【作者】 杨俊伟；

【导师】 田庆丰； 王重建；

【作者基本信息】 郑州大学 ， 公共卫生（专业学位）， 2013， 硕士

【摘要】 目的2009年《中共中央、国务院关于深化医药卫生体制改革的意见》指出,建设覆盖城乡居民的公共卫生服务体系,促进城乡居民逐步享有基本公共卫生服务。实施基本公共卫生服务的主要机构是基层医疗卫生机构。2010年国务院在下发文件中指出,要在城乡医疗卫生机构中普遍落实居民健康档案、免疫规划、健康教育、传染病防治、孕产妇保健、儿童保健、慢性病管理、老年人保健、重性精神疾病患者管理等九类国家基本公共卫生服务项目。因此,开展此次研究以掌握河南省基本公共卫生服务在基层医疗卫生机构中的实施现况。方法根据河南省的地理位置和经济发展水平,选择安阳市、洛阳市、许昌市和驻马店市四个省辖市作为研究地区。采用深入访谈、专题组讨论和现况研究相结合的方法。深入访谈以基层医疗卫生机构13个主管领导为对象进行个人深入访谈；对所抽取的4个乡镇卫生院和4个社区卫生服务机构的行政和业务人员97人进行专题组讨论；现况研究采用问卷调查法,对基层医疗卫生机构行政和业务人员97人和城乡居民共499人进行问卷调查。结果1、在97家基层医疗卫生机构中,其中城市调查点有39家社区卫生服务机构,农村调查点有58家乡镇卫生院。提供基本公共卫生服务的平均科室数目城市(6.87)多于农村(4.71)；在职人员中公共卫生人员偏少,其中城市和农村分别占3.66%和6.12%,；学历构成中,城市以大专为主,占38.69%,农村以中专为主,占55.95%；职称构成中,城乡均以初级为主,分别占37.16%和50.47%；基层技术人员的工作年限,城市和农村分别以≥20年(28.82%)和5-10年(26.62%)为最多；进修学习情况,城市接受培训次数多于农村,城乡接受培训次数平均为26.21人次和14.43人次；卫生经费中,城市有33.33%的机构可以满足工作需要,而农村只有6.90%的机构可以满足工作需要,2010年享受地方特殊政策支持的,城乡分别占10.62%和17.24%。2、在13家深入访谈的基层医疗卫生机构中,其中九类基本公共卫生服务全部开展的有健康教育、计划免疫和传染病患者管理,而居民健康档案和儿童保健开展的有10家,而孕产妇保健、老年人健康管理和慢性病管理开展的分别为9家、8家和9家,重性精神疾病患者管理开展的仅有3家。从97家基层医疗卫生机构提供基本公共卫生服务的数量看,城市高于农村的有传染病报告数、糖尿病管理人数,城市低于农村的有健康档案的建立、儿童预防接种管理人数。3、在调查的499个城乡居民中,听说过“基本公共卫生服务”的有62.12%,城市(68.13%)多于农村(56.05%)；有54.71%的居民知道基层医疗卫生机构有预防疾病的功能；有49.90%的居民在不到15分钟的时间步行可以到达基层医疗卫生机构,城市居民比农村居民到达基层医疗卫生机构更方便；2010年未到过基层医疗卫生机构的居民比例城市大于农村,城乡分别为26.69%和18.55%；2010年城乡居民享受的基本公共卫生服务项目城市居民多于农村居民的有健康档案的建立、孕产妇健康管理、老年人健康管理和高血压患者管理,而在预防接种方面,农村多于城市；城乡居民中有79.88%的居民认为目前所提供的基本公共卫生服务能够满足需求；城市居民中有54.98%的居民愿意在社区卫生服务机构接受基本公共卫生服务,而农村有45.56%的居民选择在乡镇卫生院；城乡居民可以承受的基本公共卫生服务的费用以每人每年5元和6-10元为最多,均占24.85%。结论1.基层医疗卫生机构提供基本公共卫生服务的能力不足,因此应加大对基层医疗卫生机构的人才、技术与资金支持。2.九类基本公共卫生服务项目,需要促进儿童保健、孕产妇保健、慢性病管理、重性精神疾病的实施。3.城乡居民对基层医疗卫生机构开展基本公共卫生服务项目的需求强烈,因此应积极促进基层医疗卫生机构实施基本公共卫生服务项目。更多还原

【Abstract】 Objective<the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System> in2009points out that Chinese Government will construct public health service system covering both urban and rural residents, promote urban and rural residents gradually enjoy basic public health services.The main institution of the implementation of the basic public health services is the primary medical and health institution, In2010, the State Council pointed out that the government would generally implement Residents’ health records, immunization programs, health education, prevention and treatment of infectious diseases, maternal health, child care, chronic disease management, Health care for the elderly, and patients with severe mental illness management,9kinds of national basic public health service projects included. So carry out the research to grasp the current implementation status of the province nine basic public health services in primary health care institutionsMethodsAnyang, Luoyang, Xuchang and Zhumadian were selected as the research semple areas, according to their location and level of economic development in Henan. Qualitative research and quantitative research were used in this paper.97people who are administration and operational staff from the pumping county were investigated, then to discuss in different grouping, and13executive leaders chose from the primary medical and health care institutions as the objects to conduct in-depth interviews. Questionnaire research are used in the Quantitative study.499urban and rural residents as the research object choosed from the extracted area to do questionnaires.ResultsIn the97primary medical and health institutions, there are39community health service centers in the city survey spot,58village and township hospital in the country survey spot. The average department number of provide basic public health services in the cities (6.87) is higher than rural areas (4.71); The public health manpower of the people on the job is too few, which in urban areas and rural areas respectively accounted for3.66%and6.12%. On the constitute of education background. urban residents mainly have Junior College degree, accounting for38.69%, in the rural it is mainly made of technical secondary School, accounting for55.95%; On titles Constitution, both urban and rural areas are mainly made of primary, respectively accounting for37.16%and50.47%. On the basic level technicians’working life, in the urban it is≥20years (28.82%), in the rural it is5-10years (26.62%); Regarding the further study situation, the city accepted training more often than rural areas, urban and rural areas receive training times in average is26.21man-time and14.43man-time; In the health funds, the city having33.33%institutions can meet the work requirements, but only6.90%of the rural institutions to meet the work requirements. In2010, urban areas and rural areas respectively accounted for10.62%and17.24%can enjoy local special policy support.2. In the13in-depth interviews of primary medical and health institutions, including nine kinds of basic public health services for all patients with health education, immunization and infectious disease management, but10institutions have Residents’ health records department and child health department,9institutions carried out maternal health department,8institutions have elderly health management department, and9institutions have departments for chronic disease management, but only3institutions carried out departments for the management of patients with severe mental illness. The number of service from97primary medical and health institutions provided shows that, the cities’ number higher than the rural areas is in the reported infectious disease area and diabetes management area, while the cities numbers lower than the rural is in establishment of health records and vaccination management of children.3. In a survey of499urban and rural residents,62.12%people had heard the "basic public health services", including urban (68.13%) which is more than rural areas (56.05%);54.71%of the residents knew that the primary medical and health institutions have ability to prevent disease;49.90%of the residents could walk to the primary medical health institutions in less than15minutes, and the resident of urban were more convenient than the rural residents to go to the primary medical and health institutions. In2010, about the number of people who has not been to the primary medical and health institutions, the number of cities is higher than that of the rural areas are respectively26.69%and18.55%. At the same time about enjoying the basic public health services projects, the urban is more than the rural areas in the these aspects, such as the establishment of health records, maternal health management, the elderly health management and high blood pressure patient management. However, in the area of vaccination the rural areas is more than the urban;79.88%of residents in the urban believes that the basic public health services provided currently can meet their demands. While54.98%urban residents is willing to accept basic public health services in the community health service centers, while45.56%of the rural areas residents choose to accept the services in towns and township hospitals; The resident can all afford the cost of the basic public health services per year per person is Y5and Y6-10most, both account for24.85%.Conclusions1.The primary medical and health institutions lack of the ability to provide basic public health services, therefore the government should increase the talents, technology and financial support to the primary medical and health institutions.2.Regarding the9kinds of basic public health services, the government needs to promote the implementation of children’s health, the maternal health, chronic disease management, and severe mental disease.3.The urban and rural residents had strong demands of the basic public health services projects, so the government should actively promote the primary medical and health institutions implementing the basic public health services.更多还原