社区卫生服务机构参与城市居家养老服务的途径和方法

社区卫生服务机构参与城市居家养老服务可提高老年人生活质量，分解子女生活压力，化解社会问题和矛盾。然而，社区卫生服务机构参与城市居家养老服务是一项新兴事业，笔者就社区卫生服务机构参与城市居家养老服务的概念、服务模式和运行机制进行了探讨。社区卫生服务机构参与城市居家养老服务是居家养老服务的一种延伸，需要民政行政部门和卫生行政部门以及社区卫生服务机构高度重视。以社区为范围，依托民政部门和街道的服务网络，组织社区卫生服务机构，以全科医师为骨干的团队服务形式，为社区居家养老人员提供预防保健、医疗康复、护理照料等便捷的一体化服务，是社区卫生服务机构参与城市居家养老服务的途径和方法。     

浅谈新形势下疗养服务创新

为适应新军事变革和疗养院体制编制调整新形势，本文从适应医学模式转变、更新服务理念入手，分析了当前疗养服务的规律与特点，阐述了如何从疗养服务的规律和特点出发，研究发现服务薄弱环节，丰富服务手段、改进服务措施、拓宽服务领域、提高服务水平、树立良好的服务形象，为各单位开展疗养服务工作提供创新思路。     

医疗纠纷沟通技巧六要素

医疗服务是为有身心健康问题的人服务，即医务人员为特殊群体即患者提供的特需服务。它非同于一般行业的服务，它的服务理念、内涵、外延、技巧、方式、方法等都有其特殊性。医疗服务等同于医疗技术，甚至在某些情况下，超越了医疗技术，是对医疗技术的补充、完善与提升，足医疗工作的润滑剂，足医疗工作的重要组成部分。尤其是当今社会倡导以人为本，服务尤关重要。服务要落实到工作中的每个方面，要落实到每位服务对象，要充分尊重对方的权利，要充分体现人文理念。医疗服务受服务主体即医务人员的知识、技能、技巧、方式、方法等制约，同时也受到服务客体即患者的文化素养、认知能力、牛活习惯、区域文化、价值取向等影响。     

浅谈方便服务的整体理念

方便服务是医疗服务整体的一部分，其涉及到医疗服务的方方面面，关乎服务的整体质量。医院在追求医疗服务高质量、诊疗技术高层次的过程中，更应注重医疗质量的持续性改进，注重人性化医疗服务理念的理解和实践。方便服务提出了一个富含服务哲理和服务人性化的问题。社会活动的快节奏以及高标准的健康需求，呼唤着全维、便捷、有效、适宜和无缝隙的医疗服务。     

实施“5S”护理服务 提高科室护理质量

目的为满足病人不同层次的需求，不断提高护理质量。方法实施人性化的服务语言、人性化的服务行为、人性化的服务环境、人性化的服务流程及人性化的服务品牌(简称“5S”)。结果“5S”护理服务，规范服务语言和护理服务行为，推行“五个一”工程，融洽护患关系，保持护理服务零投诉。结论提升了护士自身价值，提高了护理质量。     

涉外医疗中心医院服务文化的实践体会

涉外医疗中心由于服务对象的特殊性，从而使加强医院服务文化建设成为管理的重点。全国创办最早、规模最大的涉外医疗中心惠侨科，在20多年的涉外医疗服务中不断摸索、实践、提炼，形成了独具特色的医院服务文化建设氛围。本文根据涉外病人的需求特点，从服务理念、服务氛围、服务模式、服务态度、服务流程、服务技术等方面进行总结。     

社区卫生服务机构收支两条线改革的实践及思考

我国社区卫生服务经过多年的发展，目前已初具规模，但是不同地区不同模式运行效果差距甚大，特别突出的问题有：政府投入不足、重医轻防、过度服务行为、工作效率低下，等等。为此，杭州市下城区开展了社区卫生服务机构收支两条线改革，通过完善社区卫生服务机构运行和补偿机制，以期建立起一个以社区卫生服务为基础，社区卫生服务机构与医院、预防保健机构分工合理、协作密切，高效、经济、公平的新型城市社区卫生服务模式，努力满足广大人民群众日益增长的医疗卫生服务需求。     

政府主导齐推动社区卫生促和谐——义乌市创建浙江省社区卫生服务先进市活动的启示

社区卫生服务以解决社区主要卫生问题，满足居民基本卫生服务需求为目的，融预防、医疗、保健、康复、健康教育、计划生育技术服务等为一体的有效、经济、方便、综合、连续的基层卫生服务。大力发展社区卫生服务，对于方便群众就医、减轻费用负担、建立和谐医患关系，具有重要意义。国家对社区卫生服务十分重视，《中共中央、国务院关于卫生改革与发展的决定》明确指出，要“改革城市卫生服务体系，积极发展社区卫生服务，逐步形成功能合理、方便群众的卫生服务网络”。此后，国家相关部门先后颁发了一系列文件，各地社区卫生服务迅速展开。目前，全国95％的地级以上城市、86％的市辖区和部分县级市开展了社区卫生服务。然而，尽管如此，社区卫生服务仍面临着不少难点，如认识没有到位、财政投入不足、全科医生缺乏等，限制了社区卫生服务的可持续发展，其作用难以有效发挥，这也是导致“看病难、看病贵”的主要原因之一。为此，《国务院城市社区卫生服务的指导意见》（以下简称《指导意见》），要求各地切实做好社区卫生服务，推动其持续健康发展。     

浅议计划生育技术服务中的告知说明义务与知情同意权利

计划生育技术服务（简称技术服务）是计划生育技术服务人员（简称服务人员）对计划生育技术服务的对象（简称服务对象）进行包括：避孕和节育的医学检查；计划生育手术并发症和计划生育药具不良反应的诊断、治疗；施行避孕、节育手术和输卵（精）管复通手术；开展围绕生育、节育、不育的其他生殖保健项目。因为服务对象主要是健康的育龄群众，技术服务又是解决健康人的生理问题，所以广大群众认为在技术服务中是不会出问题的。随着群众法律意识和维权意识的不断增强，技术服务纠纷的比率也在不断增加，虽然近些年来，经过各级人口计生委和计生服务机构不懈努力，技术服务质量管理有了明显进步，各项管理措施也在不断落实到位，但纵观技术服务全过程，仍存在一些问题和隐患，绝大部分不属技术问题，而是多与服务态度不好、服务质量不高、相互沟通不够和服务不全面、不到位有关。在技术服务中，服务人员对服务对象告知说明义务与知情同意权利了解不全面，履行落实不够，成为诸多问题和隐患中重要且常见的问题，也常为此发生一些不该发生的纠纷。     

医疗服务的与时俱进

医疗服务是一种特殊的服务，服务对象是有病的人，医疗服务的优劣直接影响到人的健康，甚至生命。因此医院要为患者提供优质的服务，除了做好基本服务以外，还必须努力创造服务品牌，把患者的期待变为服务机会，让患者与亲属参与整个医疗过程的决策，真正享受知情参与、决策，提高患者对医疗服务的满意度。同时医疗服务要与时俱进，不断创新服务理念，为患者提供感动服务，即患者不敢想的，我们认为经过努力创造条件可以办到的服务，这样的服务会令患者感到意外，患者对医疗服务的满意度会直线上升，这就是医疗服务的品牌。医疗服务要不断创新。不断改变服务内容和服务方法，我们想的和做的要永远比患者期待的多，这样我们的医院就永远生机勃勃。     

The equity and efficiency principle in the financing system of the NHS in Portugal

The public financing systems of primary health care services and hospital services in Portugal have traditionally been separated. In the United Kingdom where a similar separation exists, inefficient transfers of services take place from the hospital services to the primary care services. In this article a new way of financing of the NHS is proposed which will try to combine the efficiency principle existing in the financing of hospital services with an equity principle reflected in a ceiling on target expenditure for each district.     

Users of home‐care services in a Nordic welfare state under marketisation: the rich,the poor and the sick

Stricter access to public services, outsourcing of municipal services and increasing allocation of public funding for the purchase of private services have resulted in a marketisation wave in Finland. In this context of a Nordic welfare state undergoing marketisation, this paper aims to examine the use of Finnish care services among older people and find out who are using these new kinds of private services. How wide is their use and do the users of private care services differ from those who are using public services? How usual is it to mix both public and private care services? The questionnaire survey data set used here was gathered in 2010 among the population aged 75 and over in the cities of Jyväskylä and Tampere (N = 1436). The methods of analysis used include cross‐tabulation, chi‐square tests and multinomial logistic regression. The findings showed that among those respondents who used care services (n = 681), 50% used only public services, 24% utilised solely private services and the remaining 26% used both kinds of services. Users of solely private services had significantly higher income and education as well as better health than those using public services only. The users of public services had the lowest education and income levels and usually lived in rented housing. The third group, those mixing both public and private services, reported poorer health than others. The results increase concerns about the development towards a two‐tier service system, jeopardising universalistic Nordic principles, and also suggest that older people with the highest needs do not receive adequate services without complementing their public provisions with private services.     

Socioeconomic patterns in the use of public and private health services and equity in health care

Background  

Several studies in wealthy countries suggest that utilization of GP and hospital services, after adjusting for health care need, is equitable or pro-poor, whereas specialist care tends to favour the better off. Horizontal equity in these studies has not been evaluated appropriately, since the use of healthcare services is analysed without distinguishing between public and private services. The purpose of this study is to estimate the relation between socioeconomic position and health services use to determine whether the findings are compatible with the attainment of horizontal equity: equal use of public healthcare services for equal need.     

医院新技术与新项目的管理

医院开展新技术、新项目对提高医院竞争力和医疗技术水平具有重要意义,但它同时具有很大的风险性和高度的复杂性。医院应加强对新技术、新项目的全过程管理,从实行项目准入制度入手,强化项目的立项管理、目标管理、政策管理、常态管理、风险管理、绩效管理、成果管理和经济管理。另外,在项目全过程管理中要突出项目的创新性、重视自主创新,体现创新价值。     

Policies and innovation in mental healthcare: limits to decoupling from the performance of the SUS

We studied Brazilian policies on mental health with respect to normative, supply and demand and financing aspects. We concluded that the sustainability of innovations in psychiatric reform depends on enhanced financing and integration with primary care community services, on the overall performance of SUS and the reduction of autonomous and exclusive services in primary care. There is high and rising pressure in demand for services measured in DALY and the incidence of disease. The reduction observed in psychiatric beds was accompanied by the systemic reduction, though with selective reduction for psychiatric hospitalizations. CAPS services have institutional limits due to the model adopted of direct public administration and local government capacity. Secondary data available show that: (i) SUS has a virtual monopoly on general outpatient and hospital services; (ii) mental health specialists belong mostly to SUS; (iii) most mental health services are outpatient services; (iv) few CAPS have day-bed services available; and (v) there is reduced federal financing for these innovations.     

Analysis on the availability of programs and services for elderly people in Puerto Rico

This research was conducted with the purpose of analyzing the programs and services available to the aged population in the municipalities of Puerto Rico during 1999 and 2000. The analysis was performed using an evaluation instrument which collected data of the programs and services directed exclusively to the aged population, such as: senior centers, foster homes, institutions, independent living, employed and/or volunteer people, geriatric services, adult education (literacy), recreation, discounts, corporations and/or associations that benefit the aged population, aging offices, support groups, social services, home meal services, and financial aid. Data was also collected from programs and services that benefit diverse aged populations in areas such as: health, housing, employment and social welfare. The sources for the collection of data were directories available to government and private agencies, telephone directories, telephone interviews, and personal visits. The municipalities were divided into two zones, the Northern zone, constituted by 40 municipalities and the Southern zone, constituted by 38 municipalities, for a total of 78 evaluated municipalities. In the Northern region, which accounted to approximately 295,938 aged persons, 18 types of programs or services were found to serve the aged population directly and 50 types were aged-related programs or services. In the Southern region, which accounted for approximately 169,798 aged persons, 13 types of programs or services served the aged exclusively and 43 were aged-related services. The following were among the principal programs or services available: senior centers, foster homes and/or institutions, employment programs, home care services and hospices, independent living, and agricultural extension services. Among the least available programs or services were private home meal services, literacy and retraining, arts and travel services, corporations or associations for the benefit of the aged, geriatric evaluation programs, home repair services, home-assistance programs, support and respite programs, adequate or specialized transportation services, diverse housing models, different types of senior centers, and programs for psychological or psychiatric assistance. In conclusion, the availability of the programs and services in this study and the evaluation of the services needed for a community of aged persons indicate the need for increasing and developing services considered essential in accordance to the population demands.     

Politics and inter-medicality in the Upper Xingu: from model to practice in indigenous health care

The indigenous healthcare model in Brazil is premised on comprehensive care combined with the notion of differentiated care and provides for respect for cultural diversity, seeking to incorporate traditional therapeutic practices into the health services that serve indigenous peoples. This study aimed to determine how to reconcile universal access to health goods and services with a model of care that guarantees differentiation, without interfering in the quality of services. It is also necessary to define which parameters should be used for evaluating the quality and efficacy of such services in an intercultural context. Based on a case study - the implementation of health services in the Upper Xingu - the author addresses some issues related to the political uses and "dangers" associated with "health spaces" and the distinct concepts (indigenous and non-indigenous) of what constitutes health and quality of health services. These issues affect not only health services but also the local political situation.     

Social inequality in the use and comprehensiveness of dental services

Abstract: Fair access is a value enshrined through universal insurance for health care in Australia. However, dentistry is not included in this system. As a consequence, there is a strong likelihood of inequalities in access to dental services among adults. Data from the 1989–90 National Health Survey were analysed to determine sociodemographic factors related to use and comprehensiveness of dental services. Age, income, age of leaving school and occupation were independently associated with the use of dental services, and occupation was associated with an indicator of comprehensiveness of care: self-reported extraction at the last visit. In different adult age groups these sociodemographic factors had different effects, with the disparities in use of dental services greater in older age groups. Planning of dental services in the 1990s and beyond should include not only the removal of financial barriers to dental services among adults but also attention to the specific barriers experienced by the elderly.     

Health problems and service utilization in the homeless

This study examined the health problems and utilization patterns of homeless individuals (n = 292) seeking medical services in a small, southern community. Results showed that the medical problems for which the homeless sought treatment were often (72.6 percent) a reoccurring problem for which treatment had been previously received. The most prevalent medical problem was upper respiratory infection (47 percent), likely exacerbated by the high rate (73 percent) of cigarette smoking found among the sample. More than half (51.4 percent) of the participants had used other medical services in the past month. Despite these high rates of utilization, the homeless may, in fact, be underutilizing appropriate preventive medical services, waiting until the medical problem becomes serious before seeking treatment, and overutilizing emergency rooms for nonemergency care. Community-based services sensitive to the needs of the homeless are likely to cost communities less money while providing better services to the homeless.     

Determinants of the utilization of maternal and child health services in Jordan

The utilization of antenatal, delivery and postnatal services by a random sample of married women in Jordan during their most recent pregnancy resulting in a live birth is analysed. Marked variations are shown in the use of these services and of preventive infant care for women living in urban and rural areas. Women with increasing levels of formal education and those living near services were significantly more likely to use services. If effective coverage of these services is to be achieved then it is suggested that greater emphasis should be placed upon outreach and realistic social marketing.