要保护医务人员积极性

浙江省绍兴市卫生局副局长王宏达分管医政，对推进公立医院改革取得的效果有着客观的评价，对深化公立医院改革有自己的思考和建议。     

调动青年医务人员工作积极性的探索

我院是一家青年医务人员比例较高的医院，占全院医务人员的71．2％。几年来，我们结合医院青年医务人员的特点，就如何调动青年医务工作者的工作积极性进行了积极探索，并取得了一定的实效：     

绩效制度的建立是调动医务人员积极性的钥匙

《关于深化医药卫生体制改革的意见》关于公立医院改革试点主要内容之一就是要改革公立医院运行机制,重点“推行聘用制度和岗位管理制度,实行以服务质量及岗位工作量为主的综合绩效考核和岗位绩效工资制度,有效调动医务人员的积极性。”广大的医疗卫生人员是医改的主力军．所以医疗卫生人员的积极性．必须要给予保护。     

凌峰：调动积极性的五建议

“公益性”和“积极性”是今年两会议论公立医院改革时每每必涉及的“热门话题”。如何调动600万医务人员的积极性？全国政协委员、首都医科大学北京宣武医院神经外科主任凌峰教授经过深思熟虑提出五项建议：     

“油门”、“刹车”与“内驱动”求解调动积极性

维护公益性、调动积极性是公立医院改革的根本方向和核心任务,也是公立医院改革必须着力解决好的两个根本问题。有观点质疑,这两项任务存在着矛盾。对此,陈竺部长的解答是：坚持公益性、调动积极性两者相辅相成,假如忽视对医务人员的支持,坚持公益性难达目的;而过于强调医务人员待遇,忽视提供基本医疗服务的任务,医院的发展就会跑偏,就会发展为创收的积极性。     

推动公立医院内部改革 调动医务人员积极性

深化医药卫生体制改革的基本要求,是“真正做到让老百姓得到实惠,让医务人员受到鼓舞，让监管人员易于掌握”,这也是检验改革成效的重要标志。调动医务人员积极性是维护医疗卫生事业公益性的内在要求。《中共中央国务院关于深化医药卫生体制改革意见》（以下简称《意见》）为调动医务人员积极性创造了良好的外部环境，     

谈医务人员的社会角色

当今社会医务人员的社会角色有所偏移,正确认识医务人员社会角色定位,有益于认清医务人员的社会责任、弘扬医学人文精神与推进医学事业的健康发展。医学的目的决定医务人员的社会角色非功利性,医务人员在社会大舞台中担当着守望生命、救死扶伤的公益性角色;现实生活中,由于受市场经济环境、现代医学技术的发展、现行医疗体制存在不足等社会因素的影响,造成医务人员社会角色有所偏移。要重新回归医务人员的社会角色,必须加强医务人员的职业道德教育,加快医疗体制改革,切实维护和保障医务人员自身的基本权利。     

调动积极性 需要制度保障

落实基本医疗卫生的公益性质，不仅是指医疗机构不以营利为目的，而是要真正能提供一定福利性的服务，例如对老人、儿童、妇女等弱势群体人群要有所照顾，提供和一般医疗机构特别是营利医疗机构有所区别的服务。而调动医务人员的积极性和创造性，是指医务人员能对外履行公益性的职责，对内来说则是指医务人员愿意工作，医务人员的贡献在报酬上能够体现，所作的工作被社会所承认，同时具备科学的绩效考评机制。落实公益性、调动积极性是相互联系的，需要通过制度安排和保障，使二者在实际工作中能够结合起来。     

医务人员的服务态度和医疗质量

无论是门诊病人还是住院病人对改革后医务人员的服务态度,医疗质量及医院环境都给予充分肯定。100%的住院病人认为医生的服务态度较改革前有显著提高：80%以上的住院病人认为改革     

只有调动积极性，才能落实公益性

卫生事业必须坚持公益性,而公立医院作为实现卫生事业公益性的重要载体,必然要履行公益性职能。那么,如何激励公立医院履行公益性质呢？     

A bill of health for the IUD: Where do we go from here?

Although intrauterine devices (IUDs) are a highly cost-effective contraceptive method, they have been unfortunately associated with increased risk of pelvic inflammatory disease (PID). However, new studies, including a 1992 World Health Organization (WHO) report, have demonstrated that there is little evidence of a causal link between IUD use and PID. IUD-related risk of PID is increased only during a short period following insertion, and exposure to STDs is probably the major determinant of PID risk for IUD users. Furthermore, no increased risk of PID use has been demonstrated with long-term IUD use. This paper examines the evidence, focusing on the 1992 WHO study, and looks to the future with suggestions for IUD research and programmatic approaches in the hope of vindicating the IUD's reputation and broadening the indications for its use.

---

Resumen Si bien los dispositivos intrauterinos (DIU) son un método anticonceptivo muy eficaz en función de los costos, han estado asociados lamentablemente con un mayor riesgo de enfermedad pélvica inflamatoria (EPI). Sin embargo, nuevos estudios, entre ellos un informe de la OMS de 1992, han demostrado que hay pocas pruebas de una relación de causalidad entre el uso del DIU y la EPI. El riesgo de EPI relacionado con el DIU aumenta sólo durante un período breve despuûs de la inserción y la exposición a las enfermedades transmitidas por contacto sexual es probablemente el determinante principal del riesgo de EPI para las usuarias del DIU. Por otra parte, no se ha demostrado ningún riesgo aumentado de EPI con el uso prolongado de DIU. En este trabajo se examinan las pruebas, concentrándose en el estudio de la OMS de 1992, y se considera el futuro, con sugerencias de investigaciones relativas al DIU y enfoques programáticos en la esperanza de vindicar la reputación del DIU y ampliar sus indicaciones de uso.

---

Resumé Bien que les dispositifs intra-utérins (DIU) constituent une méthode contraceptive extrêmement efficace par rapport à son coût, ils ont malheureusement été associés à un risque accru de maladies pelviennes inflammatoires. De nouvelles études, notamment un rapport de l'OMS établi en 1992, ont cependant démontré l'insuffisance des preuves d'une relation de cause à effet entre l'utilisation des stérilets et les inflammations pelviennes. Le risque d'inflammation attribuable aux DIU n'est accru que pendant une courte période après l'insertion, et l'exposition à des MST est probablement le principal facteur déterminant du risque d'inflammation pelvienne chez les utilisatrices de DIU. En outre, l'augmentation du risque de maladie pelvienne inflammatoire n'a nullement été démontrée chez les femmes qui ont, pendant longtemps, porté un, DIU. Le présent article examine les preuves, en s'appuyant sur le rapport de 1992 de l'OMS, et propose qu'à l'avenir on procède à des recherches et à des programmes destinés à justifier la réputation des DIU et à élargir la gamme des cas dans lesquels il convient de les utiliser.

     

Employers' benefits from workers' health insurance

Even though many employers believe that health insurance and health affect employees' productivity and firms' performance, health economists typically overlook and rarely measure firms' returns on health-related investments. Some research, however, suggests that firms may benefit economically by providing health insurance coverage for workers and their families. For example, health coverage may help employers recruit and retain high-quality workers. Health may contribute to productivity by reducing the costs of absenteeism and turnover and by increasing workers' productivity. This article reviews the evidence and proposes an agenda for future research. A better understanding of the benefits to employers of offering health coverage to workers may help clarify employers' behavior and help private employers and public officials make appropriate investments in health.     

Where do students in the health professions want to work?

Background  

Rural and remote areas of Australia are facing serious health workforce shortages. While a number of schemes have been developed to improve recruitment to and retention of the rural health workforce, they will be effective only if appropriately targeted. This study examines the factors that most encourage students attending rural clinical placements to work in rural Australia, and the regions they prefer.     

Where do UK health services researchers publish their findings?

Health services research has emerged as the third vital requirement for understanding and improving health care, alongside basic science and clinical research. This has coincided with more stringent management of research, in particular by funding bodies. The latter are seeking to use bibliographic databases to aid the monitoring of the output of their investments. The principal source of data in the UK is the Research Outputs Database (ROD) set up by the Wellcome Trust primarily to monitor basic and clinical research. Health services researchers' output is difficult to monitor in view of the large number and wide variety of journals in which they publish. In addition, nearly half the journals (representing 35% of the articles) are not currently covered by the ROD. Funding bodies will underestimate the quantity of health services researchers' output unless they take these findings into account.     

Where do the leading candidates for governor stand on health care?

Health care reform and the issues surrounding this sensitive and often contentious subject will play a significant role in the 1994 California governor's race. California Hospitals asked democratic candidate state Treasurer Kathleen Brown and republican candidate Gov. Pete Wilson to share their views on three of health care's most pressing issues: Proposition 186 on the November ballot; health care reform in California; and MICRA, the Medical Injury Compensation Reform Act of 1975.