安全分娩基本医疗卫生服务均等化研究——实现流动人口孕产妇基本医疗卫生服务均等化的路径探讨

逐步实现基本公共服务均等化已成为我国现阶段国家工作的重要内容,而基本医疗卫生服务则是基本公共服务的重要组成部分.文章拟对基本医疗卫生服务均等化的若干理论问题加以阐释,在此基础上,指出了流动人口孕产妇分娩过程中享有基本医疗卫生服务的现状和问题,并提出了实现流动人口孕产妇基本医疗卫生服务均等化的路径对策.     

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。     

江西省基本医疗和公共卫生服务均等化的现状与实现途径

就基本医疗和公共卫生服务均等化而言,江西不仅落后于经济发达省份,而且省内各地区之间、城乡之间、居民之间,也存在明显差距。江西要实现基本医疗和公共卫生服务均等化,必须采取以下措施：多渠道筹集资金,减小收入差距和医疗保障制度之间保障程度差异,提高公立医疗机构的运行效率,在农村和城市社区大力开展健康促进项目。     

推进基本医疗服务均等化的思考

推进基本医疗服务均等化具有十分重要的现实意义,但是面临许多问题,主要与政府卫生管理职能的偏差密切相关。笔者认为,推进基本医疗服务均等化必须从供需双方来考虑,做到四个“结合”。     

基本医疗卫生服务均等化研究进展与路径选择

加快推进基本医疗卫生服务均等化,已成为实现新医改提出的建立健全覆盖城乡居民基本医疗卫生制度的重要内容和热点问题。本文从国内外基本医疗卫生服务均等化理论基础、发展内涵、实施策略、筹资与供给机制、测量评价等方面系统阐述其研究进展,并在综合述评的基础上,提出了进一步明确基本医疗卫生服务均等化内涵界定、探索基本医疗卫生服务均等化筹资机制、构建基本医疗卫生服务均等化评价体系以及完善城乡基层基本医疗卫生服务及政策体系等方面的路径选择和思考建议。     

论我国基本医疗和公共卫生服务均等化的对策

由于长期实行城乡二元经济结构和三元医疗保障制度,处于转型期的我国经济改革又导致地区之间、城乡之间、居民之间收入差距不断扩大,政府对医院的监管能力脆弱,居民基本医疗和公共卫生服务非均等化现象令人堪忧。笔者认为应在总目标框架内,设置分阶段目标,渐次推进我国基本医疗和公共卫生服务均等化。通过缩小区域经济差距、提高医疗机构效率、三元医疗保障制度并轨等综合措施,最终实现全民基本医疗和公共卫生服务均等化目标。     

黑龙江省农村基本公共卫生服务均等化存在的问题及建议

通过对黑龙江省农村基本公共卫生服务的现状进行分析,阐述了目前黑龙江省农村公共卫生面临的主要问题并提出建议,为完善农村公共卫生服务体系、全面提升农村公共卫生水平提供科学依据。     

我国基本医疗卫生服务均等化程度判别方法的建立

目的：建立我国基本医疗卫生服务均等化程度判别方法。方法：依据2009年中国各省（自治区、直辖市）人均GDP将各省（自治区、直辖市）基本医疗卫生服务均等化程度分为4级,以《2010中国卫生统计年鉴》为依据选择与基本医疗卫生服务相关的72个指标,建立数据库,并采用Fisher判别法进行统计分析。结果：卫生监督所数/千人口、三级医院数/千人口、管理人员数/千人口、医疗机构床位数/千人、出院病人人均医药费用（元）、危重病人抢救成功率（%）、急危重症抢救成功率（%）、3岁以下儿童系统管理率（%）、7岁以下儿童保健管理率（%）、人口出生率（‰）、城镇居民和职工基本医疗保险参保人数/总人口数（%）指标可作为基本医疗卫生服务均等化程度的判别依据,其中每千人口拥有的三级医院数是判别均等化程度最敏感的指标。结论：可为深入贯彻《2009—2011年深化医药卫生体制改革实施方案》提供参考。     

南京市基本公共卫生服务现状及均等化政策建议

新医改明确提出努力实现人人享有基本公共卫生服务均等化,从2009年起,逐步向城乡居民统一提供疾病预防控制、妇幼保健和健康教育等基本公共卫生服务。南京市基本公共卫生服务工作起步早,相关制度健全、管理规范,社区卫生服务的南京模式被国家卫生部推广。但南京市基本公共卫生服务城乡差距明显,与均等化目标差距较大。在审计实践的基础上,描述了南京市基本公共卫生服务现状,提出了实现均等化政策建议,旨在促进南京市基本公共卫生服务健康、持续发展。     

实现基本公卫服务均等化的人力资源思考

促进基本公共卫生服务逐步均等化,是当前深化医药卫生体制改革的一项重要制度安排。在其实现的过程中,我们不得不面对卫生人力资源配置和使用的合理化均等化等问题。本文通过分析基本公共卫生服务均等化的实现对我国现阶段卫生人力资源提出的挑战,进而对卫生人力的优化配置和利用开发提出了相关的对策和建议。     

政策工具视角下我国基本公共卫生服务均等化政策研究

目的：通过对基本公共卫生服务均等化政策的量化分析,全面了解其总体特征、政策工具组合运用情况,为促进我国基本公共卫生服务均等化政策完善提供建议。方法：以2009—2022年中央政府发布的促进基本公共卫生服务均等化的政策为研究对象,构建“政策工具(X维度)—利益相关方(Y维度)—政策过程(Z维度)”三维政策分析框架,开展政策内容分析。结果：供给型政策工具比例合理、政策重点立足于政府部门和政策执行阶段;主要运用公共卫生项目推进,重视基层医疗机构能力提升,并给予资金、人才支持。但存在总体结构失调、利益主体政策格局失衡和政策阶段关注不均等问题。建议：优化政策工具内部结构、对利益相关方投入多元化政策关注及合理布局政策阶段。     

Experiences of transition from children's to adult's healthcare services for young people with a neurodevelopmental condition

Previous research has highlighted a lack of continuity of care when young people with a neurodevelopmental condition make the transition from children's to adult specialist healthcare services. A lack of planning, consistency, and availability of adult services has been found to lead to; increased anxiety, poor health outcomes, reduced support and some young people not receiving healthcare. The majority of transition research has focused on what health professionals consider important in the transition process, rather than focusing on the experiences of the young people and those closest to them. Our objective was to gather evidence from young people (and their families) who had experienced transition from children's to adult specialist healthcare services through semi-structured interviews. Volunteers were recruited from two London boroughs. All young people were aged between 18 and 25 years with a neurodevelopmental condition (Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and/or an Intellectual Disability). Overall, we interviewed six young people with support from a family member. Five further family members were interviewed on behalf of the young person. In total, ten semi-structured interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Four themes emerged from the analysis: (a) Parents as advocates, (b) Availability of adult's specialist health and social care services, (c) Lack of information sharing and (d) Transition as a binary, abrupt change. Our findings suggest the transition experience could be improved by changing service specifications to incorporate assessment and handover across the age range of 16–20 years. Additionally, statutory services should understand and provide the coordination role now offered by parents in transition. We suggest future research could evaluate the feasibility of a patient-owned online information sharing tool with information about relevant services for young people and their families.     

基本卫生技术包应用研究概述

影响卫生服务提供绩效的主要因素之一是服务提供的过程（即临床诊疗流程）及所需的各类卫生技术（包括人力资源、设备、设施、药品等）.基本卫生技术包（EHTP）是一种优化临床诊疗流程和卫生技术配置的管理工具,可通过这种核心技术,对卫生技术实施优化干预,以促进和改善服务提供的绩效.作者介绍了基本卫生技术包的方法学原理、技术路线、研究设计和其在单病种质量管理中应用的可行性,以便为决策者提供循证依据,将有限的卫生技术投入到最具成本效果的服务项目上.     

我国婚前保健服务筹资机制研究

本文从婚前保健服务的属性入手,探讨其筹资机制,为完善我国婚检制度提供科学依据。采用文献调研和现场调研相结合的方法,梳理国内外婚检筹资现状,收集福建、广西、江苏等8个调研地区婚检筹资相关数据,并对政府有关部门、婚检机构相关人员进行访谈。婚前保健服务属于准公共产品的范畴,本文从筹资水平、资金渠道、资金分配、资金支付和资金监管等方面对其筹资机制进行探讨,提出应明确婚检服务性质、建立财政专项投入机制,进行科学论证、统一婚检服务基本筹资标准,及时足额拨付婚检专项经费、加强经费监管等政策建议。     

Factors related to frequent usage of the primary healthcare services in old age: findings from The Swedish National Study on Aging and Care

People aged 60 or more are the most frequent users of healthcare services. In this age range, however, both frequent and infrequent users can be found. Frequent users have high rates of illnesses. Previous research has found that the frequency may be influenced also by psychological and social factors. The aim of this study was to investigate to what degree such factors add to the explanation of differences in number of visits to a physician. A cross-sectional study was conducted with a random sample consisting of 1017 individuals, aged 60 to 78 years, from the Blekinge part of the Swedish National Study on Aging and Care database. The data were collected during 2001 to 2003. Hierarchical logistic regression analyses were used with frequent (three visits or more during a year) and infrequent use as a dichotomous dependent variable. The final statistical analyses included 643 individuals (63% of the sample). Independent variables were sense of coherence (SOC), internal locus of control, education level and social anchorage. Control variables were age, gender, functional ability and comorbidity. The results showed that comorbidity was most strongly related to frequent use [adjusted odds ratio (OR) = 8.17, 95% confidence interval (CI) 5.54–12.04]. In addition, SOC and internal locus of control had small, but significant effects on the odds of being a frequent user (adjusted OR = 1.03, 95% CI 1.00–1.06 and adjusted OR = 1.14, 95% CI 1.02–1.27, respectively). The lower the SOC and the internal locus of control were, the higher were the odds of frequent use. Education level and social anchorage were unrelated to frequency of use. The results indicate that frequent healthcare services users are more ill than infrequent users. Psychological factors influence the use only marginally, and social factors as well as age and gender are not by themselves reason for frequent healthcare services use.     

A scoping review on the experiences and preferences in accessing diabetes-related healthcare information and services by British Bangladeshis

Diabetes is a chronic condition requiring lifelong self-management. Patients are encouraged to access appropriate services to facilitate optimum management of diabetes. Although equitable access to healthcare in the United Kingdom is a legal right, not all groups and individuals in the community experience equity. Despite various equality laws and numerous efforts to minimise health inequalities related to access, particular community groups are more likely to experience inequitable access than others. The Bangladeshi community are one such community who experience some of the worst diabetes-related health outcomes in the United Kingdom. Little is known about their experiences and preferences in accessing diabetes healthcare information and services. Consequently, we undertook a scoping review of the literature by following the York Scoping Reviews Framework to identify the experiences and preferences of Bangladeshi patients and carers when gaining access to diabetes-related healthcare information and services. We identified eight articles and reported our results in relation to four domains of access: health service availability, health service utilisation, health service outcomes and the notion of equity. The review identified that language and literacy issues were the most common barriers hindering access to information and services. Patient knowledge regarding diabetes and its management was generally low, and friends and family were frequently being used as information sources and as informal interpreters. Additionally, there were feelings of isolation from mainstream information and services possibly resulting in the high prevalence of depression in the Bangladeshi community with women more affected than men. Social networks combined with religious and cultural beliefs as well as wider societal duties played a crucial role in accessing information and services for this population, and the identification of these issues merit further research and are possible avenues towards improved access to healthcare information and services for the Bangladeshi population.     

基本公共卫生服务均等化指标体系研究

基本公共卫生服务均等化指标体系是测量基本公共卫生服务均等化的基础工具。本文首先介绍有关指标体系的设计理念,然后给出经专家咨询获得的指标体系,最后对部分基本公共卫生服务提供指标进行了省际均等化综合测量。     

国外婚前保健服务的经验与启示

婚前保健服务在预防传染性疾病、维护婚姻生活和谐、保护下一代健康等方面发挥了重要作用。不同国家和地区根据各自实际情况设计并实施婚检制度。本文从婚检模式、项目设置、资金筹集、婚检结果的应用等方面,梳理了部分国家和地区婚检主要做法,总结经验和特点,提出我国开展婚检工作的建议。     

成都市门诊就诊患者就医选择及影响因素分析

目的 了解成都市门诊患者就医选择及其影响因素。 方法 采取分层随机抽样方法,抽取在高等级医院和基层医疗机构就诊的门诊患者共300人,通过面对面访谈的形式进行问卷调查来收集资料。 结果 成都市门诊患者当前就医选择较为理性,62.8%在高等级医院就医的门诊患者有过基层医疗机构就诊经历,但仍存在改进空间,因其中只有30.1%的患者是在医生建议下转诊。此外,患者就医选择受到包括医疗机构的诊疗水平、就医便利度、就医价格等外部因素和患者的学历、经济收入、对疾病的了解程度以及疾病对其活动的影响等内部因素的综合作用。结论 应进一步加强基层医疗机构的医疗质量,并通过宣传与引导树立民众科学的就医意识,以确保卫生资源的合理利用。     

婚前保健服务对出生缺陷的影响研究——以广西为例

目的:以广西为例探讨婚前保健服务对出生缺陷发生的影响,为推动婚检工作提供参考。方法:收集广西2000—2014年婚检率、出生缺陷发生率等相关数据,利用SPSS18.0统计软件进行描述性分析、等级相关分析和时间序列协相关分析。结果:随着婚检率的升高,出生缺陷发生率及神经管畸形、总唇裂、胎儿水肿综合征发生率降低。婚检具有后继效应,即婚检率越高,次年的先天性心脏病、神经管畸形发生率越低。结论:婚检与出生缺陷发生密切相关,对提高出生人口素质有重要作用,应重视与加强婚检工作,以改善拟婚人群健康状况,减少出生缺陷的发生。