保亭县县、乡、村卫生管理一体化的探索与实践

海南省辖19个市县,总人口787万人,农业人口占74%.海南建省10多年来,卫生事业有了长足的发展.但由于海南经济基础差、底子薄,地方财政困难,对农村卫生的投入不足,农村卫生整体建设起步晚,地区之间、城乡之间卫生发展差距较大.为了加强农村卫生工作,省卫生厅在广泛深入开展农村卫生调研的同时,选择了贫困地区具有代表性的保亭黎族苗族自治县(以下简称保亭县)进行农村卫生体制改革试点,积极探索县、乡、村卫生管理一体化新模式,并具体组织指导实施.     

实施乡,村一体化管理 发展农村卫生事业

为了不断满足农民基本就医需求,降低就医成本,防止农民因病致贫、因病返贫,我市从1999年起,在商桥镇试行镇、村卫生组织一体化管理。经过半年多的运行,实践证明,这一管理方法调动了广大乡村医生的积极性,保护了农民的利益,方便了农民就医,充分利用了现有的卫生资源,促进了农村卫生事业的发展,取得了显著的社会效益和经济收益。     

宁阳县县乡村卫生服务管理一体化的基本内涵

近几年来，宁阳县按照科学的发展观和正确的政绩观的要求，认真贯彻以农村为重点的卫生工作方针，以整合县域卫生资源为抓手，以强化技术协作和行业管理为核心，以改革创新为手段，以提高农民健康保障水平为目标，不断健全完善县乡村三级卫生网络，初步形成了以县乡村三级联网一体运作机制为内容的一体化管理模式。     

深入实施乡村卫生服务管理一体化促进农村卫生事业健康发展

迁安市属半山区县级市,辖19个乡镇,534个行政村,总人口66万,其中农业人口占57万.全市有医疗卫生机构54个,村级卫生所259个,卫生技术人员1 110人,乡村医生1150人.     

重庆市城乡卫生统筹条件下县乡村卫生一体化管理研究

党的十七大报告中明确提出：科学发展观的根本方法是统筹兼顾。在需要统筹发展的多种关系中,统筹城乡发展无疑处在十分重要地位,而与广大人民群众生命健康息息相关的农村卫生事业对于城乡统筹发展又起着突出作用。在城乡卫生统筹条件下,开展县乡村卫生一体化管理,对农村卫生事业发展具有重要的理论价值和现实意义。     

新疆农村卫生服务一体化管理新模式探析

文章根据新疆乡村卫生服务一体化的实施现状,在检索相关文献的基础上,结合实际调研,提出将农村三级医疗预防保健网(以下简称三级卫生网)的医疗职能和防保职能分离,从医疗服务体系和公共卫生服务体系出发探索适宜于新疆的农村卫生服务一体化管理模式——政府主导和市场引导相结合的县乡村医疗服务一体化和以政府为主导的县乡村公共卫生服务一体化.     

乡、村卫生组织一体化管理与农村卫生资源配置

农村实行联产承包以后,农村卫生工作的经济背景发生了巨大变革。原依附集体经济生存与发展的农村卫生工作三大支柱(乡村医生队伍、村卫生室、合作医疗)受到了猛烈的冲击,随后形成的农村医药市场由于缺乏有效的组织和监控,使农村卫生服务的供给陷入无序状况,严重影响了农村卫生资源的合理配置和有效利用。在农村新的经济背景下,如何以市场为基础,建立新的农村卫生工作管理体制与运行机制,充分发挥农村卫生资源配置的最大潜力,推动农村卫生事业发展是摆在我们面前的重要课题。     

林甸县实施乡村卫生服务一体化管理的实践与思考

林甸县把建立乡村卫生服务一体化管理体制和运行机制作为基层医改的重要内容,把缓解农民"看病难、看病贵"矛盾作为出发点和落脚点。该县于2010年年初开始实施乡村卫生服务一体化管理。在实施过程中,主要抓了以下工作:一是加强了服务能力建设,统一了村卫生室的结构布局,统一了诊疗设备配置,统一了信息化建设内容。二是加强了人才培养,对1/3的村医进行了中等专业学历教育。三是建立和完善了运行机制,即人员管理机制、财务管理机制、药品管理机制和考核机制,创新了公共卫生服务券制度。这些举措,改善了诊疗服务条件,提高了诊疗服务水平,提升了基本公共卫生和基本医疗服务能力,缓解了农民"看病难、看病贵"的矛盾。1现状     

发展农村卫生组织一体化管理应坚持的原则

随着卫生改革的深入发展,不少地方实行了农村卫生组织“一体化”管理。把乡镇卫生院与村卫生室联成一个整体,其目的是加强管理,推动农村卫生工作,更好地解决广大农民的医疗预防保健问题。从目前看,“一体化”管理有利于开展农村卫生工作;从长远看,总体上它适应农业规模经营的体制,有很强的生命力 推行农村卫生组织“一体化”管理符合农村卫生服务社会化的要求,使医疗服务的供给与群众的需求相适应;使农村卫生组织的管理与农村经济体制相适应,从而促使     

海南省农村地区卫生服务提供现况及对策分析

目的:了解海南省农村地区卫生服务的提供现状。方法:采用分层随机抽样法,选取15所乡镇卫生院和25所村卫生室进行问卷调查。数据采用Epidata 3.0软件建库,运用SAS 8.1软件进行统计学分析。结果:海南省农村地区医疗卫生机构存在以下问题:人员学历和职称相对较低,专业技术相对落后;部分基础医疗设施陈旧,常用医疗设备配置不足;资金投入不足,卫生机构收支不平衡;公共卫生服务体系薄弱等问题。结论:海南省农村地区卫生服务的提供现状整体较好,但在某些方面需要进一步改善,建议加强人才培养、增加资金投入和优化卫生资源配置。     

“纵向合作，错 层下沉”构建新型农村医疗卫生服务体系

烟台市地处胶东半岛 ,总人口 6 4 5 .8万人 ,农村人口占 6 9% ,是一个农村人口所占比重较大的地市。近几年来 ,我们先后投资 2 .8亿元完成了农村卫生工作三项建设 ,基本实现了人人享有初级卫生保健目标。但随着社会主义市场经济体制的逐步建立以及农村经济体制改革的进行 ,原有的农村医疗卫生服务网络面临着严峻的挑战。为使农村医疗卫生服务体系适应新的形势 ,我们进行了积极地探索 ,采取有力措施 ,推动卫生资源“错层下沉”,经过两年多的实践 ,取得了初步成效。根据部里的安排 ,现将我市卫生资源“错层下沉”的有关情况汇报如下。1　“错…     

New payment model for rural health services in Mongolia

This article describes experiences in Mongolia in designing and implementing a new method of payment for rural health services. The new method involves using a formula that allocates 65% of available funding on the basis of risk-adjusted capitation, 20% on the basis of asset costs, 10% on the basis of variations in distance-related costs, and 5% on the basis of satisfactory attainment of quality of care targets. Rural populations have inferior health services in most countries, whether rich or poor. Their situation has deteriorated in most transition economies, including Mongolia since 1990. One factor has been the use of inappropriate methods of payment of care providers. Changes in payment methods have therefore been made in most transition economies with mixed success. One factor has been a tendency to over-simplify, for example, to introduce capitation without risk adjustment or to make per case payments that ignored casemix. In 2002, the Mongolian government decided that its crude funding formula for rural health services should be replaced. It had two main components. The first was payment of an annual grant by the local government from its general revenue on the basis of estimated service population, number of inpatient beds, and number of clinical staff. The second was an output-based payment per inpatient day from the National Health Insurance Fund. The model was administratively complicated, and widely believed to be unfair. The two funding agencies were giving conflicting types of financial incentives. Most important, the funding methods gave few incentives or rewards for service improvement. In some respects, the incentives were perverse (such as the encouragement of hospital admission by the National Health Insurance Fund). A new funding model was developed through statistical analysis of data from routine service reports and opinions questionnaires. As noted above, there are components relating to per capita needs for care, capital assets, distance, and quality of care. The risk-adjusted capitation component determines needs classes by use of age, gender, and family income. The model was accepted by all concerned parties, and steps are now being taken to implement it under transitional arrangements. Many of the data used to parameterize the model are inaccurate and will need to be updated in the near future. However, the model is inherently valid, and procedures have been set in place that will ensure accuracy is improved on a continuing basis. An important reason why the government strongly supported implementation was its commitment to implement output-based budgeting across all government sectors. The new model provided a convenient way of applying output-based budgeting to one major component of the health sector.     

开拓创新锐意进取全面推进我省农村卫生改革与发展 --在全省农村卫生改革现场会上的讲话

1保亭县农村卫生改革的主要经验 1999年以来,我厅立足于以卫生改革促发展,在大力推进城镇医药卫生体制改革的同时,把农村卫生改革列入重要议事日程,选择保亭县作为农村卫生改革试点,以人事制度改革为突破口,积极探索"县乡村卫生管理一体化"模式,取得了较好的成效,其主要经验是:     

A rural service-learning model for health administration education

Service learning for students in the health professions can best be described as an educational methodology based on the collaboration between an academic discipline and a community agency to link student learning with community-based service. This paper describes a service-learning model in rural and medically underserved communities used in a master in health administration program in a rural Southern state. It presents the process, components, outcomes, and challenges. Over the past five years, 56 students completed 116 experiences involving internships, field projects, or special projects in rural and medically underserved communities. A total of 27 percent of our graduates who completed rural and medically underserved experiences accepted job positions in rural health care entities. Strategies utilized by this rural service-learning model include interdisciplinary team training, partnerships among rural and medically underserved community health care entities and academic institutions, faculty-preceptor retreats, and involvement in local community initiatives. These experiences prepare future health administrators to contribute in a meaningful way toward building an effective rural health care delivery system.     

海南省农村卫生现状调研报告

为了全面掌握海南省农村卫生工作面临的新情况和新问题 ,明确新世纪农村卫生工作的思路 ,制定切合实际的海南农村卫生改革与发展的政策和措施 ,海南省卫生厅于近期组织了 18个市县 (全省除海口市外 )和海南省农垦总局卫生处等卫生部门 ,开展了以乡镇、村委会和国营农 (林、茶 )场为重点的农村卫生现况调查 ,并专人实地深入三亚、琼山、琼海、屯昌、乐东、保亭、陵水、白沙等 12个市县的 6 3个乡、村以及 9个国营农场等地 ,就海南省农村卫生改革与发展专题进行了调研 ,现报告如下 :1　结果1.1　一般情况1.1.1　农村人口、社会经济　 18个市县…     

海南省汪啸风省长在全省农村卫生改革现场会上的讲话

省政府决定在这里召开农村卫生改革工作现场会,总结和推广保亭县农村卫生改革工作经验,是省委、省政府落实"三个代表"重要思想和省第四次党代会精神作出的重要部署.保亭县农村卫生改革试点经验,是省政府、省卫生厅和保亭县委、县政府做了长期准备工作,组织多次调查研究,采取得力措施,闯出的一条农村卫生改革的新路,是中部地区社会事业发展的典范.刚才,梁盛同志就农村卫生改革作了很好的报告,保亭县政府、县卫生局分别就农村卫生改革工作经验作了详细的介绍,会议期间还组织了现场参观.我希望通过这次会议,大家得到启发,统一思想,提高认识,进一步明确农村卫生改革的思路和任务,推进我省农村卫生改革与发展.下面,我就农村卫生工作提几点要求.