优化区域卫生规划 夯实合理配置医院基础

区域卫生规划是政府对区域内卫生资源合理配置、有效利用和对卫生发展宏观调控的重要手段。其作用是通过提高资源的配置效率，保证城乡居民公平地获得基本医疗，满足多层次的卫生服务需求，解决“看病难”问题，实现医疗服务的公平性。     

卫生Ⅷ支持性项目中卫生服务提供与利用现状调查分析

为了解贫困地区卫生服务提供情况，便于以后有针对性的进行干预活动，对重庆市巫溪县、黔江区卫生服务提供情况进行了调查。结果显示通过对重庆市巫溪县、黔江区实施卫生Ⅷ项目：（1）改善了卫生服务提供系统；（2）提高了该县、区提供卫生服务的能力；（3）群众对卫生服务的利用得到较大提高。建议进一步加强政府重视，改善其规划管理能力和卫生服务提供能力，增强农民的健康保健意识，提高特困人群、妇女、儿童对基本卫生服务的可及性和健康水平。     

满足社会整体发展需要科学制定区域卫生规划

《中共中央、国务院关于卫生改革与发展的决定》中指出: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,地(市)级政府根据中央和省级人民政府制定的区域卫生规则指导原则和卫生资源配置标准,制定当地区域卫生规划,并组织实施。区域卫生规划是指对在一定区域内的卫生服务活动所做的规划,包括双重含义:一是指对某一区域范围内卫生服务发展的整体规划,主要从区域卫生服务需求与供给平衡上来解决区域内卫生资源的合理配置;二是区域间卫生服务协调发展的规划,主要是从社会整体发展的角度来解决区域之间卫生服务非均衡发展等问题。     

提高卫生管理水平 改善农村卫生服务质量--安徽省卫生Ⅷ项目地区卫生服务管理水平分析

对安徽省利用世行贷款对卫生Ⅷ项目地区基本卫生服务管理水平的改善情况进行分析。结果显示：各级卫生规划与管理能力提高；乡镇卫生院服务条件改善，服务效率提高；乡镇卫生院领导层管理水平提高。但是存在配套资金落实困难较大，激励机制不健全，软硬件失衡等问题。建议：加大项目管理力度，完善项目监督机制，建立项目示范点。     

天津市区域卫生规划的实施与政策环境分析

区域卫生规划的有效实施与当地的卫生政策环境密切相关。近年来，在天津市政府的领导下，卫生部门通过营造有效的政策支持环境与整体制度设计，不仅使区域卫生规划得到较好的实施，也促进了天津卫生改革与发展。在区域卫生规划指导下，天津在卫生资源调整、卫生服务体系建设、提高卫生服务的公平性方面进行了有益的实践。     

民族贫困地区实施区域卫生规划的思考

实施区域卫生规划是政府在社会主义市场经济体制下对卫生资源进行宏观调控和合理配置，协调医疗卫生服务供需平衡，推进卫生事业健康持续发展的基础手段和重要依据。如何实施区域卫生规划，调整长期计划经济体制对卫生资源配置的不良影响，不少卫生管理专家对此进行了广泛...     

区域卫生可持续发展战略规划研究

中国是一个幅员辽阔的国家 ,各个地区的经济社会发展水平差异很大 ,各地面临的疾病类型及防治措施有所差异 ,同时各地对医疗卫生保健方面的需求也存在差异。可见 ,中国的卫生问题首先是个区域性问题 ,因而需要通过有效的区域规划来解决。区域卫生规划是在一定区域范围内 ,根据自然环境状况、经济与社会发展水平 ,针对区域卫生服务需求与卫生服务供给矛盾 ,合理配置卫生资源 ,确定区域内卫生发展目标、模式和速度及相应的政策体系 ,从而向全体居民提供更好、更有效的卫生服务 ,以提高居民的健康水平的一项长期性发展规划。区域卫生规划是当今…     

开展区域卫生规划进行卫生资源调整积极探索社区卫生服务发展新思路

全面实施区域卫生规划，加强卫生资源的宏观管理，能够充分地合理配置和有效利用卫生资源。文章介绍了天津市在充分做好调查研究的基础上，以区域卫生规划为指导，开展全市卫生资源调整，积极推进社区卫生服务发展的思路和具体做法，以期引起讨论。     

关于《医疗机构设置规划》若干问题的探讨

《医疗机构设置规划》是设置和审批医疗机构的依据，体现了医疗卫生服务的公平性，可以提高医疗卫生服务的效率，是医疗管理法制化的重要步骤，是社会经济改革总体规划的组成部分，而且将对建立健全农村三级医疗预防保健网发挥积极作用。《规划》应体现卫生服务的公平性，有利于建立健全医疗服务体系，体现卫生服务的效益和效率原则，体现卫生服务系统的发展，应立足于基本医疗卫生服务，体现中西医并重的卫生工作方针，并在政府领导下，统一布局。文章还论述了《规划》与区域卫生发展规划、社会经济发展规划、社会主义市场经济体制的关系，阐述了制定《规划》的基本步骤和方法，讨论了目前存在的问题和对策。     

湖南省精神卫生服务现状及对策研究

目的分析2002年湖南省精神卫生机构服务现状，为卫生职能部门制定精神卫生工作规划提供参考。方法采用描述性的分析方法，对湖南省2002年精神卫生机构的服务现状进行分析。结果湖南省精神卫生机构资源比较贫乏，同时卫生资源利用率较低。结论建立精神卫生管理机构；增加卫生资源投入；加强专业人员的培训；坚持专科发展方向，不断拓宽相关专科服务领域；开展社区精神病防治。     

Health planning and the closure of a community hospital.

The overall purpose of the research reported in this article is two-fold: firstly, to describe the efforts of a regional health planning agency in the United States to reduce the size of acute care facilities in its planning area; and, secondly, to frame these events into a general theory of structural problems of state interventions in the American health care sector. Specifically, a case study is presented that documents--over time--the process of decision making, in seeking to close a community hospital against strong, and vocal, local interests. This analysis supports the view that, in the real world of health planning, power is exercised through a process of bargaining between health care providers and government, and between health care providers. Overall, the study illustrates the constraints upon the American health planning agencies to steer a relatively autonomous health care sector.     

Planning and politics of resource allocation for primary health care: Promotion of meaningful national policy

Securing resources for primary health care (PHC) involves consideration of the entire health sector: the higher levels of the health service as well as the primary level, and the private and/or social security sub-sectors as well as the government service. Reshaping resource distribution is less a redistribution of existing resources than the allocation of new resources in accordance with PHC priorities. In this the planning of future current costs is a crucial element and requires a budgetary system that identifies expenditures by geographical area and level of care. Resources should be allocated geographically to reduce health care inequalities through the provision of an appropriate mix of different levels of care. Central resource planning and local health care programming (with ‘dialogue’ between the two) should be the basic planning division of labour, which largely resolves the so-called topdown /bottom-up dichotomy. The private medical sub-sector exerts economic, ideological and political influences on the public health service. Compulsory health insurance schemes can have some similar effects. Success of a PHC policy requires that governments adopt a holistic approach to the health sector.The allocation of health care resources on the bases of need and equity, as opposed to demand, is a political decision. The establishment of a national PHC policy backed up by adequate resources involves a specific politico-technical exercise with four components: research, planning, policy formulation, and government policy decision-making. The resource planning method, based on social epidemiology, is contrasted with conventional health planning methods, based on epidemiology. The articulation of these two approaches is discussed in terms of WHO's Managerial Process for National Health Development.Examples are quoted from Zimbabwe.     

The role of strategic health planning processes in the development of health care reform policies: a comparative study of Eritrea, Mozambique and Zimbabwe

This paper reports on comparative analysis of health planning and its relationship with health care reform in three countries, Eritrea, Mozambique and Zimbabwe. The research examined strategic planning in each country focusing in particular on its role in developing health sector reforms. The paper analyses the processes for strategic planning, the values that underpin the planning systems, and issues related to resources for planning processes. The resultant content of strategic plans is assessed and not seen to have driven the development of reforms; whilst each country had adopted strategic planning systems, in all three countries a more complex interplay of forces, including influences outside both the health sector and the country, had been critical forces behind the sectoral changes experienced over the previous decade. The key roles of different actors in developing the plans and reforms are also assessed. The paper concludes that a number of different conceptions of strategic planning exist and will depend on the particular context within which the health system is placed. Whilst similarities were discovered between strategic planning systems in the three countries, there are also key differences in terms of formality, timeframes, structures and degrees of inclusiveness. No clear leadership role for strategic planning in terms of health sector reforms was discovered. Planning appears in the three countries to be more operational than strategic.     

Role of GIS in Social Sector Planning: Can Developing Countries Benefit from the Examples of Primary Health Care (PHC) Planning in Britain?

Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary health care is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary health care. This paper examines the scope of GIS in social sector planning by concentration on primary health care delivery system in Pakistan. The work is based on example of the UK’s decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities’ needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for health care, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary health care planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change.     

Gender differences in the use of outpatient mental health services

Current economic constraints necessitats careful planning and evaluation of mental health services. Gender differences in need and use of outpatient mental health services are synthesized based on current epidemiological research. Although overall prevalence rates of mental disorder are similar, women use more outpatient mental health services than do men. This disparity exists largely within the primary care sector. The study of social roles and behavior may help explain these gender differences. Implications for planning and organizing outpatient mental health services are discussed.     

An Implication of Health Sector Reform for Disadvantaged Women's Struggle for Birth Control: A Case of Kurdish Rural–Urban Migrant Women in Van,Turkey

In this article, we examine how socioeconomically disadvantaged women are affected by health sector reform and family planning policy changes in Turkey through a case study of Kurdish women's struggles for birth control. In Turkey, a family planning program became relatively marginalized in primary health care services as a result of health sector reform as well as a shift of population policy toward a moderately pronatal approach. We argue that an emerging health care system would leave disadvantaged women unable to benefit from contraceptives and would perpetuate reproductive health inequalities between women in the country.     

中国医药卫生体制改革与中国卫生政策研究类型

中国医药卫生体制改革处于总体制度框架设计与改革发展模式选择的关键时刻，改革发展实践迫切需要卫生政策研究。卫生政策研究质量决定卫生改革的成败。卫生政策研究在医药卫生制度框架设计、发展模式选择、体制改革实践、卫生保健体系创新、医院质量管理和构建和谐医患关系等工作中扮演基础性和核心角色，发挥举足轻重的作用。本文简要论述医药卫生体制改革与卫生政策研究关系，介绍中国卫生政策研究的基本类型。     

From home,to market,to headquarters,to home. Relocating health services planning and purchasing in New Zealand

Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand's four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989-1991) with planning and purchasing located at "home" in local areas and closely aligned with service provision; a competitive internal market system (1993-1996) which separated planning and purchasing from service provision; a centralised system with a "headquarters" controlling planning and purchasing (1997-1999) while maintaining the distance from provision; and the district health board system currently under development (1999-) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand's experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.     

Die Nutzung der GKV-Daten für die kleinräumige Analyse und Steuerung der stationären Versorgung

In Germany, only few data sources enable a small-area analysis of medical care. However, this is necessary for empirically based planning of future medical care. Here claims data of the statutory health insurance provide new insights into medical care by utilization analysis at district and postal zip code levels. Examples of small-area analysis of hospital care show manifold possibilities of using these data for purposes of health services research and planning. The most important result of these analyses is the considerable variation of hospital care utilization which is constant over time and regions. Claims data are updated regularly, complete, unbiased, and of high quality. They also have a clear reference to population and region. Limitations of using claims data arise from the absence of clinical information. For purposes of hospital planning the restriction to the hospital sector is more important. In the future this limitation will be overcome by using claims data from primary and hospital care together.     

Mental health services system research: the National Institute of Mental Health program.

There is a critical need for research to examine the changing mental health services system, to evaluate major innovations in the provision of mental health treatment, and to remove existing barriers to comprehensive and cost-effective care. To achieve these aims, collaboration is needed among government agencies, mental health services programs, academic institutions, and the private sector. The National Institute of Mental Health supports research and research training on the mental health services system primarily through the Division of Biometry and Applied Sciences. This article focuses on the division's three priority research areas of the mental health services system: the provision of mental health care in the primary care sector, the organization and delivery of care for the chronically mentally ill, and financing and reimbursement of care. The various mechanisms of research support are also highlighted.