社区环境与村医疗点业务收入关系的研究

世界卫生组织(WHO)在1998年第51届世界卫生大会上提出:21世纪人人享有初级卫生保健的目的,在于继续实现1978年阿拉木图会议发起的人人享有卫生保健的理想。并确定了21世纪人人享有卫生保健的总目标和具体目标。我国农村初级卫生保健工作的进一步落实要依靠三级卫生服务网,其中作为网底的村级卫生组织是初级卫生保健的主体,是切实保障全体农村居民享受基本卫生服务、实现2000年全球卫生目标和我国2010年第二个初级卫生保健十年规划目标的关键。     

《中国初级卫生保健》杂志2004年选题参考

1.21世纪初级卫生保健战略研究2.初级卫生保健的依法监督与管理3.初级卫生保健的分级监测与评估4.国外初级卫生保健比较研究5.健康扶贫与长期经济增长6.公共卫生、基本医疗服务项目界定及其支付政策7.突发公共卫生事件应急机制、疾病预防控制体系和卫生执法监督体系的构建8.城镇化与卫生服务体系建设9.基本卫生干预措施的普遍覆盖研究10.贫困人口对基础卫生服务的可及性研究11.对贫困家庭实行医疗救助资金的筹集和主要形式12.危害农村居民健康的主要公共卫生问题的确定及其防治对策13.完善农村卫生体系、基本医疗体系、环境卫生体系和财政保…     

《中国初级卫生保健》杂志2004年选题参考

1.21世纪初级卫生保健战略研究2.初级卫生保健的依法监督与管理3.初级卫生保健的分级监测与评估4.国外初级卫生保健比较研究5.健康扶贫与长期经济增长6.公共卫生、基本医疗服务项目界定及其支付政策7.突发公共卫生事件应急机制、疾病预防控制体系和卫生执法监督体系的构建8.城镇化与卫生服务体系建设9.基本卫生干预措施的普遍覆盖研究10.贫困人口对基础卫生服务的可及性研究11.对贫困家庭实行医疗救助资金的筹集和主要形式12.危害农村居民健康的主要公共卫生问题的确定及其防制对策13.完善农村卫生体系、基本医疗体系、环境卫生体系和财政保…     

国际卫生改革经验对我国卫生体制改革的借鉴

通过对国际卫生改革经验的研究,作者建议,我国的基本卫生保健制度改革要立法先行;体现"公平优先、兼顾效率"的原则,确保人人享有公共卫生服务和基本医疗服务;基本卫生保健内容要与具体国情和财力相适应;正确认识政府和市场的作用,实现政府主导与市场机制的有效结合;做好卫生发展规划,发展社区卫生服务,建立健康"守门人"制度;建立社会化的老人照顾体系;拓宽卫生筹资渠道等。     

卫生部门是实施初级卫生保健工作的主力军

“2000年人享有卫生保健”是世界卫生组织提出的全球战略目标,实施初级卫生保健是实现“2000年人人享有卫生保健”的关键,是实现这一目标的基本途径,是加速卫生事业发展的治本措施。就卫生工作而言,实施初级卫生保健是为全体居民提供最基本的卫生保健服务,来预防疾病与促进人民健康,提高全民族的身体素质,是体现为人民服务这一宗旨的。因此,卫生部门在推行初级卫生保健工作中是负有重要责任的,应是实施初级卫生保健工作的主力军。     

任重道远 前程无量——祝《中国初级卫生保健》杂志发行百期

保障人民的基本卫生服务,保护人类健康,不仅是卫生人员的共同任务,也是各级政府的职责。推行初级卫生保健则是实现“2000年人人享有卫生保健”全球卫生战略,保护人类健康,促进社会发展的关键; 我国卫生部门从80年代起,在各级政府领导下,在全国范围内推动初级卫生保健,取得了显著成就。我国城乡人民的卫生服务水平明显提高,人民健康指标在发展     

城市初保是城区政府的一项重要任务

城市实施初级卫生保健既是“2000年人人享有卫生保健”全球战略目标的要求,也是经济和社会发展的重要组成部分。如何将城市的基本卫生服务尽快纳入初级卫生保健的轨道,使城市全体居民在本地区社会经济发展的同时,享受到有效的卫生保健服务,这是摆     

初级卫生保健的内涵及其在我国的发展回顾

由世界卫生组织及其成员国于1978年《阿拉木图宣言》提出的“初级卫生保健”,是指最基本的、人人都能得到的、体现社会平等权利的、人民群众和政府都能负担得起的卫生保健服务。初级卫生保健所反映的核心价值观是社会公平,所信奉的理论是“健康乃人类的基本权利”,所追求的目标是“人人享有健康”,所采用的技术是适宜技术。中国初级卫生保健实践始于建国之初,20世纪50年代初确定的“面向工农兵、预防为主、团结中西医、卫生工作与群众运动相结合”四大方针,已包含了初级卫生保健的基本思想和内容。建国后的前30年取得的成就为国际上形成初级卫生保健策略奠定了实证基础,随后20年是我国初级卫生保健发展阶段,政府承诺实现2000年人人享有卫生保健的目标,但取得的健康效果有限。21世纪以来,政府仍然把初级卫生保健作为农村卫生的中心任务,但是可持续性问题还没有解决。     

面向21世纪 初级卫生保健工作只能加强——纪念《中国初级卫生保健》杂志发刊100期

1978年阿拉木图会议之后,世界卫生组织不遗余力地推动全球初级卫生保健的实施。各会员国政府也都作出了承诺,发展中国家各自都取得了不少进展。事实证明,初级卫生保健策略既是解决发展中国家公民比较公正地享有卫生资源的正确途径,同时对于发达国家的卫生服务也有积极意义。21世纪即将来到,我     

江阴市编印一套初级卫生保健宣传画

为了使“2000年人人享有卫生保健”的规划目标家喻户晓,深入人心,江苏省江阴市初级卫生保健委员会和江阴市卫生局编印了一套三幅宣传画。其标题分别为:《2000年人人享有卫生保健》、《实施初级卫生保健》、《健康为人人,人人为健康》。这套宣传画以“2000年人人享有卫生保健”的规划目标为主线,突出了初级卫生保健的基本内容和三级卫生保健网,融疾病控制、卫生监督、妇幼保健、卫生行为予一体。色彩鲜明,图文并茂,形象生动;以初级卫生保健内容为主成套制版彩印这在国内尚属首家,可供城乡广泛张贴宣传。首版15000     

Lessons from understanding the role of community hospital director in Thailand: clinician versus manager

In 2001, Thailand adopted the Universal Health Coverage (UHC) policy. This policy focuses on primary health care (PHC), with the aim of reforming the Thai health system to provide health services to all, regardless of a person's ability to pay. The community hospital director (CHD) is the middle manager of the provincial health system and the leader of the district health system of Thailand. In recent reforms the emphasis for improving efficiency lies with changes in the provision of primary health services at the community level and this entails understanding the role of the CHD. A qualitative study, utilizing individual interviews and a focus group discussion, was undertaken in order to understand the factors affecting the implementation of rural health care in Thailand. Findings identified several barriers that limit the role of the CHD and a major result of the study was recognition of the dual role of the CHD as both clinician and manager. This study concluded that the goal of the UHC policy in providing equity of access to PHC to all citizens may not be achieved unless the role of CHDs is supported with training in health management and PHC and is supported by the government.     

论我国卫生保健服务的公平性

卫生保健服务公平性是指无论社会成员的社会地位、收入等因素如何,都应该以需求为导向获得卫生保健服务。通过卫生保健服务公平性评价体系,分析目前在我国卫生保健服务的公平性方面存在着卫生保障覆盖面小、卫生资源配置不平衡及卫生服务费用分担不合理等问题。要改变这一状况,就应该从增加卫生资源的投入、优化卫生资源配置结构、健全和完善医疗保障制度方面着手,推进卫生保健服务的公平,使每一个社会成员都能得到基本的、公平的卫生保健服务,最终实现人人享有卫生保健的目标。     

Better Measurement for Performance Improvement in Low‐ and Middle‐Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection

Policy Points:

• Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC).
• The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement.
• Results from the initial PHC performance assessments in low‐ and middle‐income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross‐country comparisons and peer learning to improve PHC.
• New indicators and sources of data are needed to better understand PHC system performance in LMICs.

Context

The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low‐ and middle‐income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released.

Methods

The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross‐referenced against indicators available from international sources, and evaluated through 2 separate modified Delphi processes, consisting of online surveys and in‐person facilitated discussions with experts.

Findings

The PHCPI conceptual framework builds on the current understanding of PHC system performance through an expanded emphasis on the role of service delivery. The first set of performance indicators, 36 Vital Signs, facilitates comparisons across countries and over time. The second set, 56 Diagnostic Indicators, elucidates underlying drivers of performance. Key challenges include a lack of available data for several indicators and a lack of validated indicators for important dimensions of quality PHC.

Conclusions

The availability of data is critical to assessing PHC performance, particularly patient experience and quality of care. The PHCPI will continue to develop and test additional performance assessment instruments, including composite indices and national performance dashboards. Through country engagement, the PHCPI will further refine its instruments and engage with governments to better design and finance primary health care reforms.     

加强农村卫生服务体系建设 促进人人享有基本卫生保健

建立国家基本卫生制度、实现人人享有基本卫生保健是国际社会＂全民健康覆盖＂目标的具体体现。过去几十年,江苏省农村卫生服务体系得到了较好发展,基本建立具有较高可及性的农村服务组织网络,为实现农村居民人人享有基本卫生保健打下了良好的基础,同时还存在诸多亟待解决的问题。为此提出建议：明确政府健康责任,改革卫生投入机制;优化卫生服务体系布局,提高高质量卫生服务的可及性;加强基层卫生人才队伍建设,提高基本卫生服务质量;完善薪酬分配制度,调动卫生人员积极性。     

Identifying challenges and barriers in the delivery of primary healthcare at the district level: a study in one Thai province

In 2001, the universal health coverage policy was adopted by Thailand with primary healthcare (PHC) as the major focus of the policy. In order to understand the structural and institutional factors affecting the implementation of PHC in rural Thailand, a qualitative study, utilising individual interviews with national and provincial policy decision makers, community health directors, heads of hospital primary care units, chiefs of district health offices, heads of health centres and community representatives, from one rural province was undertaken. Findings showed that the sustainability of PHC service provision under the administration of community hospitals is problematic as barriers exist at the policy and operational levels and access to PHC for all citizens may not be achieved until these barriers are addressed. Furthermore, although PHC needs to be acknowledged and implemented by all stakeholders within the health industry and government, the roles and responsibilities of the stakeholders in health services management at the district level need to be clarified. Copyright © 2012 John Wiley & Sons, Ltd.     

2000-2018年我国城乡居民医疗保健支出公平性变化研究

目的:了解我国城乡及地区间医疗保健支出现状及差异性,分析我国城乡居民医疗保健支出的公平性,为我国医药卫生体制改革提供科学参考。方法:收集2000—2018年城乡医疗保健支出、人均可支配收入及人均纯收入等相关数据,采用集中指数和集中曲线对我国城乡医疗保健支出进行公平性分析。结果:2010—2018年城镇居民人均医疗保健支出(实际值)年平均增长速度为3.55%,农村居民人均医疗保健支出(实际值)年平均增长速度为10.00%。2000—2017年我国城镇居民人均医疗保健支出集中指数呈下降趋势,其中2006年出现最大值为0.1332,除2015—2017年外,其余年份差异均具有统计学意义(P<0.05);2000—2017年我国农村居民人均医疗保健支出集中指数呈下降趋势,2004年出现最大值为0.2522,差异均具有统计学意义(P<0.05)。结论:我国城乡人均医疗保健支出逐年增加,全国和各地区城乡人均医疗保健支出差距较大。我国城乡人均医疗保健支出存在不公平性,城镇人均医疗保健支出优于农村人均医疗保健支出,公平性逐渐趋好。     

新中国70年初级卫生保健回顾与展望

新中国成立70年以来,我国一直在丰富着初级卫生保健（PHC）的内涵和实践,用较小的投入取得了较好的健康绩效。本文将我国70年来初级卫生保健发展历程分四个阶段,总结了在基层卫生服务体系、医保覆盖、基层卫生人力、基本公共卫生服务项目、妇幼保健、健康扶贫等方面取得的成效,并提炼出中国初级卫生保健的经验,分析了面临的问题与挑战,提出了未来的发展建议。     

Evaluation of primary health care reform in Estonia

Estonia began to reform its health care system by reorganizing primary health care (PHC). Ten years ago, the health care system was inefficient, supply was biased towards institutional care, and PHC was almost non-existent in the western understanding: it was provided by different specialists in policlinics, and the financial basis of the system was in crisis. The reform had the following aims: to develop PHC by introducing family medicine, to guarantee the whole population access to family doctors' services, and to secure stable funding for these services. In 1998, a new phase in the reform was introduced through the creation of a new funding system for primary care services. The aim of this paper is to present a practically applicable set of indicators to evaluate PHC reform in terms of health economics criteria and then to apply these indicators in evaluation of the Estonian PHC reform.