安徽省岳西县新型合作医疗对健康及卫生服务公平性影响的研究

目的 探讨新型农村合作医疗试点地区农村居民卫生服务公平性的现状。方法 采用分层整群抽样的方法，于2005年7月1—15日对安徽省新型农村合作医疗试点县岳西县2112名农村居民的卫生服务公平性现状进行入户问卷调查。用率、比、Gini系数、集中指数（CI）和χ^2检验进行统计分析。结果 试点地区5组收入状况居民中，从最低收入组到最高收入组的2周门诊就诊率分别为48．14‰、82．90‰、65．88‰、48．72‰和50．66‰，CI值为-0．026，各组居民就诊率差异无统计学意义（χ^2=5．52，P〉0．05）；近一年内住院率分别为59．08‰、67．36‰、51．76‰、58．97‰和52．86‰，CI值为-0．017；半年内慢性病患病率分别为295．40‰、243．52‰、230．59‰、225．64‰和176．21‰，CI值为-0．055，不同收入组居民慢性病患病率存在差异（χ^2=18．42，P〈0．01），随收入降低慢性病患病率呈增高趋势。5组收入居民中，年人均医药费用占人均家庭支出比例分别为36．12％、26．18％、22．47％、23．26％和15．65％。在新型农村合作医疗补偿措施前后，住院患者的Gini系数分别为0．445和0．448。结论试点地区农村居民卫生服务利用趋于公平性，但农村居民在卫生筹资、新型农村合作医疗补偿方面存在不公平性，低收入居民有较高的卫生服务需要。     

铜山县新型农村合作医疗资金运行状况分析

新型农村合作医疗在我国全面推广,尤其受到经济薄弱地区农村居民的欢迎.新型农村合作医疗在一定程度上缓解了农村卫生服务需求高而利用低的矛盾,改善了卫生服务的公平性[1].但也有研究表明,新型农村合作医疗开展后,在贫困地区,低收入人群的卫生服务筹资和利用的垂直公平性没有得到明显的改善[2].     

新型农村合作医疗改善卫生服务公平性效果评价

文章利用陕西省第四次国家卫生服务入户调查数据,以特征分数配比法匹配后的新型农村合作医疗参保和未参保居民为研究对象,采用集中指数法和集中指数分解法分析了新型农村合作医疗对卫生服务利用公平性的影响效果。结果显示,新型农村合作医疗提高了农村居民住院服务利用公平性,但同时也扩大了低收入居民和高收入居民门诊服务利用的差距。建议新型农村合作医疗对门诊和住院服务均实施按一定比例报销的补偿模式。     

农村居民慢性病患者卫生服务利用的公平性研究

为进一步了解农村居民慢性病患者卫生服务利用的公平情况,通过对农村居民慢性病患者卫生服务的利用情况进行调查发现,因经济困难未治疗和未住院的慢性病患者比例随收入的降低而呈升高的趋势,并且不同收入组的慢性病患者自付费用也呈现出较明显的不公平性。在新型农村合作医疗制度完善的过程中,应该为低收入人群慢性病患者提供保障卫生服务利用的措施。     

云南省禄丰县参合农民住院服务利用的公平性分析

通过对被调查地区不同收入参加新型农村合作医疗的农民(以下简称参合农民)对住院服务利用的变化及公平性分析显示:新型农村合作医疗实施后人群住院率较高,但不同收入参合农民卫生服务需要的满足程度存在不公平,而且住院服务可及性的公平性也有待于进一步加强。     

新型农村合作医疗对农村居民卫生服务利用公平性的影响研究

运用标化的定量分析方法,对云南省三个新型农村合作医疗试点县和三个非试点县农村居民卫生服务利用公平状况进行了量化对比分析。结果显示,新型农村合作医疗制度的实施在一定程度上改善了农村居民卫生服务利用的公平性,特别是在改善农村居民住院服务利用和住院费用负担公平方面作用更为突出。但是,由于新型农村合作医疗保障水平还比较低,其作用有限,应加强定点医疗机构医药费用控制,保障新型农村合作医疗制度良好发展。     

结核病防治纳入新型农村合作医疗前后农村居民卫生服务利用公平性比较研究

[目的]通过对河南省部分地区将结核病防治纳入新型农村合作医疗补偿前后农村居民卫生服务利用公平性比较研究,为改进结核病诊治和管理工作、提高农村居民卫生服务公平性及完善和发展新型农村合作医疗政策提供依据. [方法]采用多阶段分层整群抽样方法,分别对实施结核病防治纳入新型农村合作医疗补偿政策的3个县的农村居民进行问卷调查及访谈,运用集中指数(CI)、不平等斜率(SII)及利用/需要比,结合文献资料,对卫生服务利用公平性进行研究. [结果]与政策实施前相比,实施后调查两周患病就诊率CI由0.008 7变为-0.040 0,SII由0.004 0变为-0.230 0;两周患病未就诊率CI由0.108 1变为0.008 0,SII由0.271 0变为0.024 0,未住院率CI由-0.3402变为-0.373 3,SII由-0.290 0变为-0.420 0.Spearman等级相关分析与经济状况无显著相关. [结论]新型农村合作医疗对结核病补偿政策的实施,使经济状况较差的农村居民卫生服务利用水平偏低的状况略有改善,有利于提高农村居民卫生服务利用公平性.     

新型农村合作医疗改善卫生服务可及性效果评价

利用陕西省国家第四次卫生服务调查数据,采用特征分数配比法对新型农村合作医疗参保和未参保居民进行匹配,进而比较分析了参保和未参保居民卫生服务利用的总体差别以及在不同级别医疗机构就诊的差别,评价了我国新型农村合作医疗制度对于改善农村居民卫生服务可及性的效果.     

蒙自县卫生服务利用的公平性研究

目的：了解新型农村合作医疗试点蒙自县农民卫生服务利用公平性的现状，探索提高卫生服务利用公平性的途径。方法：采取分层随机抽样的方法对蒙自县两个乡镇944户农户4290人进行卫生服务利用调查，分析不同乡镇和不同家庭人均收入农民卫生服务利用的差异，分析卫生服务利用的公平性。结果：实施新农合后，蒙自县农民两周患病就诊率为18．2％，住院率8．7％，均明显高于全国农村平均水平和基线调查水平。两周患病未就诊率和需住院未住院率低于全国平均水平。两个乡镇之间和不同人均收入居民之间的就诊率和住院率没有统计学差异，次均住院费用和次均住院补偿费用也无统计学差异。结论：新农合在筹资水平和补偿比方面都应该考虑向贫困乡镇和贫困人群倾斜，以提高卫生服务的公平性。     

中国农村地区合作医疗干预后不同收入组人群的医疗服务需要与利用

利用联合国儿童基金会(UNICEF)和国家卫生部“中国农村贫困地区卫生保健筹资与组织研究”8省10个县干预前、后调查数据，采用收入五分组、Gini系数和集中指数等方法，分析合作医疗干预前、后不同收入组居民医疗保健服务需要和利用的水平及其差异。研究发现：合作医疗干预后在不同收入组之间经济水平差距加大，合作医疗干预试点在一定程度上缓解了调查地区农民医疗服务需要较高而利用不足的矛盾。但是，这种作用是有限的。由于不同收入组的分布不均衡，卫生服务可及性和利用方面的公平性并没有得到真正的改善。     

CHILDHOOD DIARRHEA IN RURAL GUATEMALA

Diarrhea was found to be a prevalent illness and to have advene effects on nutritional status of infants in rural Guatemala. Pathogenic organisms were identified in only a proportion of cases.     

CATALYSING IMPROVEMENTS IN RURAL HEALTH

ABSTRACT: The National Rural Health Alliance is the peak non-government body working to improve rural health and health services. It has been fully operational since August 1993 and has produced submissions to government on a number of rural health issues. Through its work it has increased the public profile of rural health policy in Australia, without endangering the autonomy of the 15 national bodies which constitute the Alliance. Given the proliferation of individual bodies concerned with various aspects of rural health, and the complex and changing policy situation, the Alliance has a crucial role to play in helping to manage the interface between governments, consumers and rural health providers. The mission of the Alliance is informed by a strong philosophy of increased consumer involvement in the design, management and evaluation of local health services. The Alliance reflects the aspirations of rural and remote people for high quality and accessible health services. The chances of this mission being accomplished will be increased to the extent that individual professional bodies and local groups work in partnership with central organisations like the Alliance.     

CHOOSING A CAREER IN RURAL PRACTICE IN QUEENSLAND

ABSTRACT: As part of a broader investigation into the training needs of rural doctors, the reasoning behind decisions of graduates to enter rural practice in North Queensland was explored. North Queensland is a growing and diverse region that is home to 500 000 people but has had no local production of medical graduates. While prior rural exposure was found to be a powerful influence on the decision of some, a small number of those interviewed entered rural practice almost by chance, liked it and stayed. Should this finding be confirmed in more formal investigation, workforce planners would need to continue initiatives to recruit graduates who have no prior connection to rural life.     

FOOD CONSUMPTION IN RURAL BURKINA FASO

Food diaries, kept by 13 households in Burkina Faso throughout one year, showed that rural people on average consumed between 1.8 and 2.9 meals per day typically consisting of a thick porridge, made from pearl millet or red sorghum, and a sauce of leaves mainly Corchorus spp. and Adansonia digitata, calyces from Bombax costatum, or groundnuts. Spices, such as chili, Parkia biglobosa "soumbala" and dried fish were frequently added. Vegetables and pulses were occasionally eaten, but meat and milk rarely so. Meals on average included 5.6 ingredients. The diet was monotonous with but a few frequently used products constituting the bulk of food intake. The study villages are presently changing from a traditional local based consumption pattern to an increased use of marketed products, because many traditional wild food products are increasingly difficult to find and imported products are becoming available from urban areas and fashionable to eat. In order to provide people with a well-balanced and nutritionally rich food intake and a high degree of food security, it is recommended that extension projects should work to secure the supply of nutritionally important traditional products and to diversify the food base by promoting the use of under-exploited secondary crops within existing land use systems.     

STRESS IN THE RURAL EMERGENCY ROOM

ABSTRACT: This study identifies stress-producing factors reported by registered nurses (RNs) attending serious incidents in an Australian rural hospital's emergency room. A Delphi approach was used to determine the six most significant stress-producing factors, and these factors were then ranked by two groups of nurses. The rankings were compared using the Spearman Rank Order Coefficient of Correlation and were found to be dependent on years of nursing experience of the RNs taking part in the study. The more experienced group nominated 'anxiety about nursing a family member or close friend' as the most significant stress-producing factor, while the less experienced group reported 'concerns about nursing a child' as the most important stress-producing factor. Possible reasons for the variation in rankings are discussed, and recommendations are made in the light of the study's findings.     

关于试办农村妇幼保健服务站的探讨

本文结合湖北省襄樊市妇幼保健工作的实际,对试办农村妇幼保健服务站的指导思想宗旨性质、人员配备、设施标准、经费来源以及工作任务等进行了探讨.