【作者】 金铭；

【导师】 王健；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2013， 硕士

【摘要】 我国地区经济发展水平与卫生投入差异,城乡二元结构导致的公共卫生服务供给差异,中央财政转移支付、分税制以及卫生服务体系存在的种种问题导致城乡之间、地区之间、人群之间的医疗保障不均等,资源配置不均等,服务可及性不均等,健康结果不均等的卫生服务非均等化现象突出。基本公共卫生服务的提供可以满足人们日益增长的基本卫生服务需求,是调整卫生资源合理布局和配置的有效手段,是实现人人享有卫生保健的重要途径之一。研究目的：本研究通过对宁夏地区基本公共卫生服务均等化数据的分析,采用扎根理论总结宁夏三县区基本公共卫生服务均等化现状,分析三县区基本公共卫生服务实施效果,揭示宁夏基本公共卫生服务均等化实施过程中存在的问题,提出合理的建议,为深化发展宁夏基本公共卫生服务提供依据。具体研究目的如下：(1)描述宁夏三县区基本公共卫生服务均等化组织保证、服务能力卫生筹资和绩效考核情况；(2)描述宁夏三县区基本公共卫生服务均等化实施现状,分析实施效果,探讨存在问题；(3)综合现状,针对存在的问题,提出合理的意见和建议。研究方法：资料来源于教育部哲学社会科学研究重大课题攻关项目《深化医药卫生体制改革研究》的子课题2“促进基本公共卫生服务逐步均等化研究”。根据经济发展水平选取银川市兴庆区、银川市永宁县和吴忠市盐池县三县区作为调查地点,通过定量问卷和定性访谈,调查21个相关机构及其中的40名相关服务人员。利用WORD对访谈资料进行整理,并通过Weft QDA将三县区的资料进行：整合分析,文献分析法和统计描述法贯穿全文,采用扎根理论分析方法研究三县区基本公共卫生服务实施现状、实施效果及存在问题。结果：(1)三县区通过决策层、管理层和执行层三个层级实现组织保证,各层级间分工明确。(2)兴庆区、永宁县、盐池县每万人口卫生机构数分别为1.16、4.21、7.77,兴庆区和永宁县低于全国平均水平(6.99),而盐池县高于全国平均水平(6.99)：三县区每万人口卫生技术人员数分别为21.08、25.30、21.12,明显低于全国、平均水平(43.82)。(3)县级以下基层卫生机构的卫生服务经费采用打包付费和预付制,并且补助金额逐年提高,但是没有完全及时到位,而且没有相关办公经费补助。(4)三县区都开展九项公共卫生服务,从项目执行情况指标上来讲,除永宁县老年人体检率和健康管理率未达到国家规定的目标要求外,三县区其他项目都达到国家规定要求。(5)三县区基本公共卫生服务的激励与考核相互促进。采取激励措施后,积极性有提高,便还需进一步加强：考核措施较为严格,结果与奖惩措施相挂钩。结论及建议：宁夏地区：基本公共卫生服务开始实施至今,已经取得一定的效果,主要体现健康楼案建档率、重点人群系统管理率、慢性病患者管理率等数量性指标的提高,以及居民满意度的增加,亲身接受过基本公共卫生服务的居民表示愿意主动寻求基本公共卫生服务。宁夏地区基本公共卫生服务仍存在一些问题：基本公共卫生服务均等化缺乏制度保障；基本公共卫生服务均等化提供能力不足：基本公共卫生服务均等化投入和管理水平不高；部分居民意识淡薄,流动人口管理困难：基本公共卫生服务与医疗保障制度脱节。本文提出以下建议：加强领导对基本公共卫生服务均等化,重要性的认知；建立公共卫生体系母法,保障基本公共卫生服务的实施有法可依：提高卫生服务人员保障措施,提高工作积极性；强化资金监管手段,确保资金足额到位和有效使用：转变基层卫生人员观念,允分发挥基层卫生服务机构的功能：针对性加强健康教育,关注重点人群,提高全体居民健康意识。更多还原

【Abstract】 In China, the differences between economic development level and health investment, and urban-rural dual structure lead to the different supply of public health services. The central financial transfer payment, tax distribution system and problems of health service system bring about the outstanding phenomenon of the inequality of medical security, resource allocation, service availability and health outcome between urban and rural, districts and the crowds.Providing basic public health services can satisfy people’s growing health service demands, and it’s an effective means of adjusting reasonable layout and configuration of health resource, also it is one of the important ways to achieve goal of "Health for All-Objectives:General objective of this study was using grounded theory research method to understand basic public health services equalization status of three counties in Ningxia, to analyse basic public health services effect of three counties, to reveal problems of basic public health services equalization in Ningxia that exist in the implementation process, to put forward reasonable and conducive policy recommendations to deepening the development of basic public health services. Specific research purpose as follows:(1) Describe organization, service ability, health financing and performance appraisal of basic public health services equalization in the three counties of Ningxia;(2) Describe basic public health services equalization implementation present situation in the three counties of Ningxia, analyze the implementation effect, discuss existing problems; (3) Combining implementation and problems, put forward reasonable suggestions and advices.Methods:Data from the Ministry of Education, the major task of philosophy and social sciences research projects "Deepening Medical and Health System Research" sub-topic2" Study of Promoting Gradually Equalization of Basic Public Health Service". Three counties Xingqing District, Yinchuan, Yongning County, Yinchuan and Yanchi County, Wuzhong, are selected according to the regional economic development. Survey21institutions and40service staffs through quantitative questionnaires and qualitative interviews.Arranging interview information by WORD and using Weft QDA for integrated analysis, and literature analysis and statistical description throughout the text. Using grounded theory analysis summed up the status of implementation of the basic public health services in the three counties, the implementation eflect, and problems which may exist.Results:(1) Three counties achieve organization guarantee through the three levels of decision-making, management and execution layer, and a clear division of responsibilities among various levels.(2) The existing number of per million population health institutions of Xingqing District, Yongning and Yanchi were1.16,4.21,7.77,Xingqing District and Yongning Couty were below the national average(6.99), while Yanchi County was higher than the national average(6.99); per million population health technical personnel number of the three counties were21.08,25.30,21.12,significantly lower than the national average(43.82).(3) The health services funds for grass-roots using the packing fee and prepaid, and the subsidy amount increased year by year, but not fully put in place in time, and there is no enough office grants.(4) All of three counties carried out the nine public health services, from the project implementation indicators, in addition to the rate of elderly medical and the rate of health management of Yongning did not reach the target requirements stipulated by the state, three counties all meet the national requirement of other projects. (5) Incentives and assessment of basic public health service in three counties promote each other. After taken incentive measures, the enthusiasm has improved, but still need to further strengthen; test measures were rigorously, and made results related to rewards and punishments measures.Conclusions and Suggestions:Starting from the basic public health services to implement till now, there was a certain effect, not only in the quantitative indexes such as inputting rate of health records, system management rate of key crowds and chronic illness, but residents who personally experienced the basic public health service are also very satisfied, and said they wanted to take the initiative to seek the basic public health services.Basic public health services in Ningxia area still has some problems:Lack of basic public health service equalization system guarantee; Insufficiently provide capacity of basic public health services equalization; Unhigh level of contribution and management of basic public health services equalization; Consciousness of some residents and difficult management of the floating population; Basic public health services and medical security system not match.Suggestions:Strengthen leadership’s perception of importance of the basic public health services equalization; Establishing mother law of public health system, to guarantee the implementation of the basic public health services; Improve safeguard measures for health service personnel, and improve work enthusiasm; Strengthen capital regulation means, make sure funds fully in place and effective used; Chang grass-roots health workers’concept, give full play to the function of the grass-roots health services; Targeted to strengthen health education, focus key groups, and improve the residents’ health consciousness.更多还原