目前,新型农村合作医疗正在我国300多个县(市)开展试点工作.然而,在农村总体经济实力不强又面临市场经济冲击的大形势下,建立新型农村合作医疗制度将是一项十分艰难、复杂的工程.本文讨论了新型农村合作医疗制度产生的历史背景及如何增强农民对新型农村合作医疗制度的信心问题.
ObjectivesTo investigate residents’ sensitivity towards basic public health services in Sichuan province, so as to provide advice on future improvement.MethodsUsing multistage stratified sampling and through consultation of the Sichuan province's basic public health service regulatory platform to select 40 equidistant samples from the five key population groups. Specifically, 200 individuals from each of the 21 cities were enrolled. Telephone survey was conducted to acquire residents’ awareness rate, satisfaction and compliance. Technique for order preference by similarity to an ideal solution (TOPSIS) was applied to comprehensively evaluate residents’ sensitivity of basic public health services.ResultsA total of 4 200 community residents who have accepted health managements in basic health care institutions were enrolled. The mean Cj value was 0.523 6. The No.4 city had the highest Cj value of 0.751 9, and the No.10 city had the lowest value of 0.276 3.ConclusionsThe residents’ sensitivity to basic public health services varies in 21 cities of Sichuan province. We should improve the quality of medical services in primary health care institutions and provide wide publicity to enhance the well-being and satisfaction of community residents. Government should improve the quality of medical services in primary health care institutions, and narrow the gap between different cities, so as to improve residents’ experience.
Objective To describe the criteria and procedure for defining an essential healthcare package in the developed and developing countries. Method Search words were chosen by both health policy experts and search coordinators after discussion and pilot. We searched electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develope an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result One hundred and sixty-six studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objective,160 articles aimed to describe strategies, 6 articles aimed to evaluate effectiveness of strategies.Five studies evaluating effectiveness were cross-sectionnary data, and one study was time series. Conclusion An appropriate package should be defined according to both technique criteria and social welfare criteria, considering each country’s healthcare system and market structure, characteristics of the demander and provider, capacity of government’s regulation. The experience in transition countries gives us more high lights.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
Objective To summarize the research progress of health care transition (HCT) for pediatric liver transplant recipients. Method The literatures of HCT for pediatric liver transplant recipients were reviewed, and the concept, related factors, interventions and methods of health care transition were summarized. ResultsHCT is the process of moving from a child/family-centered model of care to an adult or patient-centered model of health care, and influenced by health care provider, child and caregivers, and other factors such as medical policy and economic level. Personalized transition program has more benefits for improving the experience and health outcomes of patients. Conclusion problem-oriented and demand-oriented transition program is recommended, early intervention to improve self-management abilities of children, information construction of pediatric medical system and multidisciplinary team building are important for improving health outcomes of patients.
Objective To systematically review the current situation, dilemmas and countermeasures of the regulation of health care integration services in China, and provide reference for the research on the regulation of health care integration services in China. Methods Studies and policies on the regulation of health care integration services were systematically searched from the inception of the databases to October 2022, and the included studies and policies were coded and analyzed by using the qualitative analysis software NVivo12. Results A total of 12 research articles and 15 policy announcements were included. The theoretical framework, regulatory dilemmas and regulatory countermeasures for the regulation of health care integration services were obtained through open coding, axial coding and selective coding. The regulatory framework of health care integration services was divided into five aspects: regulatory basis, regulatory subject, regulatory object, regulatory content and regulatory methods. The lack of regulatory basis led to dilemmas in the remaining aspects accordingly. Conclusion The regulation of health care integration services needs to start from the regulatory basis, introduce and improve the health care integration laws and policies, and gradually form a health care integration service regulatory model with institutional self-regulation as the priority, government regulation as the main body, and the public, third parties and other social regulation as the auxiliary.
Objective To investigate current situation of medical service and management in Gaozha Central Township Health Center (GzC), so as to provide baseline data for township health centers in both key techniques research and product development of drugs allocation and delivery. Methods A questionnaire combined with a special interview was carried out, which included the general information, human resources, medical service and management, and the practice of essential medicine list. Results a) The hardware condition of GzC was not good enough, and the economic status of the service recipients was lower than the average level of both Wuzhong City and China mainland; b) The constituent ratio of general practitioner (GP) and nurse, and GP and laboratorian were all lower than those of national level, while, the constituent ratio of GP and technician was a little bit higher. GzC was in short of medical technical personnel and, especially, the professional pharmacists. The logistics technical workers were as the same proportion as the nurses. The medical technical personnel without professional education background accounted for 3.4%, and about 38% of the staff members had no college degree, about 86.2% had at most primary profession titles. There was no personnel turnover of GzC in recently years; c) The bed utilization ratio was lower than national level (46.4% vs. 60.7%), while the average duration of stay and the in-patient and out-patient service workload of GP were longer or heavier than national level (8 vs. 4.8, 9 vs. 8.3, 4 vs. 1.3); d) The out-patient service in 2010 decreased 26.9% compared to 2009; and the in-patient service in 2010 decreased 42.4%; e) The average medical expense per outpatient and per inpatient increased 127.3% and 56.2%, respectively in 2010 compared to 2009; and f) Essential medicine list was put into practice in April 1st of 2010 and there was only 195 species available in GzC, which has not met the requirements of the national essential medicine list. Conclusion In order to meet the standards of general rural township health center in western China, GzC needs to cope with challenges of insufficient hardware conditions, short of staff, unreasonable personnel structure, low educational background and professional title of the staff, none human resources flow and low technical level of medical service. GzC dose well in drug expenses control, and the hospitalization costs are lower than those of the national level. However, it increases rapidly in 2010. The management of GzC may be influenced by zero-profit sale of the essential drugs, and appropriate subsidy and policy support are necessary to maintain its service quality. And it is required to complement the medicine based on the evidences, to carry out staff training and usage guidance of essential medicine, and to finally guarantee the safe and reasonable use of medicines.
ObjectiveTo systematically review the willingness rate of the first consultation in primary health care institutions among Chinese residents.MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science and EMbase databases were electronically searched to collect cross-sectional studies on the willingness rate of the first consultation in primary health care institutions of residents in China from January 2006 to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed using Stata 14.1 software.ResultsA total of 26 cross-sectional studies involving 36 430 subjects were included. The results of meta-analysis showed that the willingness rate of Chinese residents for the first consultation in primary health care institutions was 61.4% (95%CI 54.5% to 68.3%). The results of subgroup analysis showed that for the willingness rates of the first treatment at the grassroots level in male and female residents were 65.6% and 64.9%; urban and rural residents were 49.9% and 58.9%; <60 and ≥60 years old residents were 60.5% and 71.6%; primary school and below, junior high school, high school or technical secondary school, junior college or above educational level residents were 72.8%, 68.1%, 64.2%, and 52.8%; employees, residents, and other types of insurance residents were 74.1%, 75.9%, and 64.4%; residents with monthly income <3 000, 3 000-5 000, and >5 000 yuan were 65.8%, 65.3%, and 58.5%; high, medium, and poor levels of health status residents were 56.8%, 52.6%, and 48.8%; with and without chronic diseases residents were 61.0% and 56.9%; with and without spouse residents were 63.9% and 64.6%; with and without contracted family doctor residents were 87.1% and 62.6%; on duty, retired, and other employment status residents were 70.7%, 69.9% and 71.5%; primary medical institutions residents those were satisfied, average, and dissatisfied were 77.3%, 60.7%, and 49.4%.ConclusionsCurrent evidence suggests that it remains room for improvement in the level of willingness of Chinese residents for first consultation in primary health care institutions. Residence, age, educational level, type of medical insurance, income level, health level, family doctors contracted status, and satisfaction with primary medical institutions have an impact on residents' willingness to receive first treatment at primary hospitals. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
Objective To critically appraise and systematically reviewe the economic evaluations of all alternative interventions for hepatitis B in China. Methods We searched MEDLINE and the four largest Chinese electronic databases. The references of eligible studies were also screened. Economic evaluations of any type, which studied interventions for hepatitis B, were eligible for inclusion. A 25-item quality checklist modified from a BMJ checklist was used to appraise the quality of studies. The overall quality score was calculated against 100 points to indicate the risk of bias. Quality appraisal and data extraction were conducted by two independent reviewers. Results Nineteen full economic evaluations and two cost studies were included of which fourteen studies were scored 25-44 points, and seven scored 45-61 points. Most studies adequately documented effectiveness of interventions. However, the costs of interventions were not well reported in over 50% of studies. Many studies inadequately conducted data analysis, particular in sensitivity analysis and discounting. Ten studies compared lamivudine with interferon or conventional therapy for 1-year (or 6-month) effects, which indicated that lamivudine was generally cost-effective. Three evaluations studied 30-year outcomes of interferon compared with conventional therapy, which suggested that interferon usually saved additional costs and years of life. Another three studies compared interferon with less frequently used antiviral agents, however the comparative cost-effectiveness varied. Two cost studies showed the total costs and the percentage of medical costs increased rapidly in proportion to disease severity.Conclusions Of alternative interventions, lamivudine is cost effective for short-term effects. Interferon is superior to conventional therapy for long-term outcomes. However, the long-term economic outcomes cannot be justified by the current evidence. Quality of methods, particularly, that of costing and analytical methods, is a major limitation. There remains a b need to improve the quality of reporting. Careful considerations should be paid before applying the results to decision making.