从卫生服务供方意向调查的变迁看中医发展危机

为了进一步了解中医的发展状况，通过对2008年与2000年样本地区卫生服务供方的意向调查数据的比较，分析卫生服务供方对中医信仰的变迁。研究发现，卫生服务供方对中医信仰进一步降低，中医成为西医的简单补充。在这种情况下，如何把握中医特色，创新诊疗手段，总结推广中医特效治疗种类和范围，推广适宜技术等尤为重要，逐步提高卫生服务供方对于中医的支持和认可。     

基层和公共卫生人员激励因素研究

决定卫生服务可及性和质量的主要因素是卫生人员,决定卫生投入效果的主要因素是卫生人员,决定医疗卫生改革成效的主要因素也将是卫生人员。因为他们是卫生服务的直接提供者。卫生人员能否发挥预期作用将取决于两个方面：一是卫生人员的技术能力,包括知识、     

社区卫生服务可持续发展机制的意向论证

通过对省、市、县乡四个层次卫生服务组织者和提供者，以及医疗、预防和保健三大职能的提供者与管理者的意向调查，论证社区卫生服务可持续发展机制的各方接受程度。     

卫生改革的回顾与展望

以黑龙江省卫生事业为重点,从微观管理、宏观管理、社会卫生管理等方面回顾了党的十一届三中全会以来,我国卫生改革发展的历程。论述了我国卫生改革与发展的基本经济和存在的现实问题,提出了未来我国卫生改革发展进程中应处理好的十个关系,即医疗卫生总供给与总需求的关系;城市卫生和农村卫生的关系;预防与治疗的关系;中医和西医的关系;卫生发展和科教兴医的关系;医疗卫生服务和依靠广大群众的关系;投入和产出的关系;社会     

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。     

中小城市卫生人力继续教育模式探讨

本文从中小城市卫生人力继续教育需求者、组织者、提供者的特点出发,提出了建立分专业重点的项目型培训基地为特征的卫生人力继续教育模式,有效地解决了中小城市卫生人力在职培训的问题。     

市场经济国家卫生经济政策的特点及对我国的启示

卫生经济政策,是政府为达到一定目标,干预卫生系统经济工作的运行,调整卫生服务过程中有关各方(提供者、购买者和消费者)利益关系的经济措施和手段;是指导一段时期内卫生经济工作的方针。卫生经济政策的制定、实施和调整受到多种因素的影响,其正确与否,直接关系到有限资源的有效利用,关系到国家卫生事业的发展,关系到人民健康水平的提高     

浙江省农村卫生适宜技术的供方需求调查

目的：调查浙江省农村卫生服务提供者的卫生适宜技术需求及其原因。方法：以分层随机抽样的方法。对来自浙江省两样本县的135住县乡卫生机构技术骨干和16位村卫生室负责人进行有关卫生适宜技术需求和需求原因的问卷调查。结果：县乡卫生机构的技术需求集中在西医技术。技术需求的主要原因是病人多、目前缺少其他有效的技术以及现有同类技术成本高，病人经济负担过重。村卫生室负责人最希望学习治疗肩周炎、哮喘和高血压病症的有关中医技术。部分村卫生室负责人因为没有基础、学习困难，无法承担相应费用和没有时间学习等原因不愿意接受医疗相关的学习或培训。结论：本研究反映了浙江省农村卫生服务提供者对农村卫生服务利用情况的经验判断和技术需求等相关问题，为政策制定者快速评估卫生适宜技术提供相关参考信息。     

农村基层卫生资源配置策略研究

一、策略选择的理念和原则（一）基本思路 1．农村基层卫生资源配置的策略，关键是理念的转型，即政府由基本卫生服务的直接提供者转变为基本卫生服务的责任主体。政府不一定直接组织生产和经营，而应该集基层卫生资源配置的组织、管理、调控和提供者于一体。且无论采取什么配置手段，政府都应是主导力量。     

卫生人员行为与激励机制

卫生事业发展和改革的根本目标是通过提高卫生系统绩效,改善健康状况、避免疾病经济风险和提高社会满意程度。卫生人员作为卫生服务的直接提供者,在很大程度上决定着服务的数量、质量、方式和成本。因此,为了实现卫生发展目标,需要利用各种政策工具,充分调动卫生人员的积极性。而关注卫生人员行为研究,将为激励机制等政策设计提供基础性信息。     

从卫生服务消费者的意向分析看中医发展的危机

该文通过对9784户农村居民的意向调查,分析了不同特征的农户对中医的信任程度,以探究中医在今日中国的地位,以及中医发展的状况。结果表明,中医的地位远低于西医,几乎不被作为就诊首选,消费者对中医的信任程度非常低;在这种情况下,如何发挥中医的特长,以吸引消费者获得生存和发展的市场,是中医发展更为重要和现实的策略。     

四川省城乡居民就医路径及医疗机构选择的影响因素研究

目的 通过纵向随访数据分析四川省城乡居民的就医路径特征和就医机构选择的影响因素。方法 从四川省第五次卫生服务调查的样本区(县)中抽取1个城市点和1个农村点,监测居民3个月的卫生服务利用行为,定性描述居民就医路径特征,采用重复测量资料的多水平Logistic模型分析就诊医疗机构选择的影响因素。结果 患病后,城市点以遵医嘱治疗为主,农村点则以就诊为主;就诊时,城市以县(市、区)级医疗机构为主,农村以基层医疗机构为主;影响就诊医疗机构选择的因素有就业状况、是否患有慢性疾病。结论 四川省城乡居民就医路径特征不同,城市居民就诊机构的流向存在不合理分布。应加强城市点分级诊疗制度的推行,规范城市居民就医行为。     

Social networks – The future for health care delivery

With the rapid growth of online social networking for health, health care systems are experiencing an inescapable increase in complexity. This is not necessarily a drawback; self-organising, adaptive networks could become central to future health care delivery. This paper considers whether social networks composed of patients and their social circles can compete with, or complement, professional networks in assembling health-related information of value for improving health and health care. Using the framework of analysis of a two-sided network – patients and providers – with multiple platforms for interaction, we argue that the structure and dynamics of such a network has implications for future health care. Patients are using social networking to access and contribute health information. Among those living with chronic illness and disability and engaging with social networks, there is considerable expertise in assessing, combining and exploiting information. Social networking is providing a new landscape for patients to assemble health information, relatively free from the constraints of traditional health care. However, health information from social networks currently complements traditional sources rather than substituting for them. Networking among health care provider organisations is enabling greater exploitation of health information for health care planning. The platforms of interaction are also changing. Patient–doctor encounters are now more permeable to influence from social networks and professional networks. Diffuse and temporary platforms of interaction enable discourse between patients and professionals, and include platforms controlled by patients. We argue that social networking has the potential to change patterns of health inequalities and access to health care, alter the stability of health care provision and lead to a reformulation of the role of health professionals. Further research is needed to understand how network structure combined with its dynamics will affect the flow of information and potentially the allocation of health care resources.     

The excess health care costs of KardioPro,an integrated care program for coronary heart disease prevention

Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were €131 per person (95% confidence interval: [€−36.5; €296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon.     

中国社会办医的现状分析

通过系统分析中国社会办医的现状,为进一步促进社会办医提出政策建议。根据国内外文献,社会办医疗机构和公立医疗机构在医疗费用和服务质量方面并没有显著差异,并且由于社会办医促进市场开放与公平竞争,公立医院和整个医疗卫生服务市场的绩效也因此有所提高（正向溢出效应）。尽管如此,由于中国长期计划经济自上而下的资源配置与行政干预,社会办医长期未能得到健康发展,主要政策障碍包括准入方面存在隐形限制、经营方面缺乏税收鼓励、用人方面缺少优质医师资源。因此,建议调整区域卫生规划的功能从“封顸”向“兜底”过渡,尽快制定有利于社会办医的土地政策和人才政策,进一步完善相关配套措施,促进社会办医在中国的健康发展。     

Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.     

妇女对产后访视服务的体验与需求

为了深入了解产后妇女对社区提供的产后访视服务的看法及对此项服务的需求 ,并由此提出改进现有产后访视服务的可能做法 ,在上海某中心城区的 2个街道深入访谈了 5 3名在 1998年 12月～ 1999年 7月期间接受过产后访视服务的妇女 ,并进行了 2组产后妇女的专题小组讨论。结果 :产后访视覆盖率达 10 0 % ,其中 9%的对象接受过 1次、32 %的对象接受过 2次、5 9%的对象接受过 3次产后访视。大多数产妇接受了产后访视常规中问诊、检查和宣教。在产妇所遇的问题中有关小儿护理的问题占第 1位 ,其次是产后妇女本人的情绪问题。产后妇女对与婴儿健康成长有关的服务内容需求最大 ,希望能从专业医护人员处获取可靠信息 ,有多种媒体的健康教育教材可供家庭选用 ,同时还呼吁在社区内有形式多样的面对面教育活动 ,如咨询、父母学校和母亲俱乐部等。研究结果提示产后访视服务现已有较满意的覆盖率 ,但其内容、形式和服务质量尚有待以服务对象需求为导向 ,在条件具备的情况下不断改善。     

The tradeoff between centralized and decentralized health services: Evidence from rural areas in Mexico

This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders.     

Disparities in health care utilization among urban homeless in South Korea: a cross-sectional study

Objectives

We examined health care disparities in Korean urban homeless people and individual characteristics associated with the utilization of health care.

Methods

We selected a sample of 203 homeless individuals at streets, shelters, and drop-in centers in Seoul and Daejeon by a quota sampling method. We surveyed demographic information, information related to using health care, and health status with a questionnaire. Logistic regression analysis was adopted to identify factors associated with using health care and to reveal health care disparities within the Korean urban homeless population.

Results

Among 203 respondents, 89 reported that they had visited health care providers at least once in the past 6 months. Twenty persons (22.5%) in the group that used health care (n = 89) reported feeling discriminated against. After adjustment for age, sex, marital status, educational level, monthly income, perceived health status, Beck Depression Inventory score, homeless period, and other covariates, three factors were significantly associated with medical utilization: female sex (adjusted odds ratio [aOR, 15.95; 95% CI, 3.97 to 64.04], having three or more diseases (aOR, 24.58; 95% CI, 4.23 to 142.78), and non-street residency (aOR, 11.39; 95% CI, 3.58 to 36.24).

Conclusions

Health care disparities in Seoul and Daejeon homeless exist in terms of the main place to stay, physical illnesses, and gender. Under the current homeless support system in South Korea, street homeless have poorer accessibility to health care versus non-street homeless. To provide equitable medical aid for homeless people, strategies to overcome barriers against health care for the street homeless are needed.     

Disability-competence training influences health care providers’ conceptualizations of disability: An evaluation study

BackgroundOften, health care providers’ approach to people with disabilities is grounded in a medical model perspective. This view highlights individual deficits and does not foster patient-centeredness. Learning about and adopting a more social model, focused on creating accessible and inclusive approaches and environments, could help providers to reshape their attitudes about disability, dismantling barriers to care.ObjectiveThis study used innovative methods to evaluate a recorded, online disability-competence training for health care providers. It was hypothesized that the training would 1) shift providers’ conceptualizations of disability away from a medical model view toward a social model view of disability and 2) equip providers with actionable strategies to improve access to care for people with disabilities.MethodsQuantitative and qualitative evaluation data were analyzed for n = 192 training participants. Measures included participants’ pre- and post-training conceptualizations of disability, proposed actions steps to facilitate patient-centered care, and measures of satisfaction and self-assessed knowledge gain.ResultsBoth hypotheses were supported. After the training, participants’ conceptualizations of disability were more reflective of the social model, and participants were better able to articulate specific action steps they could take to promote accessible, responsive care.ConclusionsThis study demonstrates that health care provider training can positively affect providers’ knowledge, outlook, and approach to caring for people with disabilities. Its findings can inform broader efforts aimed at systematically changing the way health professionals are educated and trained to provide care in disability-competent ways.