Analysis of Developing Public Health Service Sector with Private Finance Initiative in Guangxi

In Guangxi Public Health Service Sector （GPHSS）, because lack of budget, it has caused a number of problems, such as weakened public health service in rural areas, poor professional quality of medical personnel in public health units at village and township levels, current urban public health service could not meet the health demand for urban residents. This paper is a secondary research. Through analysis of the financial problem and both of the advantages and disadvantages of using the Private Finance Initiative （PFI）, it intend to demonstrate that using the PFI could be considered as a good way for the Guangxi government.     

完善医疗保障制度实现全民医保

介绍了上海医疗保障体系的概况和实施成效,分析存在的问题和面临的挑战,提出完善医疗保障体系的总体目标和重点任务.上海已初步形成"三纵三横"的医疗保障制度体系,为减轻参保人员医疗费用负担、推动经济社会发展起到了积极作用,已基本实现国家医改意见中提出的基本医疗保障制度建设近期目标.为进一步贯彻落实国家医改要求,上海将通过整合各类制度、缩小待遇差距、完善医保管理、建立老年护理保障制度等举措进一步完善医疗保障体系,力争2012年户籍人口医疗保障制度覆盖率达到98%,常住人口覆盖率达到90%.

Abstract：

The paper introduces an overview of Shanghai medical security system, analyzes its effectiveness and challenges, and put forward overall goals and key tasks in the future. Shanghai has formed a multiple, medical security system and basically achieved the short-term goal of medical security system establishment which was requested to put forward in national health system reform. Shanghai medical insurance system has played a positive role in promoting economic and social development and reducing the burden of medical expenses. To further implement requirements of national health system reform, Shanghai will be conducting the integration of different schemes , narrow down the gap of benefit packages, improvement of health care management and the initiatives of nursing care insurance to further improve the medical security system, and strive to cover 98% of household population and 90% resident population in 2012.     

Utilization of traditional Chinese medicine services and its influencing factors among home‑based elderly care population in Zhejiang ProvinceCSCD

Objective To analyze the utilization of traditional Chinese medicine (TCM) services and its influencing factors among home‑based elderly care population in Zhejiang Province. Methods A multi‑stage stratified cluster random sampling method was used to enroll 2 300 home‑based elderly care population aged 65 years and over and lived in the local area for 6 months and above in Zhejiang Province. The basic characteristics, health status and behavior, TCM cultural literacy, TCM cognitive beliefs and TCM service usage of the subjects were collected by face‑to‑face questionnaires from July 15 to August 15, 2021, and 2 123 valid questionnaires were recovered. Unconditional logistic regression was applied to analyze the influencing factors of TCM service usage among home‑based elderly care population. Results The overall utilization rate of TCM services among home‑based elderly care population in Zhejiang Province was 36.46% (774/ 2 123). The utilization rates of the 6 types of TCM from high to low was oral administration of traditional Chinese medicine (22.00%), external treatment with traditional Chinese medicine (15.12%), acupuncture treatment (11.96%), medicated diet conditioning (7.44%), constitution identification (7.40%) and exercise conditioning (4.57%). Home‑based elderly care population lived in urban areas, had never been to school, with education of primary school or high school and above, suffered from chronic diseases, moderate activities or physical exercise, believed in TCM and had attended lectures on TCM knowledge were more inclined to use TCM services (all P<0.05); agricultural laborers, production and transportation workers and family laborers before retirement were less inclined to use TCM services (all P<0.05); women, those with medical insurance, those drinking alcohol and those with better TCM cultural literacy were more inclined to use 2 and more kinds of TCM services (all P<0.05). Conclusions The utilization rate of TCM services among home‑based elderly care population in Zhejiang Province is relatively high; gender, place of residence, education level, occupation before retirement, medical insurance, belief in TCM, and participation in TCM knowledge lectures are the main influencing factors of the use of TCM services among home‑based elderly care population. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

我国地级市卫生服务供需特点及其对社区卫生发展的影响

目的 分析地级市卫生服务供需特点,提出该类城市社区卫生服务体系建设的对策和思路.方法 对<第四次国家卫生服务总调查>结果按按照直辖市、副省级和省会城市、非省会地级市进行归纳整理和统计分析.结果 非省会地级市卫生服务地理可及性高,但经济、技术可及性低.两周患病率略低,但儿童患病率高.居民自评健康状况相对较高,但同时健康危险因素水平高.结论 建议在非省会地级市进一步加强体系布局建设,积极与大城市开展纵向合作,提高技术水平,加强传染病防治,开展健康促进和脆弱人群保健等公共卫生服务,不断满足居民需求.

Abstract：

Objective This article analyzed the characteristics of the health service in medium cities and the impact on community health service.Methods Summary and statistical analysis of the outcomes from the Fourth National Health Service Survey by the category of metropolitans,sub-provincial cities and provincial capital cities,and non-provincial-capital cities.Results In the medium cities,the geographical accessibility is high against low economic and technology accessibility.These cities have lower 2-week morbiditv rate but high children morbidity rate.These cities also feature high self-rated health status among residents and high health risk factors prevalence at the sarne time.Conclusion Medium cities are recommended to further build their CHS system,enhance their ties with larger cities,so as to elevate their technical competence,for meeting such public health needs of the people in infectious disease control,health promotion and vulnerable population healthcare.     

深圳市公立医院法人治理改革探索

分析了目前公立医院体制机制方面存在的问题,按照"政事分开、管办分开、医药分开、营利性与非营利性分开"的改革原则,制定了公立医院法人治理改革实施路径.一是建立公立医院管理委员会,统筹政府办医保障职能;建立公立医院管理机构,提高举办医院的行政管理水平;转变卫生行政部门职能,形成多元化办医格局.二是建立分级决策机制、自主经营制度及多元监管制度,解决政事分开问题.三是研究制定公立医院章程,促进公立医院向法定机构转变,通过法制化巩固法人治理改革成果.

Abstract：

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of "Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals", the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.     

上海市公共卫生体系建设发展现状与展望

2003年非典疫情后,公共卫生受到政府和公众前所未有的关注和重视.上海市先后实施完成了第一轮和第二轮的"加强公共卫生体系建设三年行动计划",并将启动实施第三轮行动计划,通过实施前两轮行动计划,上海市公共卫生体系框架逐步得到完善,城市公共卫生安全日益得到保障,市民主要健康状况和指标也不断得到改善和提高.本文在分析公共卫生概念和公共卫生体系范畴的基础上,回顾了上海近10年来公共卫生体系发展状况,并结合上海这个国际化特大型城市的特点,分析未来上海公共卫生体系可能面临的问题和挑战,提出体系发展方向和策略.

Abstract：

The government and general public has paid unprecedented attention to the public health after the outbreak of SARS in 2003. Based on the first and the second round of Three-year Action Plan for Public Health System Construction, the public health system in Shanghai has been gradually improved. The city's public health security has been increasingly consolidated and people's main health status and indicators have been constantly improved. Nowadays, the third round of Three-year Action Plan will be started. This paper will review the development of public health system in Shanghai in recent ten years, analyze the possible problems and challenges in the future and put forward the development direction and strategy of the system.     

Rethinking public health education and public health workforce development in China

During the fighting against novel coronavirus disease epidemic, both the public health education and public health workforce of China have exposed important challenges. The present review discusses dilemmas and weakness that relate to the position of public health education in the higher education system, public health education system, curriculum system, teaching methods, practice-based teaching, training of highly qualified personnel in public health, public health teachers, remuneration and n...     

Social Expenditure on Health Service and Its Macro Estimation

By social expenditure on health service(SEHS)we refer to the sum total of money paid by thewhole society during a certain period of year for the sake of preventing and treating diseases andof protecting and improving the people's health.It reflects objectively the total level of SEHSduring a certain period;the levels of health service expenditures on the parts of the whole society,enterprises,and individuals;the ratio between SEHS and total social expenditure;and the ratiosof SEHS to gross national product and to national income.The article discussed and analysed     

流动人口妇幼保健服务利用及服务提供模式的定性研究

采用专题小组讨论和个人深入访谈的方法,了解了现行的医疗保健服务系统为流动人口提供妇幼卫生服务以及流动人口妇女儿童对这些服务的利用情况,同时了解了服务提供者对如何提高流动人口妇幼保健服务利用的有关意见和建议。研究发现,对于流动人口这一特殊群体,大多数医疗保健机构仍然只是坐堂行医,没有树立上门服务的思想。医疗保健机构人员配置和经费供给不足等因素影响其为流动人口提供妇幼保健服务。大多数流动人口妇女在大城市艰苦的生活状况和自身的文化素质决定了她们寻求医疗保健服务的态度以及接受医疗保健服务的能力,有相当部分的人就医选择的是私人诊所和非法行医者。建议在目前现有的条件下,充分利用现有资源,调动各方面的力量,建立以社区为依托,多部门合作的流动人口妇幼保健服务模式。同时,政府在重点地区相关机构人员的配备和经费的投入上应该考虑流动人口,适当增加人员和经费。     

上海市0~6岁非户籍儿童卫生服务需求和利用分析

【目的】 了解上海市非户籍儿童的保健状况和服务需求,为相关部门制定卫生保健政策提供依据。 【方法】 分别于2006、2009年对上海0~6岁非户籍与户籍儿童就其定期体检、营养知识、卫生服务需求等儿童保健内容进行回顾性调查。 【结果】 非户籍儿童体重低下、生长迟缓的比例比户籍儿童高,且差异有统计学意义(P<0.05);非户籍家长对"定期体检"的认知上升明显,差异有统计学意义(P<0.01);非户籍和户籍家长对儿童保健知识需求的排序相同,为“生长发育”、“营养与喂养”和“智力发育”。 【结论】 为非户籍儿童提供基本卫生保健服务,针对性健康宣传教育,可以促进非户籍儿童的健康发展。     

对北京市外来务工人员健康状况和就医行为的调查研究

目的：对北京市外来务工人员的健康状况和就医行为进行调查。方法采用多阶段分层抽样方法选取北京市外来务工人员比较集中的7个区县作为调查地点,调查外来务工人员家庭431户,共1045人,其中有效问卷1002份,有效回收率为95.9%。结果外来务工人员日工作时间长、自评健康状况较好;医疗保障水平低、参保意愿强烈;社会支持网络局限,经济拮据是困扰家庭就医的主要问题;日常患病就诊单位以区县级及以下医院为主;医疗服务利用不足,呈“三低两高”。结论医疗保障和家庭资源匮乏抑制了外来务工人员对医疗服务的利用;应逐步完善社会保障制度,提高社区卫生服务的能力,以满足外来务工人员的基本医疗需求。     

兵团流动人口医疗保障现状分析

摘要:目的　描述兵团流动人口享有医疗保障的现状,为相关部门制定政策提供参考依据。方法　利用“2013年全国流动人口动态监测”中4000名调查对象的调查问卷。结果　兵团流动人口的职工医保、居民医保、商业医保参保率分别为8.1%、20.9%和3.3%。流动人口医疗保险参保率为28.6%。不同民族、年龄、文化程度、职业、户籍性质、户籍地、流入原因、个人月收入、流动范围、就业身份、居住时间的流动人口的医保参保率有统计学差异（P＜0.05）。结论　兵团流动人口医疗保险的参保率低,需建立完善的兵团流动人群医疗保障体系;不同特征兵团流动人口医保参保率差异较大,需关注重点人群。     

上海市0～6岁非户籍儿童营养状况三年变化趋势评估

目的了解上海市非户籍儿童的营养状况的变化趋势,为相关部门制定卫生保健政策提供依据。方法分别于2006年、2009年,采用分阶段、不等比例、随机整群抽样的调查方法,在同一抽样社区对0~6岁户籍与非户籍儿童的体格生长、辅食添加、一周食物摄入等内容进行回顾性调查。结果非户籍儿童"偏食、挑食"的比例高,达到30.2%,但较2006年的35.8%有所下降(P0.01);与2006年相比,非户籍儿童添加"肉"和"鱼虾"的时间有所提前,8个月后添加者比例下降(P0.01);非户籍儿童每日进食"蛋"、"鱼虾"、"豆制品"和"水果"的比例较2006年有所增加(P0.05),分别上升的数值范围为39.90%~45.51%、7.63%~16.39%、5.85%~12.33%、58.07%~65.01%;非户籍儿童体重低下、生长迟缓的比例比户籍儿童高(P0.05),分别为3.8%vs 2.0%、3.3%vs 1.8%。结论非户籍儿童的喂养和营养状况、体格生长与户籍儿童相比仍有差距,但已经有所改善。针对性提供健康宣传教育,改善儿童保健服务利用,可以促进非户籍儿童的健康。     

丹江口库区过渡期移民卫生服务需求及利用状况调查

目的分析移民卫生服务需求现状以及存在的问题,为改善过渡期移民卫生服务需求和利用状况提供建议。方法通过对丹江口库区移民卫生服务需求、利用及影响因素调查,采用多阶段分层整群抽样的方法,利用自编基本情况与家庭卫生服务调查表对淅川县搬迁到宝丰、荥阳安置的移民和原住地不搬迁居民进行人户调查。结果过渡期移民2周患病率和2周就诊率均高于原住地不搬迁居民,差异均具有统计学意义（均有P〈0．001）;半年慢性病患病率和1年住院率差异均无统计学意义（均有P〉0．05）;对移民和安置地居民进行多因素Logistic回归分析显示,影响居民2周患病率和就诊率的影响因素主要有居民类型,家庭收入,性别,年龄等因素。结论过渡期移民较原住地不搬迁移民的健康状况差,卫生服务需求更高,应加大对基层卫生服务建设的投入,提高基本卫生服务质量,为做好移民搬迁工作打好基础。     

Does health service utilisation vary by remoteness? South Australian population data and the Accessibility and Remoteness Index of Australia

OBJECTIVE: To compare rates of self-reported use of health services between rural, remote and urban South Australians. METHODS: Secondary data analysis from a population-based survey to assess health and well-being, conducted in South Australia in 2000. In all, 2,454 adults were randomly selected and interviewed using the computer-assisted telephone interview (CATI) system. We analysed health service use by Accessibility and Remoteness Index of Australia (ARIA) category. RESULTS: There was no statistically significant difference in the median number of uses of the four types of health services studied across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use (> or =6 visits, 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was not statistically significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (e.g. 5.9% for highly accessible areas). CONCLUSION: The self-reported frequency of use of a range of health services in South Australia was broadly similar across ARIA categories. However, use of primary care services was higher among residents of highly accessible areas and public hospital use increased with increasing remoteness. There is no evidence for systematic rural disadvantage in terms of self-reported health service utilisation in this State.     

社会融合对流动人口基本公共卫生服务利用的影响分析

目的 通过分析流动人口社会融合及基本公共卫生服务利用的现状,探究社会融合对基本公共卫生服务利用的影响,为改进流动人口基本公共卫生服务利用现状提出建议。 方法 收集2017年全国流动人口卫生计生动态监测数据中流入时间≥6个月的99 494名流动人口的相关数据,对流动人口社会融合及基本公共卫生服务利用现状进行描述性分析,并使用分层logistic回归探究社会融合对基本公共卫生服务利用的影响。结果 在99 494名流动人口中,有36 837人已在流入地建立了健康档案,建档率为37.0%; 75 540人在流入地接受过健康教育,健康教育接受率为75.9%; 社会融合的四个维度中,家庭平均月收入(β= -0.108、-0.085,P<0.001)、家庭平均月支出(β= -0.061、-0.126,P<0.001)、是否有医保(β= 0.349、0.294,P<0.001)、是否在本地参加过工会等组织活动(β= 0.956、0.489,P<0.001)等变量会影响流动人口利用健康档案和健康教育服务。 结论 流动人口的健康档案建立率较低,流动人口健康教育接受情况较好但仍需提升; 流动人口的社会融合情况会影响其利用基本公共卫生服务。     

流动人口就医决策代际差异及其影响因素分析

目的 比较老一代和新生代流动人口就医决策差异及其影响因素,为促进流动人口主动就医提供建议.方法 采用2017年全国流动人口动态监测调查数据,运用x2检验和二元logistic回归方法分析两代流动人口就医决策差异及影响因素.结果 纳入有效样本10042人,新老两代流动人口患病后选择主动就诊的比例分别为58.3％、61.2...     

上海市某区女性流动人口对性病艾滋病卫生服务利用的现状调查

目的研究女性流动人口对与性病艾滋病相关的卫生服务需求/需要和利用的现状。方法对696名到上海市某区疾病预防控制中心参加健康体检的外来女性进行问卷调查。结果有92人能够全部答对生殖感染6种常见症状,82人能够全部答对7种常见危害。有43.7%的人报告近3个月内出现至少一种生殖道感染的常见症状;43.5%有应就诊未就诊经历;60.3%被动接受过宣传教育;381名近3个月有性生活者中49.9%从不用避孕套,其中52.6%报告近3个月有生殖道感染症状;93.2%为自费医疗;78%认为需要了解上海市针对外来人员推出的医疗保障政策;89.9%不知道从何途径了解相关医保政策。结论外来女性对与性病艾滋病相关的卫生服务有高需求,但卫生服务利用率不高。