乡村卫生组织一体化管理的基本政策与措施模式和实施过程

基本政策与措施一、坚持集体举办村卫生组织实行乡村卫生组织一体化管理 (以下简称一体化管理 ) ,要体现“村级卫生组织以集体办为主”的宏观管理政策。通过实施乡村卫生组织一体化管理 ,将一些过去由村集体和村医个体举办的卫生室转变为由乡镇举办 ,以充实集体办医的内涵 ,为村级卫生组织的生存和发展注入新的活力。二、对村卫生组织实行统一管理实行一体化管理的核心是由乡镇卫生院对村卫生室实行“三证”、“三制”、“五统一”管理 ,通过统一管理 ,强化乡镇卫生院应承担的村卫生室管理和指导职能。“三证”即“行医许可证”、“药品使用…     

庐江县新渡乡乡村卫生组织一体化管理运作9年浅探

庐江县新渡乡于 1992年开始实施乡村卫生组织联合办医一体化管理。经过第一年试行、第二年的基本完善 ,到 1994年正式启动 ,9年来一体化管理运作正常 ,收效显著 ,乡村两级卫生组织及人员素质得到了快速发展和提高。实践证明 ,实行乡村卫生组织联合办医一体化管理适应社会主义初级阶段我国农村卫生事业发展方针。新渡乡位于庐江县西北面、合铜公路沿线 ,全乡19个行政村 ,总人口约 3.3万 ,产业以农村为主 ,人均年纯入约 2 0 0 0元。乡设有一所卫生院 ,二所分院 ,17所村卫生室 ,乡村卫生人员 76人 ,其中村卫生室 4 9人(乡村医生 2 9人 )。1　制…     

青海省乡村卫生服务一体化管理下的村卫生室运行机制探讨

目的探索乡村卫生服务一体化管理下村卫生室的有效运行机制。方法通过项目试点地区选择,各类文献和访谈资料收集,运行模式设计、试点地区干预运行与评价分析开展研究。结果本研究从村卫生室办医形式与管理办法、村医队伍建设与管理、基本医疗与公共卫生服务能力要求、村卫生室运行补偿制度建设、药品配送与管理和服务监管与绩效考核六个方面实施的运行措施取得了满意的效果,并总结出了一定的经验。结论乡村医生纳入公益化岗位,乡镇卫生院药房建成村卫生室的中心药房,建立科学系统的监管和绩效考核制度不失为推动乡村卫生一体化管理下村卫生室有效运行的重要措施。     

对乡村一体化管理的民意测验及评价

为进一步发展和完善乡村一体化管理的组织形式，我们在实施乡村一体化管理的乡镇中抽取了部分农民进行了民意测验，现将测验的结果和对乡村一体化管理体制的评价作如下报告。调查范围的乡村一体化管理是由乡镇卫生院统一规划、建设和管理所辖区域的村卫生室。根据各村的人口数、村间距离和地理状况，确定村卫生室设置的数量和位置。按各卫生室服务的人口数，确定其乡村医生人数，并在原乡医中择优录用。乡镇卫生院对卫生室实行"五统一"，对乡医采取"四制，诊疗过程中要求"四有"，通过建立健全各种规章制度，促使乡村卫生室进行科学化、制度…     

积极推进乡村卫生机构一体化管理

近几年 ,我市村卫生室的建设和管理工作 ,随着初级卫生保健工作的全面推行 ,力度不断加大。尤其是 1999年以来 ,全市推行了以“三制、四有、五统一”为主要内容的乡村卫生机构一体化管理 ,收到了很好的成效 ,对满足广大农民的医疗保健需求 ,提高医疗服务质量 ,减轻广大农民的医药费负担 ,起到了积极的作用。但是 ,部分尚未实施乡村卫生机构一体化管理的乡镇 ,村卫生室建设和管理工作相对滞后。1　存在的突出问题1 1　乡村医生诊疗收费不规范 ,增加了农民医药费负担　由于对乡村医生业务收入未实施统一管理 ,乡村医生打着“集体办”招牌 ,变…     

北京市顺义,房山两县区“规模办医”特点研究

“规模办医”是指近年来在农村中建立起来的一种村间联合举办的集体办医形式,其特点是财产归乡卫生院和村集体共有,行政、业务、核算和分配由乡卫生院管理。本次调查针对“规模办医”这种形式与一般集体办卫生室、个体办卫生室、乡设分院等形式在卫生室基本情况、医疗保健制度。卫生服务提供、卫生室管理、乡村医生报酬及对办医形式的意向等方面,进行对照比较,对“规模办医”的特点做一初步探讨,旨在为进     

西部145名村医对乡村卫生服务一体化管理的满意度分析

2010年,国家卫生部以《中共中央国务院关于深化医药卫生体制改革的意见》为指导,制定并颁布了《卫生部办公厅关于推进乡村卫生服务一体化管理的意见》,明确提出乡村一体化管理是指在县级卫生行政部门统一规划和组织实施下,以乡镇为范围,对乡镇卫生院和村卫生室的行政、业务、药械、财务和绩效考核等方面予以规范的管理体制[1].有关一体化管理的研究,前期多从患者满意度出发.但同时应考虑到,提高医务人员的工作满意度也是医疗卫生管理和医药卫生体制改革的目标之一[2].提升村医对一体化管理工作的满意度,不仅可以充分调动广大村医的工作积极性,还有助于提升村卫生室的卫生服务质量,改善乡、村两级卫生服务机构的关系[3-4].基于这一考虑,本研究拟通过对村医的调查,分析他们对乡村卫生服务一体化管理工作的满意度,从而为进一步改革与完善乡村卫生一体化管理提供借鉴.     

村卫生室办医形式小议

全国行政村卫生室办医形式多样 ,就枞阳县而言 ,大体可概括为集体办 (包括乡村一体化管理 )、乡医联办、个体办 3种形式。我县有 97万人口 ,4 31个行政村 ,乡村医生、卫生员 12 4 7人 ,已建村卫生室 4 2 8个 ,其中集体办 1个 ,乡医联办 13个 ,其它均为个体办。据有关统计资料显示 ,1997年全国农村卫生室集体办为 4 4.6 3% [1] ,而我县目前集体办不到 0 .5 %。回顾我县村卫生室建设历史 ,集体办卫生室几起几落。在上世纪六、七十年代推行合作医疗时期 ,集体办卫生室在集体经济的支撑下 ,办得红红火火。到了80年代 ,随着农业实行联产承包责任…     

医院“造血式”托管背景下“镇、村卫生一体化”管理探讨

摘 要：村卫生室是农村卫生服务体系的基础,但随着集体经济解体,村卫生室逐步成为个人办医的机构,其管理和服务质量都难以得到规范和保障。近年来,中央和各地均出台了多项政策要求进行乡村一体化管理,各地也开展了一定的探索。丰都县高镇中心卫生院在被人民医院“造血式”托管基础上,指导、帮扶村卫生室,在村卫生室基础设施、行政管理、业务管理、人员培养等方面进行了大胆的探索与实践,并不断完善,积极探索镇村卫生一体化。     

江西省村卫生室乡村卫生一体化管理现状及效果评价

目的了解江西省村卫生室乡村卫生一体化管理的现状及其效果。方法分析普查所得的数据描述村卫生室乡村一体化管理的现状,并通过比较分析评价其实施效果。结果江西省有村卫生室26287所,平均每个行政村拥有村卫生室1.57所。村卫生室中参加乡村一体化管理的村卫生室占53.2%,属于新农合定点医疗机构的村卫生室占89.9%。与未参加一体化管理的村卫生室相比,参加了一体化管理的村卫生室中属于新农合定点医疗机构的村卫生室比例高出4.7%,平均拥有卫生人员增加了0.42人,村卫生室业务用房平均面积增加了10.2m2,村卫生室房屋产权归公有的比例增加了11.8%,村卫生室药品由县医药公司统一配送的比例增加了5.1%,由乡镇卫生院统一采购的比例增加了7.8%,由村卫生室自行采购的比例减少了11.8%,服务功能有了进一步改善。结论江西省村卫生室乡村一体化管理有了一定成效,但村卫生室一体化管理的覆盖面有待扩大,一体化管理的开展有待深入。     

Education,cognition, health knowledge,and health behavior

Using data from NLSY97, we analyze the impact of education on health behavior. Controlling for health knowledge does not influence the impact of education on health behavior, supporting the productive efficiency hypothesis. Accounting for cognitive ability does not significantly alter the relationship between education and health behavior. Similarly, the impact of education on health behavior is the same between those with and without a learning disability, suggesting that cognition is not likely to be a significant factor in explaining the impact of education on health behavior.     

Public health, local health units, and the Brazilian health system

This article focuses on the development of public health in Brazil, with the aim of analyzing the present process of decentralization of health care. The authors argue that the neoliberal or conservative position is unable to offer a reasonable solution to problems in the health care system. On the other hand, the reformist position concentrates its attention on the health system and its administration, taking as its model a positivistic approach to natural and administrative sciences. The authors further argue that only a radical change in the prevailing medical paradigm and a predominance of social over biological aspects would meet the health needs of the population.     

Personal health practices,health status,and expected control over future health

Data from Wave 1 of the National Survey of Personal Health Practices and Consequences were used to examine the association between perceived control over future health and 13 health behavior indices. Analyses were conducted within three strata of health status, defined by a cross-tabulation of subjective and functional health ratings. Greater control expected over future health was associated with 11 of the 13 practices in the stratum of persons in best health, but with only 2 practices in the lowest and 3 practices in the middle health strata. Age, gender, education, and a regular source of health care were also important predictors. Overall, persons in the lowest health stratum had the fewest number and least consistent set of predictors of preventive practices. Although the rationales proposed for following preventive practices often rely upon individuals' favorable outlooks on their futures, the present data suggest that background health status may mediate the relationship. Health status can be viewed as a personal resource, which provides an opportunity for predispositions such as perceived control over future health to be consistently expressed in behavior. Attempts to develop theoretical frameworks and intervention programs that are applicable to several behaviors appear to face a difficult challenge, since few of the predictors were consistently related to more than a small number of the 13 practices. Health promotion programs may need to include health status as an additional characteristic around which to structure both the content of recruitment messages, and expectations for persons who will be relatively more easy or difficult to reach.William Rakowski, Ph.D. is Assistant Professor at the Department of Community Health Programs, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109.The data upon which this report is based were made available through a public use tape obtained from the Inter-University Consortium for Political and Social Research. The data for the NATIONAL SURVEY OF PERSONAL HEALTH PRACTICES AND CONSEQUENCES (U.S.), 1979–1980, were originally collected by the National Center for Health Statistics, U.S. Dept. of Health and Human Services. Neither the collector of the original data nor the Consortium bear any responsibility for the analyses or interpretations in this report. Support for this work was provided through a Special Emphasis Research Career Award to the author, from the National Institute on Aging, Grant No. K01-AG00266-02. Requests for reprints should be sent to the author at the above address.     

Motherhood, health status, and health care.

This study examines the impact of multiple roles and stressors on women of childbearing age, and compares the health status of women with and without children and their ability to access health care. Motherhood has many complex interactions with income level, availability of health insurance, and available social and income support. A cumulative burden of multiple stressors (eg, being poor, uninsured, less educated, employed full-time, or being a single mother) relates to worse health status, levels of depression, and opportunities for obtaining health care. Multiple stressors seem to have a stronger effect on mothers than on nonmothers. Research should focus on identifying vulnerable groups and combinations of stressors for women both with and without children, and how to mitigate adverse impacts on physical and mental health.