社区卫生服务在施实区域卫生规划的作用

社区卫生服务是全社会共同参与的新型卫生服务体系。社区卫生服务在区域卫生规则中的意义和作用应从以下几方面去认识。一、从区域卫生规划的指导原则看,推进和加强社区卫生服务是满足城乡居民健康需求的重要措施。以提高人群健康为中心、以满足社会需求为导向,是制定区域卫生规划应遵循的指导原则。以居民的健康需求为依据,这也是区域卫生规划区别于传统卫生事业发展计划的重要特征,根据这一指导原则,必须对区域内的卫生资源实行统筹规划与合理配置,从而使卫生服务的供给和卫生资源的配置与卫生服务需求相适应,满足社区居民的基本卫…     

结合区域卫生规划和社区卫生服务因地制宜深化医疗机构改革

本文从分析区域卫生规划、社区卫生服务和医疗机构配套改革的关系入手,讨论如何因地制宜深化医疗机构配套改革。指出：正确认识区域卫生规划、社区卫生服务和医疗机构改革的关系是深化医疗机构改革的前提;结合区域卫生规划和社区卫生服务是深化医疗机构改革的客观要求;因地制宜围绕医疗保险制度改革是深化医疗机构改革的关键。     

实行区域卫生规划 优化卫生资源配置

区域卫生规划主要是在一定区域范围内,根据其经济、文化、交通发展及人口分布状况,就医规律,及对卫生服务的实际需要,统一规划,合理分配卫生资源。因卫生劳务提供的是一种特殊服务,卫生服务的供需双方必须直接接触,不能有中间环节,其他人也不能代替。在一个区域范围内,合理规划卫生资源,必须解决两个方面的问题:一是广大群众的就医问题,即满足需求,保证健康;二是加强成本——效益分析,充分利用卫生资源问题。要做到这两点,必须在一定区域范围内,将各层次、各类型的医疗机构统一协调、合理布局、分工协作、综合利用,使之发挥整体功能,从而达到公平与效益兼顾,在满足人们医疗保健需求的同时,又使卫生事业健康发展。     

关于构建与和谐社会相适应的卫生服务制度的思考

为构建与和谐社会相适应的卫生服务制度，针对我国卫生服务制度中存在的与构建和谐社会不相适应的问题和矛盾，本文从现实和理论的角度，采用综合与分析的方法，探讨卫生服务制度设计的指导思想、基本原则、方法内容和保障措施。构建与和谐社会相适应的卫生服务制度，必须统筹城乡之间、区域之间、预防与医疗之间、中医与西医之间、医疗服务与医疗保障之间、不同层次卫生服务之间、公立医疗机构和民营医疗机构之间的均衡发展，改善医患关系．加强卫生监督执法，规范医疗卫生服务市场秩序。在保障措施上，必须强化政府责任，加强部门协调，注重配套改革。要实现卫生事业和谐、健康、快速发展，卫生改革与发展成果惠及广大人民群众，必须构建和谐社会相适应的卫生服务制度。     

社区卫生服务在区域卫生规划中的地位和作用

1 从区域卫生规划的指导原则看,社区卫生服务是满足城乡居民健康需求的重要措施 以提高人群健康为中心,以满足社会需求为导向,是制定区域卫生规划的指导原则。根据这一原则,必须对区域内的卫生资源实行统筹规划与合理配置,使卫生资源配置与卫生服务需求相适应,以满足社区居民的基本卫生服务需求。社区卫生服务就是以社区人群为着眼点,卫生服务供给顺应需求,走出医院大门,深入到社区,改变传统的“坐等病人”的服务模式,面向个人及家庭,以预防、保健、医疗、康复、健康教育为服务内容,为社区居民提供方便、快捷、价廉、优质的     

农村卫生服务体系的资源配置

建立农村卫生服务体系，首先必须注重对农村卫生服务资源进行统筹规划、合理配置，而要实现这一点，就必须以区域卫生规划为依据。国家计委、财政部、卫生部在1999年印发的《关于开展区域卫生规划的指导意见》中指出：“区域卫生规划以满足区域内全体居民的基本卫生服务需求、保护与增进健康为目的，对机构、床位、人员、设备等卫生资源进行统筹规划，合理配置。它的目标是构建与国民经济和社会发展水平相适应，有效、经济、公平的卫生服务体系和管理体制，改善和提高卫生综合服务能力和资源利用效率。区域卫生规划由政府负责制定并组织实施。”     

实施区域卫生规划,加强卫生预防保健工作

实施区域卫生规划是卫生管理体制的重大改革,是政府对卫生事业实行宏观调控和全行业统一管理的重要手段,是区域内合理配置和有效利用卫生资源的必然。制订和实施区域卫生规划是以社会需求为导向,以增进人民健康为中心,以满足区域内全体居民的基本卫生服务需求为目标,改变目前我们国家长期以来与计划经济体制相适应的卫生行政管理、卫生监督体制和卫生服务体系下所形成的卫生资源的布局和结构不合理的现状。如在城乡配置上,卫生资源过多地集中在城市,农村卫生基础薄弱;在区域配置上,大中城市医疗机构重叠,自成体系,集中了80%的城市卫生资源,…     

以改革为动力 推进基本现代化医院建设进程

1.继续深化医院改革1.1调整城市医疗资源配置促进医疗体制改革首先要制订好区域卫生规划和医疗机构设置规划。《中共中央、国务院关于卫生改革与发展的决定》指出“区域卫生规划是政府对卫生事业发展实行宏观调控的重要手段,它以满足区域内全体居民的基本卫生服务需求为目标,对机构、床位、人员、设备和经费等卫生资源实行统筹规划、合理配置”,同时明确,中央制定区域卫生规划的指导原则,省级人民政府制定卫生资源配置标准,市(地)级政府制定当地区域卫生规划,并组织实施。2001年,我厅与省财政厅、省发展计划委员会联合下发了《江苏省卫生资…     

区域卫生规划与医疗机构改革

区域卫生规划是政府推进医疗机构改革的一个关键切入点。在医药卫生体制改革逐步浓化、医疗机构分类管理制度广泛实施的今天，我们要正确认识区域卫生规划与医疗机构改革之间的关系，正视医院改革中区域卫生规划的障碍与难点，在规划调整进一步提高医疗资源利用效果，推进医疗机构改革。     

区域卫生规划政策措施研究

《中共中央、国务院关于卫生改革与发展的决定》明确指出:“区域卫生规划是政府对卫生事业发展实行宏观调控的重要手段,它以满足区域内全体居民的基本卫生服务需求、保护与增进健康为目标。对机构、人员、设备等卫生资源进行统筹规划,合理配置。”为推动区域卫生规划的顺利实施,必须以切实可行的政策措施作保证。1 推行区域卫生规划的关键政策 区域卫生规划是区域内国民经济和社会发展计划的组成部分,是政府对卫生事业发展实行宏观调控的重要手段,是区域内合理配置卫生资源的基本依据。为此,必须     

Postabortion care and safe motherhood in Ghana

In Ghana, a multidisciplinary Safe Motherhood Task Force complied a comprehensive Safe Motherhood plan that addresses such issues as policy, research, community education and involvement, materials development, and equipment supply. Development of this plan began after a 1993 consultative meeting called for creation of the task force. The task force met over the next year to develop clinical and health education guidelines for Safe Motherhood that included the management of abortion complications but failed to recommend that uterine evacuation be performed at the health center level. Meanwhile, another multidisciplinary group was developing a set of reproductive health service policies and standards that identified the key services that should be available at each level of the health system and the appropriate providers for each service. This group recommended that family planning nurses and midwives provide postabortion care, including uterine evacuation with manual vacuum aspiration. This policy was adopted by the Safe Motherhood Task Force, and the group began working on implementation issues such as funding for training and equipment needs related to postabortion care. Training of trainers workshops began in 1995, and the plan is now being implemented at the regional level. A study is also underway to determine the safety, acceptability, and feasibility of primary care midwives performing uterine evacuation.     

Regional centers: Part III. Three regions’ educational efforts and infant mortality rates

In this third part of my study of a northwestern level II regional newborn center, I compare the educational efforts of three regional newborn centers and then examine the infant mortality rankings of the states in which the three centers are located to determine if correlations exist. The Committee on Perinatal Health has described the three facets ofeducation with a potential effect on infant mortality in the regional development of maternal and perinatal health services:

1. Preparatory and continuing education for center personnel. The critical factor in providing service of high quality is personnel, trained and experience din the best professional techniques of maternity and newborn care and working in a coordinated regional plan for providing this care.

2. Educational services to the region. The responsibility for planning and providing these services should be assigned to a multidisciplinary group at the level III unit. The plan should include various types of courses for physicians, nurses, and any others involved in patient care.

3. Education of the care recipient or consumer. The regional center should be responsible for the programs to educate the consumer about the need for early confirmation of pregnancy, early and continuous prenatal care, and adequate nutrition and also to promote consumer awareness of maternal and neonatal risk factors.

     

欧盟罕见病保障体系及启示

欧盟在2008年正式从全欧洲的战略层面开展罕见病保障专项工作,已经形成的罕见病相关工作经验,非常值得中国借鉴。通过总结欧盟罕见病概况及孤儿药目录、罕见病组织结构与战略计划、罕见病筹资支付体系和服务提供等情况,分析欧盟罕见病保障体系的优缺点,提出我国开展罕见病保障工作的实施建议,如统一罕见病的合理定义、编码与目录;建立罕见病保障工作的组织架构,制定罕见病国家（地区）计划或政策,优化罕见病服务提供,建立可持续性的罕见病筹资体系,注重罕见病工作的综合全面性和地区差异性,为提高我国罕见病防治工作的保障力度和可持续性提供参考。     

Current trends in Canadian health care: disease prevention and health promotion

The Canadian national health insurance plan has not extended to disease prevention in any comprehensive way, and to this extent is incomplete. The Task Force on the Periodic Health Examination has done outstanding work, but no provincial insurance plan has systematically adjusted the benefit schedule to reflect its recommendations. Thus, the place of disease prevention under the Canadian system of universal health insurance is remarkably similar to that in the United States. Health promotion has a somewhat different meaning in Canada from that in the United States, emphasizing intervention at the population level more than health education of individuals. The health promotion movement now enjoys considerable support in Canada, especially in the public health sector, in voluntary agencies, and in the policies of the federal and several provincial departments of health. The movement is almost completely separate from mainstream health services, and is unrelated to the insurance program. To date, there has been mostly talk, but several structures are in place which should lead to action.     

福建省基层医疗卫生综合评价

目的：了解福建省基层医疗卫生综合情况。方法：利用福建省医改中期评估调查表中＂医疗卫生综合情况调查表＂的基础资料和该表涉及的7项核心指标,运用RSR法、功效系数法和Z分评价法,对全省的基层医疗卫生综合情况进行分析。结果：通过九个设区市排名,县级市、市辖区和县级间的排名及不同经济发展水平县（市）的排名,发现区域医疗卫生综合情况与经济发展水平相关,且在机构、人力、公共卫生服务等方面存在差异。结论与建议：福建省主要存在基层医疗卫生机构区域发展不平衡、公共卫生服务发展不均等和基层医疗卫生人才队伍整体水平较低等问题。建议自主发展和财政投入相结合,促进基层医疗卫生机构区域平衡发展;专项经费保障和标准化体系建设相结合,促进公共卫生服务均等化发展;人事和经费保障制度相结合,加强卫生人才队伍建设。     

德国等九个发达国家区域卫生规划的经验与启示

德国、英国等9个发达国家的经验表明,对医疗服务能力进行区域卫生规划,以提高资源配置效率、满足多层次医疗服务需求、控制医疗费用的膨胀,是国际通行的做法;规划一般由中央政府制定原则,由区域政府（州／省）参与并负责执行;以社会医疗保险为主的国家侧重全社会的服务能力规划,而以国民卫生服务为主体的国家则侧重对公立医疗卫生体系的规划。这些经验对我国在新一轮“医改”中进一步推动区域卫生规划具有重要借鉴意义。     

Prävention und Gesundheitsberichterstattung im ÖGD

For many years prevention of disease and health promotion have been central activities of the public health services in Germany. But especially within these areas of activity there have been difficulties in understanding "old"versus"new"in relation to public health. Previously it was not possible to generate common standards for the public health service for prevention, health promotion and health monitoring due to the regional diversity of legislation within the single provinces. However, these activities could demonstrate the strength of public health services in these fields. The forthcoming law on prevention provides a framework for strengthening the public health services through defining qualitative standards for eligible preventive measures and at the same time making clear the competences of public health services that should be available. Thus public health services could become one of the central players at the local level in the strengthening of prevention and health promotion in the future. The quality of planning and outcome of eligible preventive measures will strongly depend on the local health monitoring system. If the forthcoming law does not make use of the competence of public health services in identifying healthy and socially disadvantaged settings, a white-collar orientation of preventive and health promotion activities may be expected.     

Physicians’ Perceptions of Integration in Three Western Canada Health Regions

Over the past decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians’ perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians’ perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1-5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.     

Social and economic disparities under Canadian health care.

Central to the objectives of Canadian national health insurance were the principles that health is a basic right that should be open to all and that all Canadians, regardless of their ability to pay, would be provided with publicly financed comprehensive hospital and medical services. During the two decades that this program has been in place, substantial gains have been realized in making insured services more accessible to all Canadians, in the reduction of regional mortality disparities, and in a leveling out of earlier sharp differences in the supply of health resources across Canada. These changes have not been matched by any significant realignment of the health status of Canadians relative to their economic circumstances, nor as yet by the full removal of economic constraints affecting accessibility to health services. The Canadian experience raises the fundamental concern of whether a reasonable level of equity can be achieved in nations having distinctive regional priorities, a federal structure linking people of different cultural identities, and where a sharp gradient of economic opportunities is entrenched.