China's Rural Public Health System Performance: A Cross-Sectional Study

Background

In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China''s rural public health system performance.

Methods

The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region.

Results

China''s rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%.

Conclusions

The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.     

基于结构方程的公共卫生服务提供效果影响因素研究

为了分析公立医院提供公共卫生服务效果的影响因素,通过问卷调查,收集了黑龙江省102家公立医院公共卫生服务相关数据。运用软件SPSS18.0和AMOS7.0对数据进行统计分析,建立公立医院提供公共卫生服务效果影响因素结构方程模型,探讨公共卫生服务提供效果的影响因素。研究发现,财政补偿与政府监管、医院管理、医院投入对公共卫生服务提供效果具有促进作用。     

对城市大型医院优质医疗资源下沉若干问题的思考

改革县级公立医院的运行机制,提升县级公立医院服务能力,发挥县级公立医院的区域基本医疗中心的作用,是体现公立医疗机构的公益性,解决基层群众就医需要的关键措施。文章结合我国医疗资源配置的区域失衡,通过对浙江省城市大型医院与县级公立医院通过托管等不同形式建立协作关系的情况和效果进行了总结,对城市大型医院优质医疗资源下沉到县区开展医疗服务的活动进行了评价和分析,并且进一步阐述了从根本上改变区域医疗资源失衡、完善医疗服务体系、促进医疗卫生事业健康发展的策略。     

公立医院公共卫生服务补偿中存在的问题与对策研究

公立医院作为公共卫生体系中不可或缺的一个部分, 在公共卫生体系中起着重要的支撑作用。然而对于公立医院公共卫生服务的补偿问题一直以来都没有得到合理、有效的解决。分析了当前我国公立医院公共卫生服务补偿中存在的问题,并对进一步完善公立医院公共卫生服务补偿机制提出了相应的建议和对策。     

医改背景下医院岗位管理模式探讨与实践

????? 公立医院改革是当前医改的主要内容,岗位管理是公立医院改革的关键。通过介绍医院在医改背景下实行岗位管理改革的做法,阐述岗位管理的涵义及在公立医院改革中的重要性,为公立医院改革提供有益的实践参考。

     

我国县级公立医院改革关键问题与路径选择

自县级公立医院改革试点以来,在各领域都有所探索并形成初步的改革思路。但是,在改革中仍有不少关键问题未得到解决,诸如：改革的多元顶层设计思路、补偿机制的持续性与稳定性、地方政府财政压力加重、医院管理体制机制改革未能协同进行、调动和保障医务人员积极性的机制亟待完善、医疗服务定价无法体现医疗服务价值、人才队伍建设滞后、医保基金的使用等。建议下一步县级公立医院改革应在多元化、多层次的顶层设计指导下,坚持公益性与医院经营效益相结合,建立县级公立医院的现代医院管理制度。改革要从创新人力资本管理机制、完善破除“以药补医”后的补偿机制和配套措施、推进法人治理和政事分开、加强医保基金对居民医疗需求的引导、加快医院信息化建设等方向上寻求突破。     

公立医院公共卫生服务补偿机制存在问题与路径探讨

阐述当前我国公立医院对公共卫生服务发展的地位与作用,分析了公立医院公共卫生服务补偿机制存在的问题,并通过总结现行的政府公共卫生服务补偿方式、方法和补偿传导路径,构建了公立医院公共卫生服务补偿机制路径,并提出相应的政策建议,为建立长期有效的公立医院公共卫生服务补偿机制提供参考。

     

Patterns of local and tourist use of an emergency department.

Illness patterns of local and tourist patients in an emergency department of a medium-sized Ontario city with a single hospital were compared. Frequencies of specific and broad categories of ailments and rates of admission to the hospital were similar in the two groups. However, non-Canadian tourists were admitted to hospital at a much lower rate than Canadian tourists. Rates of visits to the emergency department within certain age categories were remarkably similar, as were rates within the sexes. It is concluded that, in view of the striking similarity in the illness pattern of a group of patients not professionally referred to the hospital and that of local patients, who have potential contact with a more extensive medical network, public attitudes, rather than availability of health professionals, determine the pattern of illness observed in an emergency department.     

基于信息技术的公立医院行政管理协同体系构建

通过对公立医院行政管理流程繁琐、协同运作不畅、体系落后等现状和存在的审核程序繁琐、工作效率低下、医疗成本剧增等问题的分析,提出基于信息技术的公立医院行政管理协同这一全新的概念,并探讨了构建公立医院行政管理协同体系的重要意义以及体系框架、功能结构和保障机制等。     

对建设中国特色现代医院管理制度的思考

公立医院在我国医疗卫生服务体系中承担着重要保障作用。随着改革的不断推进,社会各界对建立符合中国特色要求的现代医院管理制度的呼声日渐高涨。在对已有研究进行总结的基础上,结合各地开展公立医院改革的具体实践经验,从目前医院运营管理现状入手,逐步梳理医院管理制度建设面临的困境及存在的困难,对现代医院管理制度内涵进行梳理,探讨建立中国特色现代医院管理制度的具体实现路径。     

Patient waiting: care as a gift and debt in the Thai healthcare system

Drawing on fieldwork in Chiang Mai during 2010 and 2012, I examine poor Thais’ and Shan migrants’ experiences of receiving healthcare from a public hospital, and, in parallel, care from the state. While universal health coverage has become a way in which the state finds legitimacy in people's lives through giving care, being a recipient of state aid is implicated in the emotive domain of waiting. By focusing on how people feel and think of a gift and debt of care, I suggest that flows of affects that loom large in social interactions within the public hospital denote not only poor people's subordinate position but also their effort to achieve a sense of mutuality and moral autonomy. This study contributes to a broader understanding of experiences of paternalism, inequality, and dependence by illuminating people's agentive submission into relations of care.     

The frequency of adverse drug reaction related admissions according to method of detection, admission urgency and medical department specialty

Background  

Adverse Drug Reactions (ADRs) have been regarded as a major public health problem since they represent a sizable percentage of admissions. Unfortunately, there is a wide variation of ADR related admissions among different studies. The aim of this study was to evaluate the frequency of ADR related admissions and its dependency on reporting and method of detection, urgency of admissions and included medical departments reflecting department/hospital type within one study.     

RECENT TRENDS IN PUBLIC HEALTH

Environmental sanitation is experiencing a reawakening with concerted drives at control of water and atmospheric pollution, mosquito and rodent control, and improvement in restaurant sanitation. Communicable disease control efforts are being intensified.With prolongation of life, chronic diseases are assuming increasing importance as public health problems. Maintenance of standards of hospitals and provision for more adequate hospital facilities are also receiving attention. Mental health and chronic alcoholism are being considered as a public health problem.With all these new trends emphasizing prevention of disease, increasing teamwork between physicians in private practice and in public health practice is being manifested. Preventive medicine and public health are now a recognized specialty in medicine.     

对我国现代医院管理制度中公益性与生产性的分析

医药卫生体制改革已进入攻坚阶段。我国卫生事业的性质及国情决定现代医院管理制度必须兼顾公益性与生产性。面对目前医院公益性与生产性不协调的困境,在建立现代化医院管理制度中,要通过明确政府与医院的责任边界、规范监管和补偿机制、实现医院法人治理、改进人力资源管理等,从而实现医院公益性与生产性的和谐共赢。     

新医改形势下公立医院品牌建设的几点思考

在不断深化的医药卫生体制改革形势下,公立医院管理体制、运行机制、监管机制和补偿机制的改革以及加快形成多元办医格局的医改大方向,决定了公立医院必须解放思想、更新观念,科学地进行医院品牌建设。     

公益化视角下公立医院社会责任体系构建

公立医院是我国医疗服务的主体,同时也是社会责任的必然承担者。公益化视角下公立医院在获取自身生存和发展的同时,应最大程度地承担起“救死扶伤、生命至上”的社会责任新内涵。公立医院社会责任缺失与医疗市场越位、政府补偿缺位及医务人员宗旨意识错位有关。公益化视角下公立医院社会责任体系重建要改革公立医院运行机制、统筹利用社会各方力量、积极营造社会责任的文化氛围、提高医院综合管理水平及建立基于公益性的绩效考核方案。因此,要发挥公立医院社会责任要正确认识公立医院社会责任本质,应正确处理好社会责任与经营性之间的关系及充分发挥公立医院社会责任的利益相关方力量。有关企业社会责任及治理结构的理论和方法对研究医院相关问题有重要借鉴作用,但不能照搬,中国经济、管理和卫生领域专家在公立医院社会责任及实现机制方面的探索还有许多工作要做。     

Health care in Brazil.

Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor.     

Health departments in the U.S. 1920-1988: statements of mission with special reference to the role of C.-E.A. Winslow.

The mission of local health departments in the U.S. is traced from the 1920s to the present through examination of official promulgations of the American Public Health Association and other organizations. As the communicable diseases came under general control, this mission was conceived more broadly. Nevertheless, in effect their public health role was diminished due to the rapid ascendancy of private and not-for-profit medical care, which consistently sought to keep public health out of potential areas of competition. Thinking both within the public health field (as represented by C.-E.A. Winslow) and outside the public health field (as represented by the American Medical Association), had created boundaries limiting public health's role to preventive medical services. This restriction, in turn, largely excluded the public health field from participation in the tremendous expansion of medical care since World War II. The public health role was further limited in 1970 by the removal of much of environmental pollution from its purview. The sum of these and other forces has left the public health field weakened and in considerable confusion about its role at a time when the resurgence of infectious disease (e.g., AIDS and Lyme disease), environmental hazards, and medical care institutions requires a strong public health presence.     

Lessons from Lithuania: rethinking public health training.

Lithuania faces stark problems that are familiar to most countries in the former Soviet Union: high morbidity and mortality rates, pollution, an unstable economy, and rapid changes in the financing and organisation of health care. In this environment Moore and Dixon visited Kaunas Medical Academy to help identify how training in public health medicine could contribute towards improving the health of the population. Although over 200 hours are devoted to public health training for medical undergraduates, teaching is unfocused, fragmented, and includes little epidemiology--the core subject for public health physicians. Teaching is mainly through long lectures with few group discussions. Student participation and motivation are low. As well as recommending redesign of the curriculum, Moore and Dixon suggested training in teaching methods for teachers. They also suggested that postgraduate training in public health should begin and should be targeted at hospital managers, teaching staff, and existing public health physicians.     

Review of hospital cases in the assessment of hydatidosis as a health problem in the Argentine Province of Chubut

A retrospective survey of hospital cases to obtain baseline data on hydatid disease in the northwest of the Province of Chubut, Argentina, from 1973 to 1979 revealed annual mean rates that varied between 13.4 and 75.8 confirmed new cases per 100.000 population. Inclusion of data on parasitologically confirmed non-surgical cases and on the geographic origin of patients permitted a more accurate estimate of cases in the four Departments comprised in the study area. Information on cyst location, clinical status at admission, mortality, number of re-operations and length of hospitalization was obtained to assess the public health impact of hydatidosis within the area. The criteria established and methods used to collect this information are described and discussed.