【作者】 孙宏业；

【导师】 徐凌忠； 孙辉；

【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】 研究背景实施卫生监督体制改革后,多数地方医疗机构行政执法工作纳入卫生监督机构日常工作内容,医疗机构行政执法工作取得了显著的成效。但是随着社会经济的迅速发展,流动人口的增加,医疗服务需求过快增长,医疗机构呈多元化方向发展,医疗市场竞争越来越激烈,致使医疗机构超范围执业和聘用非卫技人员等违法行为时有发生,扰乱了医疗市场秩序,损害了群众的健康利益。调查研究威海市医疗机构存在的问题,有针对性的加强卫生监督管理,对保护人民群众的健康权益是非常必要和有意义的。研究目的通过对威海市区545所医疗机构进行调查研究,以了解威海市区医疗机构依法执业现状,医疗机构存在的问题及原因,并针对存在的问题及原因提出对策和建议,以强化对医疗机构的日常监管,进一步规范医疗市场、整顿社会主义市场经济秩序、提高综合执法能力提供依据,保护人民群众的健康权益。研究方法本研究对威海市区医疗机构采用普查、查阅文献等方法,设计《医疗机构基本情况登记表》,由经过统一培训的医疗卫生监督员对威海市区医疗机构进行调查,分综合医院、专科医院、民营医院、乡镇卫生院、门诊部、社区卫生服务站、厂矿卫生室、村卫生室、个体诊所九类进行登记,并对获取的结果进行分析。研究结果总体情况是,自威海市545家医疗机构调查结果表明,共有346家基本符合各项法律法规及规章要求,总体合格率为63%；共有497家医疗机构已按照《医疗机构管理条例》要求,已取得《医疗机构执业许可证》,总体持证率为91%；共有450家已按照《医疗机构管理条例》及《医疗机构管理条例实施细则》要求,按期进行年度校验,总体按期校验率为82%；共有419家按照《医疗机构管理条例》及《医疗机构管理条例实施细则》要求,在卫生行政部门核准的诊疗科目范围内开展诊疗活动,总体合格率为77%；共有477家医疗机构按照《医疗广告管理办法》要求,未违法发布医疗广告,总体合格率为88%；共有371家符合《消毒管理办法》的要求,消毒设施设备及专业消毒人员均已配备齐全,有消毒记录和消毒监测记录,总体合格率为68%；共有428家医疗机构从业人员符合《中华人民共和国执业医师法》、《护士管理办法》、《外国医师来华短期行医暂行管理办法》、《医师执业注册暂行办法》要求合法执业,总体合格率为79%。结论与建议根据调查分析研究,本文得出的结论是：部分医疗机构非法处置医疗废物存在安全隐患,院内感染、消毒管理存在薄弱环节,部分医疗机构超范围开展诊疗科目,聘用非卫生技术人员,非法发布医疗广告等问题,医疗资源配置不合理,医疗技术人员相对过剩,而且我国现行卫生监督法规体制相对滞后不能适应医疗卫生监督需求。本文提出的建议是：加强对医疗机构医疗废物管理的执法监督力度；加强医疗机构院内感染与消毒管理工作；加强医疗机构依法执业的法律培训；医疗执法要以人为本,服务为主；加强医疗机构年度校验管理工作；加强医疗广告的监督管理；全面推广医疗机构量化分级管理制度；完善法律法规；建立医疗举报投诉案件查处制度；发挥媒体作用,加强舆论监督；多部门协调,形成监管合力；加强行业管理,充分发挥行业协会的作用。更多还原

【Abstract】 BackgroundMost local administrative law enforcement about medical institution was integrated to the routine work of health surveillance system and significant progress was made in administrative law enforcement about the medical institution, after the implementation of health surveillance system reform. However, as the social and economic development, the increase of floating population and rapid growth in demand for medical services, that medical institutions was diversified development, the medical service market competition was getting more and more intense, illegal activities such as, medical institutions over the scope of practice, personnel hired without legal qualification frequently occurred which disrupted the order of health care market, impaired the health interests of the masses. It is very necessary and meaningful to protect the interests of the people’s health by investigation of existing question in Weihai Medical institution, target-oriented strengthening the sanitary supervision management.Major ObjectivesThrough the investigation of 545 Medical institution in Weihai, in order to understand the survey of Weihai medical institutions and the existing question and reason of the medical institution, and aim at the existing question and the reason propose the countermeasure and the suggestion, strengthening Medical establishment’s daily supervision, to further standard medical market and the reorganization socialist market economy order, enhancing synthesis law enforcement ability provide the basis, protecting people’s healthy rights and interests.Research MethodsThe method which used in this research included general survey, the interview of the literature and so on. The investigation of Weihai medical institution was conducted by unified training medical and health inspectors with designed’General situation of the medical institution’. It was divided 9 classes which includes the General hospital, the Specialized hospital, the privately operated hospital, the Villages and towns Public health center, the outpatient clinic, the community health service station, factories and mines clinics, village clinics, private clinics, and to get results for analysis.Conclusions and recommendationsOverall speaking, the results from the survey of 545 medical institutions of Weihai shows that 346 medical institutions conforms to legal rules and regulations basically, the overall qualified rate is 63%; that 497 medical institutions have already met the demand of’Administrative Rules of Medical Institution’ and obtained the ’Medical Institutions practicing License’ the overall rate of 91% holding cards. that 450 medical institution have met the demand of’Administrative Rules of Medical Institution and’Rules for the Implementation Administrative Rules of Medical Institution’, and carried on annual verification, overall regular verification of the rate of 82%; that 419 medical institutions have met the demands of’Administrative Rules of Medical Institution’ and’Rules for the Implementation Administrative Rules of Medical Institution’ and carried out diagnosing and treating within the scope of the administration of public health department approved the administration of public health department approves in the diagnosing and treating subject scope. that 477 medical institutions have met the demands of’Administrative Measures of Medical advertisement’ without illegally medical advertisements, the overall qualified rate is 88%. that 371 medical institution have met the demands of’Administrative Measures of Disinfection’ and have provided the disinfection facility equipment and the specialized disinfection personnel completely, with the disinfection record and the disinfection monitoring record, the overall qualified rate is 68%; That 428 medical institutions have met the demands of’Law of the Peoples Republic of China on Medical Practitioners’,’Administrative Measures of Nurse’, "Foreign Doctor Coming to China Short-term Practices medicine Temporary Policing method", "Doctor Disciple Registration Tentative method" requests the legitimate disciple, the overall qualified rate is 79%.Conclusions and recommendationsAccording to the survey, the article concluded that part of the medical institution disposed medical waste illegally, the administrative management of disinfection was relatively weak, some medical institution practiced diagnosing and treating subject beyond the scope, outpatient clinic illegal issued medical service advertisement, medical resource configuration was not reasonable, medical technicians relative surplus, and current health supervision regulations system relative delay cannot adapt to the needs of medical supervision. It was suggestions proposed by the article that strengthens law enforcement and supervision on medical waste of medical institution; Humanity, must unblock to all levels of Medical establishment primarily; Comprehensive promotion Medical establishment quantification level-to-level administration system; improving the legal system; displaying the function of media, strengthening supervision of public opinion; the Strengthening the trade management, fully plays the profession association’s role.更多还原