Trends in socioeconomic disparities in health care quality in four countries.

OBJECTIVE: To provide a targeted portrait of socioeconomic disparities in health care quality in four countries and how those disparities have changed over time. DESIGN: Within each country, comparisons between the highest and lowest quintiles of socioeconomic status were made to determine if disparities exist and if any observed disparities have been decreasing over a 5-year period. SETTING: Small geographic areas in Canada, England, New Zealand and the United States. DATA SOURCES: Data were obtained by working with national health statistics agencies in each country. RESULTS: There were socioeconomic disparities in health care quality and health status for most of the indicators studied in all four countries. The analysis included nine quality indicators in four countries, for a total of thirty-six observations. Twenty-six observations had a ratio of highest to lowest socioeconomic quintile of <0.95 or >1.05. These disparities generally persisted over time. The relative difference between the highest and lowest quintile decreased over time in eight of the twenty-one observations with time-series data available. CONCLUSION: The fact that disparities in a variety of indicators exist in four very different health systems underscores the importance of factors common to the four systems or factors outside the health system. Some successful strategies for reducing disparities could potentially be learned from the few examples of success in these countries.     

我国基层医疗卫生机构全科医生队伍建设现状

目的 探讨我国基层医疗卫生机构全科医生队伍建设的现状,提出基层医疗卫生机构全科医生队伍建设的一些建议。方法 采用文献研究法,同时结合笔者多年从事基层全科医学工作的实践经验,分析了基层医疗卫生机构全科医生队伍建设的重要性和必要性。结果 我国基层医疗卫生机构全科医生缺口比较大,必须加快全科医生队伍建设。结论 建立一支能够胜任基本医疗卫生工作的卫生队伍迫在眉睫。     

Trends in geographic disparities in allocation of health care resources in the US

OBJECTIVES: This study aimed to examine current level and historical trends in health resources distribution in the US; to investigate the relationships between both levels and trends of inequality with--geographic location, inequality of income and rates per capita of hospital-beds and physicians. METHODS: The Gini Coefficient was used to measure variations in distribution of physicians and hospital-beds (at the county level) during three decades. RESULTS: Physician distribution has become less equitable, while hospital-beds' equity has increased. physicians' distribution exhibited a geographic trend, becoming more equitable in the West. No association was found between equality in hospital-beds' distribution and rates of hospital-beds per capita. CONCLUSIONS: Rates per capita might not be sufficient in determining availability of resources. Further research is needed to determine implications for health outcomes.     

广东省专业公共卫生机构卫生资源配置公平性分析

目的 分析广东省专业公共卫生机构卫生资源配置现状及其公平性,为后续研究和公共卫生服务资源的优化配置提供数据支撑。方法 对广东省专业公共卫生机构卫生资源配置情况进行描述性分析;通过卫生资源集聚度（HRAD）分析其配置的可及性和公平性。 结果 广东省专业公共卫生机构数呈负增长,为- 10.13%,而公共卫生人力资源总量逐年递增,年均增速在3.0%以上。2019年各地市公共卫生资源配置的公平性差异显著。2013—2019年东翼地区公共卫生人力资源基于人口分布的公平性较差,而西翼和山区公共卫生资源基于地理分布的可及性较差。结论 广东省专业公共卫生机构卫生人力资源配置总量逐年增长,但增速尚需提高。区域间、区域内卫生资源配置的可及性、公平性差异显著,公共卫生资源分布不均衡的状况仍然存在,人才短缺的情况仍是短板。应持续推动优质公共卫生资源扩容和区域均衡布局,稳定和发展公共卫生人才队伍,提高现有公共卫生资源的配置效率和利用效率。     

四川省妇幼保健机构卫生人力资源配置公平性分析

目的 分析四川省妇幼保健机构卫生人力资源配置公平性状况,为合理配置妇幼保健卫生人力资源提供科学的依据。方法 采用集中指数、Kakwani指数和集聚度分析四川省妇幼保健机构卫生人力资源配置公平性状况。结果 四川省妇幼保健机构卫生技术人员、执业（助理）医师、注册护士、药师（士）和技师（士）的集中指数均大于0,说明卫生人力资源倾向于经济水平较高的地区。5项指标的Kakwani指数均为负数,说明人均GDP低的地区受益程度较高。从HRAD来看,成都平原经济区、川南经济区和川东北经济区5项卫生人力资源的值大于1,说明这些地区卫生人力资源按地理配置的公平性过高。从HRAD与PAD的差值来看,成都平原经济区5项卫生人力资源的差值大于0,说明这些地区卫生人力资源相对于集聚人口过剩;川南经济区、川东北经济区5项卫生人力资源的差值小于0,说明这些地区卫生人力资源相对于集聚人口不足。结论 卫生人力资源倾向于经济水平较高的地区,人均GDP低的地区受益程度较高,卫生人力资源总体不足、地区间不均衡。卫生行政部门要发挥妇幼保健卫生资源规划的导向作用,推动卫生人力资源充足地区对短缺地区的支援和帮扶。     

城乡基层医疗卫生机构基本公共卫生服务居民满意度研究:以湖北省为例

目的:分析湖北省城乡居民对基本公共卫生服务的满意度及影响因素,为改善我国基本公共卫生服务质量提供政策依据。方法:根据经济发展情况选取湖北省武汉、黄冈、荆州地区共12家基层医疗卫生机构,对就诊居民进行满意度问卷调查,测量居民对基本公共卫生服务的可及性、舒适性、安全性和有效性的满意状况。结果:城乡居民对基本公共卫生服务的满意度得分为71.62分,总满意率为73.44%。城乡居民对基本公共卫生服务具体指标满意度最高的为就诊方便性(83.03%)和隐私保护(80.25%),满意度最低的指标为医疗技术(61.61%)和设备设施(64.53%)。Logistic回归分析结果显示,基本公共卫生服务的可及性、舒适性、安全性对社区居民满意度影响较大,性别及年医疗支出对居民满意度也有一定的影响。结论:城乡居民对基本公共卫生服务总体满意度处于一般水平,有待提升;城市平均满意度高于农村,农村地区存在较大的提升空间;基本公共卫生服务应进一步强化质量建设,促进城乡基本公共卫生服务均等化发展。     

我国专业公共卫生机构卫生资源配置公平性分析

目的 分析2019年我国专业公共卫生机构卫生资源配置的公平性,希望为我国公共卫生资源配置的公平性提供参考建议。方法 分别以人口和面积分布为依据,计算基尼系数并绘制洛伦兹曲线;各部分差异及对总差异的贡献率通过泰尔指数详细计算。结果 2019年,我国共有专业公共卫生机构15 958家,其卫生资源主要集中在东部地区,各省之间差异较大;我国专业公共卫生机构医护比1∶0.97;以人口和面积分布为依据的基尼系数范围分别在0.110 5～0.231 4和0.551 1～0.682 4之间;泰尔指数在0.010 2～0.042 7之间。结论 我国专业公共卫生机构卫生资源配置地区间存在较大差异;以人口分布为依据较以面积分布为依据的卫生资源配置公平性更好;东部区域内床位资源、注册护士差异对卫生资源配置公平性的影响最为显著。     

基于CiteSpace的我国基层医疗卫生机构研究前沿与热点的可视化分析

目的 整理分析我国近20年来基层医疗卫生机构研究的发文趋势、发文机构及热点和前沿情况,为国内基层医疗卫生机构未来的研究提供参考建议。方法 以CNKI和Web Of Science上刊载的基层医疗卫生机构主题相关核心期刊文献作为数据来源,并运用CiteSpace可视化软件进行文献计量分析。 结果 国内和国际期刊上的发文量趋势不同,近20年来中文发文量显示第二阶段（2010—2016年）处于活跃阶段,第三阶段（2017年至今）发文量逐年下降;研究机构主要集中于高校,各核心研究机构群体间的合作较少;国内期刊研究热点以基层医疗卫生机构的制度、基本公共卫生服务、基层卫生人力三方面为主,国际期刊关注相关疾病的防治研究;研究前沿主要是政策性研究,缺乏预见性,存在时间滞后性。 结论 当前我国基层医疗卫生机构尚存短板,但近年来对该领域的研究发文量却逐年下降,应该加强研究机构间的协同合作,增强国际影响力,突破政策性研究,进行创新性研究,解决基层医疗卫生机构现存问题。     

基层医疗卫生机构基本药物增补目录制定现状分析

目的：为各地制定调整基本药物增补目录提供信息和依据。方法：资料来源于全国18个省份官方公布的基层医疗卫生机构基本药物增补目录及相关文件;采用EXCEL和SPSS13.0进行数据的描述性分析。结果：各地在目录制定层级、目录分级、目录结构、目录来源及各类别药物具体纳入情况等差异很大。建议：以省为单位统一制定目录,并按医疗机构级别进行分级;进一步规范目录的内容书写和表达,并注明来源于医保甲类或乙类目录;将相似性较高的药品纳入基本药物增补目录的核心目录品种集。     

基本药物制度在基层医疗机构的实施概况

紧密结合国家基本药物制度的具体政策规定,采用文献检索、机构调查与知情人访谈等方法,对基本药物制度的推行、零差率实施以及基本药物配置等情况进行追踪,发现国家基本药物制度正在各地逐步平稳推进,各地因地制宜地制定了各项配套政策,但也存在多重现实障碍。     

Reducing health disparities through primary care reform: the New Zealand experiment

New Zealand experiences significant health disparities related to both ethnicity and deprivation; the average life expectancy for Maori New Zealanders is 9 years less than for other New Zealanders. The government recently introduced a set of primary care reforms aimed at improving health and reducing disparities by reducing co-payments, moving from fee-for-service to capitation, promoting population health management and developing a not for profit infrastructure with community involvement to deliver primary care. Funding for primary care visits will increase by some 43% over 3 years. This paper reviews policy documents and enrollment and payment data for the first 15 months to assess the likely impact on health disparities. The policy has been successfully introduced; over half the New Zealand population (of four million) enrolled in new Primary Health Organizations within 15 months. Over 400,000 people (half of them in vulnerable groups) gained improved access to primary care subsidies in the first 15 months. The combined effect of new payment rules and the deprived nature of the minority populations was that the average per person payment to PHOs on behalf of Maori and Pacific enrollees was more than 70% greater than the per person amount for other ethnicities for the period. The policy is consistent with the principles of the Alma Alta Declaration. Barriers to successful implementation include the risk of middle class capture of the additional funding; the risk that co-payments are not low enough to improve access for the poor; PHO inexperience; and the small size of many PHOs. Transitional equity and efficiency issues with the use of aggregate population characteristics to target higher subsidies are being ameliorated by the introduction of low cost access based on age. A tension between the twin policy goals of low cost access for all, and very low cost access for the most vulnerable populations is identified as a continuing and unresolved policy issue.     

我国基层医疗机构基本药物配备使用现况分析

通过对13个国家卫生服务调查样本城区或县开展机构调查、知情人访谈等,对基本药物制度试点机构基本药品配备使用等情况进行追踪调查。研究发现,国家基本药物已落实到试点地区基层医疗机构,但其配备率仍有待进一步提高;基本药物目录设置与临床用药仍存在一定的差异,国家基本药物目录的遴选仍需调整完善。     

The gender gap in primary health care resource utilization in Central Asia

There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system.     

Mobility of primary health care workers in China

Background  

Rural township health centres and urban community health centres play a crucial role in the delivery of primary health care in China. Over the past two-and-a-half decades, these health institutions have not been as well developed as high-level hospitals. The limited availability and low qualifications of human resources in health are among the main challenges facing lower-level health facilities. This paper aims to analyse the mobility of health workers in township and community health centres.     

Value-added service in health care institutions

In today's highly competitive atmosphere, the survival of health care institutions depends largely on the ability to provide value-added services (VAS) at the lowest possible cost. Managers must identify their customers and delineate the needs and expectation of those customers. A strategy for satisfying these needs and expectations is essential. While technical advances and reasonable charges are important, a successful "high-tech," "high touch" approach demands the combination of process reengineering and employee training in customer relations.     

Improving population health and reducing health care disparities

The first goal of Healthy People 2010, to increase quality and years of healthy life, does not necessarily coincide with the second goal, to eliminate disparities among population groups. Improvement in the health of the total population without any reduction in relative disparities among racial and ethnic groups was the most frequent outcome at mid-decade for population-based Healthy People objectives. Strategies to maximize improvement in overall population health may have little or no impact on relative disparities or, indeed, may cause them to increase. An independent commitment to eliminating disparities may be necessary.