我国初级卫生保健体系形成的历史和成功因素分析

文章总结了我国初级卫生保健体系的形成过程,指出初级卫生保健体系建设从自上而下建立卫生机构、保证卫生服务可得性为起点,以逐步发展适宜卫生人力和适宜技术为特点,结合农业合作化运动,依托集体经济建立了合作医疗制度,最终基本解决了卫生服务可及性问题.文章进一步分析了初级卫生保健的成功因素,指出集权制度、社区组织和集体经济是初级卫生保健体系成功运作的重要外部制度条件:同时分析了初级卫生保健体系本身的制度安排,指出与当时社会环境和生产劳动相契合的初级卫生保健运行机制是保证初级卫生保健成功的内部原因.文章同时指出,初级卫生保健体系的内部制度安排是依赖于外部制度因素的,一旦外部制度因素变化,初级卫生保健体系将面临较大的挑战.     

1990年重点选题

我国农村卫生事业发展的回顾与反思我国农村卫生发展战略中国初级卫生保健工作与农村卫生政策研究我国初级卫生保健策略与卫生资源分配状况剖析基层卫生体制改革与初级卫生保健策略领导层开发与初级卫生保健的实施初级卫生保健工作中的思想政治工作研究农村预防保健队伍思想建设的有关论述有关实施PHC规划,改善卫生面貌的论著我国农村2000年人人享有卫生保健规划目标及达标对策初级卫生保健工作管理程序     

《中国初级卫生保健》杂志2004年选题参考

1.21世纪初级卫生保健战略研究2.初级卫生保健的依法监督与管理3.初级卫生保健的分级监测与评估4.国外初级卫生保健比较研究5.健康扶贫与长期经济增长6.公共卫生、基本医疗服务项目界定及其支付政策7.突发公共卫生事件应急机制、疾病预防控制体系和卫生执法监督体系的构建8.城镇化与卫生服务体系建设9.基本卫生干预措施的普遍覆盖研究10.贫困人口对基础卫生服务的可及性研究11.对贫困家庭实行医疗救助资金的筹集和主要形式12.危害农村居民健康的主要公共卫生问题的确定及其防治对策13.完善农村卫生体系、基本医疗体系、环境卫生体系和财政保…     

《中国初级卫生保健》杂志2004年选题参考

1.21世纪初级卫生保健战略研究2.初级卫生保健的依法监督与管理3.初级卫生保健的分级监测与评估4.国外初级卫生保健比较研究5.健康扶贫与长期经济增长6.公共卫生、基本医疗服务项目界定及其支付政策7.突发公共卫生事件应急机制、疾病预防控制体系和卫生执法监督体系的构建8.城镇化与卫生服务体系建设9.基本卫生干预措施的普遍覆盖研究10.贫困人口对基础卫生服务的可及性研究11.对贫困家庭实行医疗救助资金的筹集和主要形式12.危害农村居民健康的主要公共卫生问题的确定及其防制对策13.完善农村卫生体系、基本医疗体系、环境卫生体系和财政保…     

新年致读者

著名的阿拉木图宣言吹响了向2000年人人享有卫生保健进军的号角,体现平等健康权力的初级卫生保健所具有的巨大感召力,已唤起世界各国为之奋斗,蓬勃发展的初级卫生保健事业,开创了卫生领域的新时代。随着卫生事业走向社会化,有目标、有计划地实施初级卫生保健,已成为我国政治经济体制改革深入发展的新形势下卫生事业的鲜明主题。我国政府根据初级卫生保健的原则和人人享有卫生保健的全球策略改革卫生体制,调整各种资源的使用,认真争取各部门的密切配合,使我国的初级卫生保健工作在整顿治理、深化卫生改革中,形成由点到面,扩大试点,统筹规划,深入发展的     

荷兰卫生体制改革概况

荷兰的卫生体制在很多方面都与欧洲其他国家的卫生体制不同.在过去的十几年中,针对不同历史时期卫生体制出现的具体问题,荷兰的卫生保健服务在初级卫生保健、成本控制、管理体制,以及卫生服务系统的绩效和安全等方面进行了许多重要的变革并取得了较大成效.对荷兰卫生体制改革做了回顾和分析.     

冰岛卫生体制改革

冰岛是一个相对地广人稀的海岛国家,是世界上人口健康状况最好的国家之一.在过去的几十年里,冰岛在中央行政机构、初级卫生保健、医院系统和制药业等方面经历了几次重大的卫生体制改革.分析研究冰岛卫生体制改革的成功经验,为我国的卫生体制改革提供参考和借鉴.     

美国以Medicare为主导的综合性初级卫生保健改革概述

正初级卫生保健在有效的卫生服务体系中处于基、础性地位,其重要性已经成为共识。但近十年来,初级卫生保健体系处于较为不利的地位。一方面,初级卫生保健医生相比于大部分专科医生而言获得较少的收入,却肩负着艰巨的控费和提高医疗服务质量的重任;另一方面,初级卫生保健机构与医院相比,每年新入职的医生更少。这些挑战促使政策制定者和卫生保健管理者制定了增长性的初级卫生保     

挪威卫生服务体系概况及对我国的启示

本文通过对挪威卫生服务体系的发展脉络进行追溯,了解到挪威政府对初级卫生保健体系和专科卫生服务体系一直采取不同的管理模式,并随着人口结构、卫生服务需求的变化将初级卫生保健逐步交由自治市政府管理,而专科卫生服务则采取了市场化较强的半政府、半市场的组织管理模式,并由中央政府进行统筹。这样的管理结构从目前来看较好的解决了初级卫生服务供给不足和专科卫生服务效率低下的问题。     

以初保为龙头 推动农村卫生发展──铜山县初级卫生保健试点阶段工作评估

以初保为龙头推动农村卫生发展──铜山县初级卫生保健试点阶段工作评估窦吉有（江苏省铜山县卫生局２２１１１２）１９８７年，我县被省确定为江苏省初级卫生保健试点县。１９８８年以来，我们在深化卫生改革，实施初级卫生保健目标的过程中，根据农村实行经济体制改革后...     

初级卫生保健是构建和谐社会的卫生公平底线

中国曾经是国际初级卫生保健的典范,各国都把“人人享有初级卫生保健”作为人人享有健康权的底线,实现卫生公平是政府的公共职能,农村是初级卫生保健的重点,社区卫生服务是初级卫生保健的载体。     

The Indigenous primary health care and policy research network: Guiding innovation within primary health care with Indigenous peoples in Alberta

In 2015, the Truth and Reconciliation Commission of Canada released its Final Report with 94 Calls to Action, several of which called upon the health care sector to reform based on the principles of reconciliation. In the province of Alberta, Canada, numerous initiatives have arisen to address the health legacy Calls to Action, yet there is no formal mechanism to connect them all. As such, these initiatives have resulted in limited improvements overall. Recognizing the need for clear leadership, responsibility, and dedicated funding, stakeholders from across Alberta were convened in the Spring of 2019 for two full-day roundtable meetings to provide direction for a proposed Canadian Institutes of Health Research Network Environment for Indigenous Health Research that focused on primary health care and policy research. The findings from these roundtable meetings were synthesized and integrated into the foundational principles of the Indigenous Primary Health Care and Policy Research (IPHCPR) Network. The IPHCPR Network has envisioned a renewed and transformed primary health care system to achieve Indigenous health equity, aligned with principles and health legacy Calls to Action advocated by the Truth and Reconciliation Commission of Canada.     

Reforming the reform: the Greek National Health System in transition

The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.     

Primary Healthcare Reform in Portugal on two fronts: autonomous family healthcare units and management of groupings of Health Centers

In 2005, Portugal began a reform of Primary Health Care. This reform process through to April 2010 is described and analyzed. During this period the Mission for Primary Health Care was responsible for conducting a profound reconfiguration. The main objectives for this reform were to improve accessibility, efficiency, quality and continuity of care and increase the satisfaction of professionals and citizens. The main features are voluntary adhesion, teamwork, mandatory information system, performance-sensitive payment, contracting and evaluation. The reconfiguration of health centers was two pronged. First, there was the formation of small autonomous functional units, known as Family Health Units (USF) providing services with proximity and quality. The second measure involved the aggregation of resources and management structures, groups of health centers (ACES), seeking to achieve efficiency and economies of scale. The FHU proved to offer simultaneously more efficiency, accessibility, better working environment, greater citizen satisfaction, namely better quality. The importance of strong political support, the creation of a structure responsible for the design and implementation of reform and good liaison with the media are stressed.     

国际旅行卫生保健中心发展的几点思考

〔目的〕探讨入世后新形势、新任务下我国国际旅行卫生保健中心的工作对策。〔方法〕笔者结合工作实践,从体制创新和制度创新的角度对国际旅行卫生保健中心在改革发展过程中如何加强自身体系建设进行探讨。〔结果〕各级国际旅行卫生保健中心应明确各自职责,切实落实“垂直体制,双重管理”模式,大力推行保健中心品牌建设,完善保健中心分级管理办法并加强与出入境管理部门的横向联系,加快保健中心信息化建设步伐。〔结论〕我国国际旅行卫生保健中心作为检验检疫工作技术保障机构及具有医疗行业特色的医疗保健机构应以“服务经济,促进发展”为中心,大力推进事业单位机构改革进程,努力开拓国际旅行卫生保健事业的新局面。     

Changes necessary for continuing health reform: II. The "internal" change

The article desired organizational and managerial changes in Primary Health Care, so as to develop a sound and feasible social marketing strategy. Key elements that should be changed are: 1. Rigid and centralized administrative structures and procedures. 2. Incentives system centralized and dissociated from the managerial structure. 3. Primary Health Care management units immersed in political conflict. 4. Absence of alternative in the margin. Users cannot choose. 5. Lack of an internal marketing strategy. Several ways of internal markets simulation are assessed as potential means for internal change. The need for an administration reform leading to a less inflexible system in the Spanish national and regional health services in reviewed too. Three changes are considered essential: a) Payment systems in Primary Health Care. b) Modifications in the personnel contracts. c) Reform of the budgeting processes. Specific strategies in each of these issues are suggested, making emphasizing the need of their interrelationship and coherence.     

Primary health care in municipalities at high risk for malaria

This study aims to characterize aspects of Primary Health Care in the Amazon Region of Brazil, considered as the main endemic area for malaria in the country. The Ministry of Health recommends the expansion of Primary Health Care in endemic areas for malaria. A survey focusing on patients infected with malaria was conducted in 6 municipalities, in January and February 2007, to investigate specific aspects of Primary Health Care. Data was analyzed quantitatively and field records helped to give support to context and policy issues in the visited sites. Quality of access to health services and medicines, continuity of health care, system coordination and community orientation are still incipient in the visited areas. The study showed that there is little integration between Primary Health Care and malaria control in the region, which calls for development of joint strategies and for the strengthening of Primary Health Care per se, as a benefit to the population of this endemic area.     

HFA与PHC的全球发展政策导向及策略

30年前,世界卫生组织提出了2000年人人享有卫生保健(HFA)目标和初级卫生保健(PHC)的全球战略。至此,HFA和PHC一直引导世界各国卫生系统的发展方向,指引各成员国朝着人人享有卫生保健这一宏伟目标迈进。当世界迈入21世纪之际,HFA与PHC是否仍然是各国卫生系统的发展方向?其内涵发生了哪些变化?在评价和衡量HFA和PHC实施效果方面国际上有哪些新的进展等问题。这些问题的研究与重新思考将对我国目前卫生改革导向有重要的启迪。     

The Australian Health Care Agreement 1998–2003: Implications and strategic directions for occupational therapists

Funding for public health services in Australia is provided to the States and Territories from the Commonwealth. Contractual obligations for how these monies are allocated are detailed in the Australian Health Care Agreement 1998 –2003, which has replaced the Medicare Agreement 1993–1998. Key issues identified in the new Agreement, which will impact on occupational therapy services, include arrangements for mental health services, palliative care initiatives, casemix, health system reform, and private health insurance. Particular implications stem from the proposed reforms to the health system. These include the quality agenda, outcome-based funding and evidence-based practice. Other themes identified include future opportunities for occupational therapists working in health services and the imperative to form collaborative partnerships with consumers and other health care providers. The Australian Health Care Agreement is analysed and suggestions given for strategic directions for occupational therapists to consider.     

The health-disease process and the family health strategy: the user's perspective

OBJECTIVE:

to analyze the meanings Primary Health Care users attribute to their health-disease process and the services used.

METHODS:

this qualitative research uses the focus group technique to interview two groups of users the service monitors. The first is a group of elderly people and the second of pregnant women. To analyze the meanings, the discourse analysis technique and the reference framework of health promotion are used.

RESULTS:

the group of elderly, being mostly female arterial hypertension and diabetes mellitus patients, visualizes the health-disease process as the evolution of human existence controlled by divine power, signifying the health service as a blessing in the control of the disease. The Group of young pregnant women signified health as the ability for self-care and disease as the disability for that purposes, considering the Primary Health Care service as responsible for the recovery of individual and family health.

FINAL CONSIDERATIONS:

the users demonstrated dissatisfaction with bureaucratic and vertical relations present at the health services. In each group, it was observed that the meanings for health and disease and meanings of the health service the users elaborated can be related.