为:-0.108 0、0.118 8、0.172 4,表明我国妇幼保健资源的配置向经济水平较高的地区倾斜较为明显,地区之间妇幼保健资源配置不公平。泰尔指数显示,我国妇幼保健资源地区间仍存在配置差距。各地区内部配置不公平性较为严重,是影响我国妇幼保健资源配置公平性的主要因素。结论　妇幼保健资源配置不合理,妇幼保健资源中机构数、床位数的公平性优于卫生技术人员数的公平性;妇幼保健资源配置地区间较为公平,优化妇幼保健资源配置应重点关注地区内部的不公平,尤其是东部地区;妇幼保健资源配置城乡差异显著,农村地区优于城市地区。     

NGOs in community health insurance schemes: examples from Guatemala and the Philippines

In poor rural communities, access to basic health care is often severely limited by inadequate supply as well as financial barriers to seeking care. National policies may introduce social health insurance, but these are likely to begin with the salaried public and private sector workers while the informal sector population may be the last to be covered. Community initiatives to generate health care financing require a complex development process. This paper covers attempts to develop such schemes in rural populations in Guatemala and the Philippines through non-government organizations and notes the major factors which have contributed to unequal progress in the two schemes. The scheme of the Association por Salud de Barillas (ASSABA) in Guatemala was not sufficiently established as an administrative body at the conceptual stage and there was no clear national policy on health care financing. By the time the necessary action was taken, local conflicts hindered progress. In the Philippines, the ORT Health Plus Scheme (OHPS) was implemented during the period of legislation of a national health insurance act. The appraisal after three years of operation shows that OPHS has made health care affordable and accessible to the target population, composed mainly of low and often unstable income families in rural areas. The major success factors are probably the administrative structure provided by a cooperative and controls in the delivery system and in expenditures, through the salaried primary health care team, referral process and the capitation agreement for hospital-based services. The proliferation of such schemes could benefit from national guidelines, a formal accreditation process and an umbrella organization to provide assistance in design, training and information services, involving government, non-government and academic institutions as an integral part of the development process.     

医学毕业生到乡镇卫生院就业意向的影响因素分析

目标：探讨影响医学毕业生到乡镇卫生院就业意向的因素,为有关部门及医学院校制定农村卫生人才政策提供科学依据。方法：运用问卷调查方法对福建省2009届医学毕业生到乡镇卫生院就业的意向进行调查,采用二分类Logistic回归分析进行多因素分析。结果：专业、英语水平、家庭所在地、期望月薪、对乡镇卫生院人力状况了解程度等5个因素对医学毕业生到乡镇卫生院就业有影响。有农村背景,对乡镇卫生院人力状况了解程度好、对就业工资待遇期望值较低的医学生更有可能去乡镇卫生院工作。建议：根据当地需要,从农村地区招生,委托医学院校培养,实行面向农村卫生的教育,同时引导医学生树立正确的就业观。     

我国农村公共卫生资源配置现状与对策探讨

分析了我国大陆农村公共卫生资源配置存在的经费投入不足、机构设置未达到全覆盖、现有人力资源难以满足需要、资源配置结构性失调等问题,提出制定引导公共卫生资源向农村流动的相关政策、强化政府公共财政投入责任、加强农村公共卫生机构建设、提升公共卫生人力资源素质、调整农村公共卫生资源配置结构、推进乡村一体化管理等对策,为提高农村公共卫生服务水平、推动基本公共卫生服务城乡均等化进程提供参考。     

Cost recovery in Ghana: are there any changes in health care seeking behaviour?

The study aimed to investigate the impact on health care seeking behaviour of the cost-sharing policies introduced in Ghana between 1985 and 1992. Qualitative research techniques were used to investigate the behaviour of patients after the introduction of these policies. Focus group discussions of cohorts of the population and in-depth interviews of health workers and selected opinion leaders were used to collect data from rural and urban health care facilities in three districts of Ghana. The study findings indicate that the cost recovery policies have led to an increase in self-medication and other behaviours aimed at cost-saving. At the same time, there is a perception of an improvement in the drug supply situation and general health delivery in government facilities. The study advocated enhanced training of drug peddlers and attendants at drug stores, especially in rural areas. User fee exemption criteria need to be worked out properly and implemented so that the very needy are not precluded from seeking health care at hospitals and clinics.     

Evaluating the outcomes of rural health policy

With the development of policies specifically relating to rural health and health care provision, it seems apposite to consider evaluating their outcomes. Although little has apparently been done that specifically studies policy or processes, much of rural health research implicitly 'measures' policy effects; for example, study of the effects of rural medical education. Given what is known about the policy-making process, rural health researchers should beware of thinking that policy outcome evaluation might be straightforward or that evidence produced from evaluation will seamlessly influence future or evolving policy. Nonetheless, as rural health research and policy mature, it is worth adopting some of the complex approaches to health policy outcome measurement and applying them to understand our field – to find out the extent that policy, and indeed our role and research, have effects on rural health and care provision. In this paper, we identify some of the quirks of policy and policy evaluation and provide examples.     

海南省农村卫生室项目建设前后比较分析及建议

目的:通过对比项目实施前后海南省农村卫生室现况,评估海南农村卫生建设扶贫项目的执行情况及总体成果成效,为制定海南农村卫生事业发展政策及改革措施提供理论依据。方法:采取定性、定量和文献检索相结合的综合研究方法,对项目进行基线调查、中期评估和终期评估研究。结果:相对于项目实施之前,农村卫生机构的环境得到改善,危房数减少、建筑和布局平均增加,设备配置率提高,评估得分增加。但仍然存在很多需要解决的问题。结论:项目在海南农村卫生机构建设及卫生人员培训中发挥了重要作用,成果成效得到肯定。农村卫生事业发展的关键在于加强机构科室建设,解决好人才问题,加大资金投入,同时重视吸取项目经验,促进和发挥项目的激励效应。     

Incoherent policies on universal coverage of health insurance and promotion of international trade in health services in Thailand

The Thai government has implemented universal coverage of health insurance since October 2001. Universal access to antiretroviral (ARV) drugs has also been included since October 2003. These two policies have greatly increased the demand for health services and human resources for health, particularly among public health care providers. After the 1997 economic crisis, private health care providers, with the support of the government, embarked on new marketing strategies targeted at attracting foreign patients. Consequently, increasing numbers of foreign patients are visiting Thailand to seek medical care. In addition, the economic recovery since 2001 has greatly increased the demand for private health services among the Thai population. The increasing demand and much higher financial incentives from urban private providers have attracted health personnel, particularly medical doctors, from rural public health care facilities. Responding to this increasing demand and internal brain drain, in mid-2004 the Thai government approved the increased production of medical doctors by 10,678 in the following 15 years. Many additional financial incentives have also been applied. However, the immediate shortage of human resources needs to be addressed competently and urgently. Equity in health care access under this situation of competing demands from dual track policies is a challenge to policy makers and analysts. This paper summarizes the situation and trends as well as the responses by the Thai government. Both supply and demand side responses are described, and some solutions to restore equity in health care access are proposed.     

我国村级卫生人力资源充足性研究

目的 分析新医改实施前后我国村级卫生人力资源变化情况,发现数量和质量方面存在的问题,为制定基层医疗卫生人力政策提供参考.方法 利用村卫生人员数量、村医定基比和环比变化、村医相对数量、执业资格构成、村医学历构成等指标,分析医改前后村卫生室人员变化.结果 近年来我国村级卫生人员有所增加,但占全国卫生员比重下降;2011年后乡村医生出现负增长,千农业人口及村均乡村医生配备不足;执业(助理)医师和注册护士数量不断增加,但比重不足26％;乡村医生以中专学历为主,大专学历不到5％.结论 村卫生室缺乏吸引人才的长足动力;农村将面临村医(尤其是高学历村医)严重短缺问题;乡村医生向执业(助理)医师转化速度较慢.建议改善农村执业环境;提高村医收入水平,制定优惠政策引进人才;改进执业医师考试内容,提高村医报考积极性.     

安徽省农村基层卫生人员工作满意度及影响因素简

目的：分析农村基层卫生人员满意度及影响因素,为加强卫生人才队伍建设提供参考。方法：在安徽省抽取3个样本县发放调查问卷,共调查380名乡镇卫生院人员和村医,用多元线性回归方法分析工作满意度的影响因素,对定性资料的主要问题和观点进行提炼。结果：基层卫生人员总体满意度水平较低,仅有40．90％的人对工作满意;不同满意度因子中,对收入水平、福利等最不满意;不同专业人员中,村医满意度最低。收入水平低、工作量大是工作满意度低的主要影响因素。结论：较低的工作满意度会导致较低的服务质量和较高的人员流失率,亟需将增加的政府投入转变为卫生人员收入与福利水平的改善,进而提高工作满意度水平,这是吸引和留住农村基层卫生人才的关键。     

基于分级诊疗的广西卫生人力资源配置分析

目的:从推进实施分级诊疗的视角,对比分析广西的医院和基层医疗卫生机构卫生人力资源配置状况与存在问题,并有针对性地提出政策建议。方法:对广西相关年份的医院及基层医疗卫生机构的卫生人力资源配置状况进行分析和讨论。结果:广西医院及基层医疗卫生机构卫生人力资源均呈增长趋势,但医院与基层医疗机构之间在人员数量、学历及职称构成等人员质量方面仍有较大差距,优势资源仍有向医院汇集的态势。结论:广西的卫生人力资源配置与分级诊疗的需要仍不相适应,建议政府加大基层卫生人力供给、改革基层医务人员薪酬制度、加快推进医联体改革,引导卫生人力资源向基层流动。     

State Legislation and Policy Affecting Rural Hospital Conversion and Closure

Many rural hospitals have closed or converted to organizations that provide health services other than general, acute inpatient care. However, little is known about why rural hospitals convert rather than close. This study evaluates the relationship between state policy and rates of rural hospital conversion relative to rates of rural hospital closure. The expectation was that the relationship among state policies and rates of conversion and rates of closure differs as a function of whether a state policy facilitates rural hospital transition to alternative models of care or supports them in their existing form. National data were analyzed for all rural hospitals from 1984 to 1991. Results indicate that state policies have done little to facilitate widespread adoption of conversion among rural hospitals. Despite these findings, results also indicate that some state policies have resulted in an increase in the rate of rural hospitals conversions as an alternative to closure.     

我国农村基层卫生人力资源现状与发展探讨

通过查阅文献、专家咨询等方式，分析了我圄农村基层卫生人力资源的现状：总量不少但整体素质不高、结构和分布不够合理、招募困难、流失严重、队伍不稳、乡村医生执业化程度低等，提出了从调整目前医学教育的专业结构、加强现有农村卫生人才的教育和培训、政府制定优惠政策吸引和稳定卫生人才三个方面，加强农村基层卫生人才建设的发展策略.     

Women and health care in rural Pakistan

The provision of medical facilities to rural areas is a major objective of development in Pakistan and the government has undertaken several programs to train and deploy auxiliary health workers on a large scale. Programs to train lady health visitors, dispensers and sanitary inspectors, have been in operation for decades and their graduates have a place in the workforce. Currently the Government is developing a Basic Health Program to train auxiliary health workers and to establish a network of rural health facilities throughout the country. The research here reported was meant to help plan this program.The 4 week study was conducted in four districts of the Punjab and North West Frontier Provinces. We first interviewed women patients of rural dispensaries in the four districts to determine their views of their needs and of the constraints of the purdah system when seeking health care. We then interviewed principals of medical colleges and training institutes, who were in a position to assess the availability of women to enter the medical workforce and female mid-level health workers who were currently serving in their posts.Finally, since allopathic medical institutions compete with indigenous medical specialists, we interviewed two hakims and a homeopathic physician to obtain their view of rural health needs, as well as their potential for contributing to a broad based rural health care system.     

基本药物制度对基层医疗机构运行和费用负担的影响分析

基于全国431家基层医疗机构的调查,对基本药物制度实施后基层医疗机构收支结构、门诊量及居民医疗费用负担的变化情况进行评估,发现国家基本药物制度的实施加强了政府对基层医疗机构的财政补助,但收入和支出结构仍存在不协调,制度实施后药价的下降及对药品配置和使用的限制引起基层机构服务量普遍上升,实施基本药物制度的基层医疗机构次均费用得到一定程度的降低。     

Developing Policies Responsive to Barriers to Health Care Among Rural Residents: WhatDo We Need to Know?

A substantial body of research has been devoted to the subject of access to health care services for rural residents, much with the intention of shaping government policies to remove barriers or equalize the distribution of health care services. A number of programs and policies hove grown out of or been affected by access research, yet despite identifiable successes of the policy research process, barriers to health care services still exist in rural areas. This article attempts to stimulate discussion about ways that rural health researchers can build on past research on access to care. A framework for posing access questions is proposed, suggesting that access research focus on the following areas: factors that drive differences in utilization, availability, and acceptability; consumer satisfaction and an understanding of why rural consumer satisfaction has been found to be high; factors that impede access that are mutable; and services that can be shown to improve outcomes.     

我国居家社区医养结合服务筹资政策分析

目的：对2013年以来国家层面发布的居家社区医养结合服务筹资相关政策进行分析。方法：以“医养结合”“居家社区”等为关键词检索国家卫生健康委、民政部等相关政府部门官方网站2013年1月—2021年9月发布的政策文件;对纳入政策文本进行编码和主题框架分析。结果：共纳入28项相关政策,国家卫生健康委参与发文最多(19项),其次为民政部(14项)。纳入政策涉及的筹资主题包括财政经费支持(14项)、保险制度(基本医疗保险、长期护理保险和商业保险)(19项)、社会资本(10项)、投融资和财税价格政策(5项)以及其他(福利彩票和社会捐赠)(3项)五类主题。现有居家社区医养结合服务筹资政策的资金筹集和风险分摊功能亟待提高。结论：国家应从顶层设计层面进一步明确国家、社会和个人在居家社区医养结合服务筹资的责任,加强资金风险分摊原则,以实现充足、可持续的筹资目标;加强对不同举办主体机构筹资政策安排的均衡性,确保社会资本和公立基层医疗机构的有效参与;同时注意加强政策内容的可操作性和具体化,促进政策落地与实施。