【作者】 陈春辉；

【导师】 周金玲；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 研究背景和目的劳动教养是我国特有的一项政治制度,它不属于刑事处罚,而是为维护社会治安,预防和减少犯罪,对轻微违法犯罪人员实行的一种强制性教育改造的行政措施,其期限为1-3年。被决定劳动教养的人,由司法行政部门的劳动教养管理所收容并进行改造。西方国家较早开始关注被监管人群的卫生问题,开展了多方面的研究,结果发现：监管场所内各种传染性和非传染性疾病的患病率要比社会上高得多；监管场所内开展医疗卫生服务对囚犯的健康状况有重要影响；卫生部门应与监管场所共同承担对囚犯卫生的责任等。近年来,我国政府部门和学者对劳教人员健康状况的研究逐渐增多,发现劳教人员由于吸毒、卖淫嫖娼等行为,体质普遍较差,罹患各类疾病的可能性较一般人群更大。劳教所依法保障劳教人员包括健康权在内的各项合法权益。我国政府一直高度重视对各类被监管人员健康权的保护,采取各种积极有效的措施开展被监管人员的健康保护和健康促进工作,明确政府对被监管人员医疗保健的责任,保障其能够依法获得基本卫生服务。我国劳教所的卫生工作由司法行政部门负责组织管理,公共卫生部门主要起业务指导作用。但由于劳教所内医疗条件有限,单纯依靠劳教所内的力量很难满足劳教人员卫生服务需求。这种情况下,劳教所与卫生部门的合作就显得尤为重要,关系到劳教人员能否获得高质量的卫生服务。本研究的主要目的是以我国劳教所与卫生部门在卫生方面的合作为研究对象,描述我国劳教所与卫生部门目前的合作机制,分析双方合作的特点,发现双方在合作中存在的主要问题,提出改善劳教所与卫生部门合作的建议,为政府有关部门决策提供参考和依据研究方法本研究采用描述性研究的方法。研究资料主要来自三个方面：现有文献和政策的收集,本次样本劳教所的问卷调查以及样本劳教所和相关卫生服务部门关键人物访谈。本研究在我国东、中、西部分别抽取山东省、江西省和云南省作为样本省份,每个省份抽取2-3个劳教所,共计7个样本劳教所开展调查。对各样本劳教所进行了机构问卷调查,与41名关键人物进行了访谈。主要运用定性方法对资料进行整理、描述、分类和分析。主要结果本研究的主要结果：1、劳教所与卫生部门合作的必要性：1)劳教所医疗服务提供能力不足,供求矛盾突出：医疗设备配置不足,限制了劳教所的医疗服务提供。劳教所卫生专业人才缺乏,造成卫生人员工作重、压力大。劳教所的卫生经费紧张。所内医疗引发的纠纷日益严重,劳教所更倾向于从社会医疗卫生机构取得卫生服务；2)劳教所提高医疗服务供给的手段比较。虽然提高劳教所医疗卫生服务能力的方式有多种,但其他手段都有不足之处。与地方卫生部门的合作减少了前期庞大的资金投入。由于距离一般较近,可以很快将病人送达医院,提高了劳教所医疗服务的反应性,是最适合推广的提高劳教所卫生服务水平的方式。3)：社会卫生部门与劳教所进行合作的动机：对于疾病预防控制部门而言,劳教人员享有与普通居民同等的健康权利,应得到同等的公共卫生服务。同时,为劳教人员提供足够的公共卫生服务也有助于提高全社会的公共卫生水平。对于各类医院而言,与劳教所合作可以接纳所内病患,获得更多的、稳定的业务收入。2、劳教所与卫生部门合作现状：1)劳教所提供卫生服务的内容和程序；2)劳教所与卫生部门合作的主要内容：入所体检,具体合作形式包括直接将学员送往合作医院进行体检；社会医疗部门专业人员到所内进行入所体检；在劳教所内采样,送到社会医疗部门进行检查。就诊,具体合作形式包括医院医生来所会诊、社会医院就诊、社会医院住院和所外就医四种。日常体检和疾病筛查,主要指所在地的医院和疾控中心定期到劳教所对劳教人员进行体检和常见病、传染病筛查。健康教育,主要是指给所内劳教人员与劳教所工作人员进行传染病防治、职业防护等方面的培训。3、劳教所与卫生部门合作的特点：1)双方工作上的合作实际存在,并促进了劳教所的工作；2)工作需要是促成双方合作的最原始动机；3)双方合作是自上而下的,领导间的感情带动工作的开展；4)各种非正式的交流促进了双方的合作；5)各种基金项目成为双方合作的重要推动力量。6)在双方的合作中,劳教所处于相对被动的地位。双方合作中存在的主要问题：1、相关法律、法规与政策方面：1)与双方合作密切联系,能够直接指导合作的法律、法规太少。虽然有多部法规对双方的合作提出了指导性意见,但缺乏强制性和可操作性；2)各地具体情况差异较大,造成相关政策文件适用性差,无法起到真正的指导和借鉴意义。2、双方合作机制方面：1)劳教所与社会卫生部门的合作缺乏长效机制,合作的主观性较大；2)经费缺乏是劳教所与社会卫生部门合作的一大障碍。3、双方合作内容方面：1)部分传染病患者在劳教所内得不到及时治疗；2)双方在法定传染病上报方面的合作较差；3)医院对劳教病患就诊没有专门程序,造成外出就医繁琐；4)对所外就医患者的追踪成为双方合作中忽略的环节。结论和建议劳教所与社会卫生部门在劳教人员入所体检、日常疾病筛查、就诊、健康教育等各方面都有不同程度的合作。通过双方的合作,弥补了劳教所医疗服务提供能力的不足,让劳教人员得到了更好医疗服务,也为劳教所管理提供了有利的条件。针对合作中存在的问题,建议通过如下几个方面改进劳教所与社会卫生部门的合作：1、完善相关法律法规与政策：1)出台直接指导双方合作的法规文件；2)各地应制定针对本地实际情况的合作政策文件。2、改进双方合作机制：1)建立长效合作机制；2)保证劳教场所卫生经费供给,提高资金使用效率。3、深化双方合作内容：1)加强传染病患者治疗和管理方面的合作；2)完善法定传染病上报制度；3)医院应针对劳教病患设置专门就诊程序,方便劳教人员就诊；4)做好所外就医劳教人员的追踪工作。更多还原

【Abstract】 Background and ObjectivesRe-education through labor is a special political system of China, re-education centers are designed to held minor criminals for 1-3 years. People sentenced undergoing education through labor are accepted and reformed by Re-education-through-labor centers which is under the jurisdiction of administrative department for justice.Western countries began to concern about the prisoner’s health issues earlier, and issues, carried out many researches in various aspects. The results showed:there are much higher incidences of infectious disease and non-infective disease in penal institutions than in the society. Carrying out medical and health services in penal institutions is of great importance to the health of prisoners. Health departments should take on the responsibility of prisoners’ health with penal institutions, and so on. In recent years, Chinese government and scholars increased the study on health conditions of prisoners gradually, and found that most of the prisoners were in poor health because of drug taking and prostitution. They are more likely suffering from various diseases than general people.Re-education centers protect the legitimate rights and interests of prisoners according to law, including right to health. Chinese government attaches great importance to the health of every kind of prisoners including those in re-education centers.The judicial administrative department of health is responsible for organization and management of Chinese re-education centers. And public health department plays the roles of business guide. As medical condition in re-education centers is limited, it is very hard to meet the demand for health services of prisoners relying solely on the strength of re-education centers. In this case, the cooperation between the re-education centers and the health departments is particularly important, bearing on whether the prisoners access to health services with high quality. The main purpose of study is to make the cooperation in medical and health between the re-education centers and the health departments as the object, describing the current cooperation mechanism between the re-education centers and the health departments, analyzing the characteristics of cooperation, finding the main problems, raising suggestions for decision makers to improve cooperation between the re-education centers and the health departments.MethodsThis study is designed to be a describing one. Data resources includes existed literature and policy documents, data collected through questionnaire prepared for institutions and key informants interview of re-education centers and related health departments.Considering social economic development level and geographical distribution,7 re-education centers in Shandong, Jiangxi and Yunnan provinces were selected,7 re-education centers and 41 key informants were interviewed. Qualitative methods were mainly used to sort, describe, classify and analyze data.Main resultsThe main results of the study include:1. Necessities of the cooperation between the re-education centers and the health departments:1) Re-education centers provide insufficient medical services, and there is an obvious contradiction between supply and demand:Inadequate medical device limited re-education centers to provide medical services. The re-education centers are lack of funds of health. As growing dispute for the health care inside, the re-education centers tend to get health services from social medical institutions; 3) For re-education centers, cooperation social health departments is the most effective way to improve the supply of medical services. There are several ways to increase the capacity of health services in, but other ways have defects more or less. It is the most appropriate way to improve the health services in re-education centers; 2) The motivation for social health departments to cooperate with re-education centers:For centers for disease prevention and control, prisoners enjoy the same right to health with general population, and they should get same public health services. To provide adequate public health services will also help to improve the social health. For hospitals, cooperating with re-education centers could accept patients from re-education centers, and get more stable revenue.2. The current situation of the cooperation:1) Contents and processes of health services provided by; 2) The main contents of the cooperation:Physical examination when entering the re-education centers. Specific forms of cooperation include cooperation sending the patients directly to hospitals, professionals of social health departments entering the re-education centers to do examination, and sampling in re-education centers and checking in social health departments; Visiting. Specific forms of cooperation include hospital doctors coming to consultation, visiting in social hospital, being in social hospital and medical treatment outside the re-education centers; Routine physical examination and disease screening. Mainly refers to the location hospitals and CDC on a regular basis undergo a medical examination and common diseases, infectious disease screening; Health education. Mainly refers to training the prisoners and officers in re-education centers about communicable disease control, occupational protection, and so on.3. The characteristics of the cooperation:1) The cooperation of both sides is actual existence, and it promotes the work of the re-education centers; 2) Work demand is the most original motivation to promote the cooperation; 3) Cooperation is top-down, and the feelings among the leaders drive the work; 4) A variety of informal communications promote the cooperation between the two sides; 5) Various fund projects to become an important driving force for bilateral cooperation; 6) The re-education centers are in a relatively passive position in the cooperation.The main problems in the cooperation:1. Relevant laws, regulations and policies:1) the laws and regulations closely related with and directly guiding the cooperation are few; 2) The specific circumstances are quite different, resulting in poor application of relevant policy documents, and of little guidance and reference.2. Cooperation mechanisms:1) The cooperation is lack of long-term mechanism, and has greater subjectivity; 2) Lack of funds is a major obstacle to the cooperation.3. The contents of bilateral cooperation:1) Some infectious diseases are not treated in time in the re-education centers; 2) The cooperation in the reporting of infectious diseases is poor, and some infectious diseases in re-education centers can’t be treated in time; 3) The hospitals have no special procedures for patients from re-education centers, resulting visiting in social hospital in inconveniently; 4) Making tracks for the patients getting medical treatment outside the re-education centers becomes the areas neglected.Conclusions and suggestionsRe-education centers has cooperation with social health departments in Physical examination when entering the re-education centers, visiting, routine physical examination and disease screening, and health education. It makes up the lack of medical services in the re-education centers, so that the prisoners receive better medical care. For the problems in co-operations, it is recommended that:1. Improving the relevant laws, regulations and policies:1) Introducing framework of cooperation documents with direct guidance and regulations; 2) The cooperation policy documents should be established around the actual situation. 2. Improving the cooperation mechanism:1) Establishing i long-term cooperation mechanism; 2) Ensuring the supply of health funding, and improving fund use efficiency.3. Deepening the contents of cooperation:1) Strengthening the cooperation in the treatment and management of infectious patients; 2) Improving the reporting system of legal infectious diseases; 3) Hospital should be dedicated for detention visits in order to facilitate visits of prisoners; 4) Make tracks for the prisoners getting medical treatment outside the re-education centers.更多还原