芜湖市基本公共卫生服务项目实施进展及公平性研究

目的了解芜湖市基本公共卫生服务项目进展及其实施的公平性,为项目推进提供参考。方法通过分层抽样调查了解该市各县区基本公共卫生服务项目进展,应用基尼系数评估其公平性。结果截至2012年,305家基层医疗卫生机构累计建立电子居民健康档案162.9万份,建档率为52.2%;A+C流脑第一剂次免疫接种率最高,为93.1%;白破疫苗接种率最低,为83.2%;儿童保健覆盖率、孕产妇早孕建册率、65岁以上老年人健康管理率分别为86.7%、77.5%、65.3%;高血压、2型糖尿病、重性精神病患者健康管理率分别为48.3%、59.3%、53.7%。按人口供给服务的基尼系数均处于最佳公平状态,按地理面积供给部分服务的基尼系数处于警戒状态。结论芜湖市基本公共卫生服务项目取得了一定成效,但各县区间存在一定差异,基本公共卫生服务均等化程度有待提高。     

东莞市某镇基本公共卫生服务成本测算

目的 测算东莞市某镇基本公共卫生服务项目成本,为政府建立合理的补偿机制提供科学依据.方法 采用供方分析法,测算社区卫生服务机构完成基本公共卫生项目所需的标准配置人力,在此基础上测算人力成本、机构运营成本及总成本.结果 该镇2011年基本公共卫生服务项目的总成本为9 251 887元,人均成本为22.10元;2012-2014年人均成本分别为24.62元、27.43元和30.56元.结论 该镇人均基本公共卫生服务成本相对较低,社区卫生人力配置有待进一步提升,政府应该根据基本公共卫生服务项目内涵的变化以及社会经济发展状况对基本公共卫生服务项目进行合理补偿.     

深圳市基本公共卫生服务工作中存在的问题及建议*

通过对深圳市基本公共卫生服务工作进行现场调查与资料查阅,梳理深圳市基本公共卫生服务工作中存在的问题并提出相关建议,旨在为深圳市基本公共卫生建设提供更全面、更有针对性的指导。分析发现,现阶段深圳市基本公共卫生服务工作中存在的问题包括:基层慢性病管理信息化程度不足,基本公共卫生服务各系统无法互联互通;现有社区健康中心整体布局与居民健康需求存在差距;基本公共卫生项目的考评与服务经费关联机制欠成熟;现行基本公共卫生服务项目年人均补助标准与基本公共卫生服务项目需求不匹配;基层公共卫生机构专业技术人员缺乏并且薪资待遇低。未来工作改进建议:加强基层公共卫生信息系统建设;加强社区健康中心服务能力建设;完善基本公共卫生服务经费保障机制;适当提高基本公共卫生服务经费补助标准;提高基层公共卫生医生待遇。     

2013-2015年新疆维吾尔自治区基本公共卫生服务项目实施现状分析

目的分析2013-2015年新疆维吾尔自治区基本公共卫生服务项目实施的现状,找出项目实施过程中存在的问题并提出对策建议,为制定基本公共卫生服务项目管理政策提供依据。方法通过对2013-2015年基本公共卫生服务监测数据的整理,分析基本公共卫生服务项目实施现况,比较不同疆域服务对象基本公共卫生服务利用的均衡性和公平性,具体指标包括复合增长率(GAGR)、基尼系数和泰尔指数。结果基本公共卫生服务项目实施现状基本达到国家标准,各别服务项目存在区域间不均衡和城乡不公平现象。结论基本公共卫生服务项目工作应严格按照国家标准进行,强化项目管理,加强分工协作;明确公共卫生任务,制定合理工作目标;落实服务规范,注重服务效果;强化绩效考核,建立奖惩机制。     

成都市基层医疗卫生机构公共卫生人员配置现状研究

[目的]了解成都市基层医疗卫生机构公共卫生人员配置现状,分析存在的问题,为基层医疗卫生机构公共卫生人员队伍建设提供决策参考和政策建议,为促进基本公共卫生均等化提供人才保障。[方法]问卷调查法、访谈法。[结果]成都市基层医疗卫生机构卫生技术人员学历低、职称低,部分卫生技术人员无执业医师资格;公共卫生人员配置不足,每万人口公共卫生执业(助理)医师数平均为0.25人,公共卫生医师需求量与实际之间缺口较大,基本公共卫生服务团队的专业素质有待提高。[结论]应进一步加强基层医疗卫生机构公共卫生人员队伍建设,提高公共卫生人员素质,促进基层医疗卫生机构公共卫生服务的可持续发展。     

四川省城乡基本公共卫生服务项目培训需求差异性分析

摘要:目的　分析四川省城乡基本公共卫生服务项目的培训现状及需求差异,为完善四川省基本公共卫生服务项目的培训工作和促进基本公共卫生服务均等化提供参考建议。方法　选取成都温江和南充仪陇作为样本地区,采用深入访谈法、现场问卷调查法等定性研究和定量研究相结合,并运用SPSS18.0对相关数据资料进行统计分析。结果　38.64%认为公共卫生服务相关培训次数相对较少;78.84%的基层卫生人员认为培训有利于提高其开展公共卫生服务工作的能力;社区卫生服务中心慢性病患者健康管理培训需要率为91.8%%,低于农村乡镇卫生院;中心乡镇卫生院老年人健康管理培训需要率为92.6%,低于其他基层卫生机构。结论　四川省城乡基本公共卫生服务项目培训工作有待进一步加强,一般乡镇卫生院人员较社区卫生服务中心和中心乡镇卫生院的培训需求更大,培训效果与基本公共卫生服务工作完成的情况紧密相关。     

我国基层卫生人力资源配置现状及公平性分析

目的:基层医疗卫生服务人员是提供基本医疗服务和基本公共卫生服务的主力军,是影响服务提供数量、质量和效果的核心要素。文章旨在通过分析我国各省市基层卫生机构卫生技术人员配置数量、结构和公平性,为进一步完善基层卫生人力资源相关政策奠定基础。方法:查阅中国卫生统计年鉴2006-2009年基层卫生人力资源数据,对其结构进行分析,并利用洛伦兹曲线和基尼系数对对其公平性进行评价。结果2006-2009年,全国每千非农业人口社区卫生服务机构卫生技术人员数呈迅速增长趋势,省际间Gini系数由2006年的0.65降低到2009年0.24,不公平性状况得到明显改善;每千农业人口乡镇卫生院和村卫生室卫生技术人员数较稳定,省际间Gini系数均小于0.1,公平性较好。社区卫生服务机构和乡镇卫生院人员年龄主要集中在25-44岁之间;大学及以上学历人员比例较低,中专及以下学历人员所占比例较高,尤其是在农村地区;以初级及以下职称为主;全科医师占执业医师总数的比例仅为3.5%。结论:基层卫生服务人员配置日益均衡,但是人员结构仍亟需改善。应逐步建立全科医生培养制度,完善激励机制,引导专业人才到基层执业,提升基层卫生服务能力。     

基层基本公共卫生服务项目管理工作探讨

基本公共卫生服务项目的推行,对促进基本公共卫生服务均等化的实现具有重要意义。基层单位作为公共卫生服务的主体,其服务能力直接影响卫生服务项目的实现,因此基本公共卫生服务管理工作需要落实到基层。基本公共卫生相关服务项目管理工作顺利开展,不仅能够提升基层公共卫生单位管理质量,而且能够有效为基层相关卫生服务单位获得良好社会及管理效益。但是现阶段在实际的基层基本卫生服务项目管理工作中,相关管理工作仍然存在部分问题。为进一步提升基层基本公共卫生服务项目管理水平,该文旨在分析基本公共卫生服务项目的现状,并提出解决问题的方法,通过从项目管理工作需要面向基层单位以及合理利用各种资源和平台的方式,最终达到提高基层单位项目工作管理质量,以及服务项目取得良好的管理效果和社会效益的目的 。     

基本公共卫生服务疾控项目实施进展及公平性研究

目的:了解我国国家基本公共卫生服务项目中疾病预防控制项目(以下简称疾控项目)的进展情况以及各地之间的公平性状况。方法:按照立意抽样方法,根据行政区划、地理分布与经济发展水平,在全国范围选择北京、广东、湖北、吉林、云南、新疆6个省市作为调研地区,分析其监测系统报表中的疾控项目相关数据,并用基尼系数测算各省疾控项目服务之间的公平性。结果:2009—2014年样本省份基本公共卫生服务疾控项目进展稳中有升,各项服务的基尼系数大多处于0.3~0.4的区间范围,公平性相对较低,其中各省之间高血压和糖尿病患者健康管理项目差异较大。结论:样本地区的基本公共服务疾控项目的公平性有待提升,高血压和糖尿病患者管理项目尤为关键。     

基于2022年四川省基本公共卫生服务费用的成本测算分析

目的 测算四川省不同地区基层医疗卫生机构基本公共卫生服务成本，为政府财政补偿提供依据。方法 采用分层随机抽样与典型抽样相结合的方法，从四川省6个市州抽取54家基层医疗卫生机构，调查其2022年开展基本公共卫生服务项目所花费的时间和物质消耗情况。运用时间分配系数法，测算基层医疗机构开展基本公共卫生服务所花费的实际成本；使用标准工作时间矫正获得标准成本。结果 调查机构2022年基本公共卫生服务项目的实际总成本为11 968.28万元，标准总成本为12 719.85万元；实际人均成本为73.85元/年，标准人均成本78.49/年。结论 项目标准成本高于实际成本，标准人均成本也高于人均项目经费补助标准，四川省基本公共卫生服务项目投入总体不足，政府应提高项目经费补助。     

Paying for and receiving benefits from health services in South Africa: is the health system equitable?

There is a global challenge for health systems to ensure equity in both the delivery and financing of health care. However, many African countries still do not have equitable health systems. Traditionally, equity in the delivery and the financing of health care are assessed separately, in what may be termed 'partial' analyses. The current debate on countries moving toward universal health systems, however, requires a holistic understanding of equity in both the delivery and the financing of health care. The number of studies combining these aspects to date is limited, especially in Africa. An assessment of overall health system equity involves assessing health care financing in relation to the principles of contributing to financing according to ability to pay and benefiting from health services according to need for care. Currently South Africa is considering major health systems restructuring toward a universal system. This paper examines together, for both the public and the private sectors, equity in the delivery and financing of health care in South Africa. Using nationally representative datasets and standard methodologies for assessing progressivity in health care financing and benefit incidence, this paper reports an overall progressive financing system but a pro-rich distribution of health care benefits. The progressive financing system is driven mainly by progressive private medical schemes that cover a small portion of the population, mainly the rich. The distribution of health care benefits is not only pro-rich, but also not in line with the need for health care; richer groups receive a far greater share of service benefits within both public and private sectors despite having a relatively lower share of the ill-health burden. The importance of the findings for the design of a universal health system is discussed.     

海南省基本医疗卫生服务均等化分析

目的：了解海南省市县际间基本医疗卫生服务均等化现状,为促进全省基本医疗卫生服务均等化建设提供参考。方法：利用海南省、我国及经合组织国家等卫生统计数据,对海南省市县际间基本医疗卫生服务均等化指标进行分析。结果：资源分布均等化方面,机构地理可及性相差较大,医护比为1∶1.2,资源分布的基尼系数大于0.3;筹资均等化方面,人均医疗保健支出低于全国,人均政府卫生支出额高的市县主要集中在各区域的中心,多数市县新农合住院实际补偿比在50%左右;服务提供均等化方面,多数市县床位使用率低于90%,药费占比在30%～40%,地区之间孕产妇及儿童健康管理差距较小,但管理率普遍低于全国。结论：基本医疗卫生服务资源分布与政治、经济等条件有关,筹资机制不健全、基本医疗和公共卫生服务提供能力低影响了基本医疗卫生服务的质量。建议合理布局基本医疗卫生服务资源,加大卫生筹资力度,提高基本医疗卫生服务提供能力。     

Oral health care services in Europe

Health care is being reformed in Europe. Comparative analyses of oral health care services are scarce. Little is known about the relationship between organisation and financing of services and the effectiveness, efficiency and equity of the services. The purpose of the paper is to present some features of the delivery of oral health care services and to discuss some recent changes in a public health perspective. Some of the recent changes in oral health care are: Decentralisation of management in the public services, less third party payment and higher patient charges, more emphasis on free consumer choice. The dominant model of delivery of oral health care is the single private practitioner. The traditional structure of delivery of dental services is challenged by the demands of societies. There seems to be a trade-off between simplicity and the tailor-made mixed payments: gains in degree of freedom through the use of mixed payment systems have to be balanced against losses in terms of simplicity of implementation and equality of the oral health outcome. The roles of the provider, the consumer and the financing institutions are imbedded in trust and regulation. There is therefore a growing recognition of the necessity for a strong role of public health.     

论卫生保健的社会公平性

随着社会经济的发展和利益格局的变化,以及医疗保健制度的全面改革,卫生保健的公平性日益受到人们的关注,卫生保健的公平性,实际上就是指社会成员获得卫生保健的均等性,主要通过卫生保健服务的筹资与提供两方面体现的。卫生筹资的公平性应遵循支付能力原则,而卫生服务的公平性则应遵循可及性原则,需要原则和健康原则,近几十年来,我国在卫生保健的公平性方面做了大量工作,取得了一定的成就,但也还存在着卫生保健覆盖面小,     

我国公共卫生筹资改革措施评价

我国公共卫生筹资改革有两个明显特点：一是政府经费补助相对减少，二是对公共卫生服务实行有偿服务，改变了公共卫生机构的筹资结构。在1980年实行筹资改革以前，公共卫生机构的一切支出全部由政府经费补偿；在实行改革之后的90年代中期，政府经费占机构总收入的比例下降到30％－50％，仅能补偿人员工资，有偿收入所占比例相应地增加到50％－70％，以市场为导向的公共卫生筹资虽能提高机构的经济活力与生产效率，但同时也暴露出一些问题。经济激励机制导致了不必要卫生服务的过度提供与必要卫生服务的提供不足。有偿服务减少了人们对具有正外部效应的预防保健服务的需求和利用，政府经费不足导致了公共产品的供给不足。以往的实践证明：政府在公共卫生筹资中的作用减弱可导致社会资源利用的低效率；实行有偿服务会抑制人群对这些服务的需求，增加疾病发生的危险性；以市场为导向的公共卫生筹资改革不能作为一项政策选择，一旦采用这类政策，就会造成许多不良后果。     

Barriers to Formal Emergency Obstetric Care Services’ Utilization

Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on “public relations” could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be put in place to enhance security in the slums at night.     

发展中国家的医疗卫生服务体系

考察了发展中国家的卫生筹资和服务提供体系,并认为发展中国家需要扩大医疗保障覆盖面,需要重新关注初级卫生保健和公共卫生,只有这样才能不断完善其卫生体系。     

Public/private financing in the Greek health care system: implications for equity

The 1983 health reforms in Greece were indirectly aimed at increasing equity in financing through expansion of the role of the public sector and restriction of the private sector. However, the rigid application of certain measures, the failure to change health care financing mechanisms, as well as growing dissatisfaction with publicly provided services actually increased the private share of health care financing relative to that of the public share. The greatest portion of this increase involved out-of-pocket payments, which constitute the most regressive form of financing, and hence resulted in reduced equity. The growing share of private insurance financing, though as yet quite small, has also contributed to reducing equity. Within public funding, while a small shift has occurred in favor of tax financing, it is questionable whether this has contributed to increased equity in view of widespread tax evasion. On balance, it is most unlikely that the 1983 health care reforms have led to increased equity; it is rather more likely that the system in operation today is more inequitable from the point of view of financing than the highly inequitable system that was in place in the early 1980s.     

卫生立法的国际经验对我国的启示

本文通过分析典型国家卫生立法的现状和发展的共同点,结合我国政治、社会和经济环境,对我国《基本卫生法》立法提出政策建议。多数工业化国家都有一个相同的价值观,即政府确保公民不受地域和经济能力的限制享有卫生服务。各国卫生立法都经历了与政治发展同步的数次改革。几乎每一个以公共筹资体系为主的国家,都同时存在商业医疗保险和私人医疗服务,但医疗卫生服务体系很少以市场为主导。所有国家都在向建立整合的协同医疗服务体系方向努力,并已建立了与经济发展和国民收入相适应的、长期稳定的卫生筹资模式。作为卫生领域的根本法,《基本卫生法》应以更宏观的视角对卫生和健康问题的基本定位、基本价值和基本框架进行定位,突出"无论公民的性别、年龄、宗教、社会地位和经济状况,政府都有责任确保其获得基本医疗卫生服务和基本药物"的核心价值观。     

The Danish health care system from a British perspective.

The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weakness, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system, and a one-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. The dominance of tax financing helps to achieve control over the level of health care expenditure, as well as securing equity in financing the services. The reliance on local government for financing and running health care has both advantages and disadvantages, and the split between county and municipal responsibility leads to problems of co-ordination. The remuneration of general practitioners by a mix of capitation payment and fee for services has the advantage of capping expenditure whilst leaving the GPs with an incentive to compete for patients by providing them with good services. The GP service is remarkably economical. The hospital sector displays much strength, but there seem to be problems with respect to: (i) perceived lack of resources and waiting lists; (ii) impersonal care, lack of continuity of care and failures in communication between patients and staff; (iii) management problems and sometimes demotivated staff. The relationship between patients and providers is facilitated by free access to GPs and absence of any charges for hospital treatment. The biggest threat is continuation of avoidable illness caused by poor health habits in the population. The biggest opportunity is to strengthen public health measures to tackle these poor health habits.