Access to Child Health Care, Medical Treatment of Sick Children and Childhood Mortality Relationships in Kenya

Child health care factors such as medical treatment of sick children have direct and indirect effect on childhood mortality. Through international cooperation, a number of countries including Kenya have gathered information on provision of child health services at facility level from periodic Service Provision Assessment (SPA) surveys. Kenya has also gathered information on medical treatment of sick children at household level from periodic Demographic and Health Surveys (DHS). However, establishing how health care information in the SPA surveys relates to childhood mortality and also how these factors relate to medical treatment of sick children in the DHS has been constrained by differences in sample designs of the surveys. This study deployed a fstrategy of constructing community level variables derived from the SPA survey data and incorporated them into DHS data which served as the main data source. The SPA and DHS sampling designs for Kenya allow computation of stable estimates of regional demographic and health service indicators at provincial level. This study analyzed information gathered from 690 health facilities in 2010 SPA and 6079 births born less than 60 months from 2008/09 DHS. The study found that access to child health services, waiting time before service in facility and time to the nearest referral facility were significant facilitating factors for medical treatment of sick children. The study also established that waiting time before service in facility was the only access to health care factor which had a significant effect on childhood mortality when HIV prevalence was excluded in the analysis. However, the significance of waiting time before service diminished with inclusion of HIV prevalence. Further research is required to refine definition and measurement for child health care variable on female autonomy.

Family caregivers of demented elderly people and access to medical care: Who gets worn out, why and what for?

Demented persons in the process of slowly becoming dependent have to rely on the assistance of others. These others are health professionals (formal care), on the one hand and family carers (informal care) on the other hand. The latter, whether or not they have chosen to play a role which is hardly defined officially, have to face many difficult situations such as complicated access to care due to lack of equal opportunities under the health system, unable to support them efficiently. Taking care of a demented patient is a life challenge often leading to burn out, having impact on physical and mental health. Caregivers may thus even have no time or opportunity to take care of their own health. So, is it not high time for the decision-makers to think it over and take care of the carers by setting up programs and giving them the opportunity to learn, to work as a team with the professionals so as to protect themselves and their dignity as well as that of their patients. The difficulties/problems carers of demented patients may encounter should be a major issue for public health care because their role is a vital one and because the consequences which may have on their own health can be negative.

Spatial Differentiation and Influencing Mechanism of Medical Care Accessibility in Beijing:A Migrant Equality Perspective

Spatial equality of access to basic public services, especially medical care services which are directly related to life safety, is the first step to achieve the goal of equalization of basic public services for all the people proposed by central government of China. Using the spatial analysis and the statistical analysis, this study evaluates the spatial differentiation of medical care facilities accessibility by constructing STT(Shortest Travel-Time) and SAI(Spatial Accessibility Index). And then this study explores the neighborhood effects on the medical care facilities accessibility in Beijing, with a particular focus on the effect of neighborhood migrant proportion by constructing spatial dependent regression model. The spatial accessibility analysis of medical care facilities show that the spatial distribution of medical care facilities was basically consistent with administrative regions but not with population demands. Bivariate LISA cluster maps identify that suburban areas are the overlapped clusters of high percent of migrants and limited medical care services. This is associated with the public service allocation rule in China, which stresses equality within urban areas and within rural areas but overlooks equality between urban areas and rural areas; and stresses local resident demands but overlooks migrant demands. To estimate the effects on medical care accessibility of neighborhood migrant proportion, spatial dependence models are applied due to spatial dependence of accessibility of medical care facilities. The regression results show that neighborhoods with high percent of migrants, even conditioning on neighborhood SES, are related to limited spatial accessibility of medical care services. Besides neighborhood characteristics, another important factor influencing spatial accessibility of medical care services is the process of spatial spillover effects. This indicates that the attenuate accessibility of medical care services for migrants is not only because of their own constraints but also because of their proximity to other disadvantaged neighborhoods. Therefore, it is urgently needed to increase the medical facilities in the suburban areas, to take into account migrants' demands and to reduce residential segregation between local residents and migrants for local governments to achieve the goal of equalization of medical care service.

State Scholarship and Loan Forgiveness Programs in the United States: Forgotten Driver of Access to Health Care in Underserved Areas

State-supported programs providing loans and scholarships in exchange for service in under-served areas provide an important source of financial support for medical students while encouraging them to select careers in primary care. The purpose of this research was to seek a better understanding of these often unheralded but important state sources of support, and learn if they have continued to grow in the twenty-first century. Administrative data were obtained on state-supported programs operating in 2008 that provided financial support to students, resident or practicing physicians, physician assistants, nurse practitioners, certified nurse midwives, dentists, and licensed mental healthcare providers in exchange for service in an underserved area. The authors identified numbers, types of state-supported programs, program workforce strength, and features of state programs. In 2008, 75 state programs, operating in 37 states, collectively had 5113 program participants under contract. Loan repayment programs (n = 42, 56%) were the most common type of state-supported programs. Practitioners signed initial contracts in 2008 totaled 1173, with more non-physicians (n = 681, 58%) signing initial contracts than physicians (n = 492, 42%). Additionally, 2803 practitioners were serving in programs in 2008. Field placement was also slightly greater among non-physicians in 2008 (n = 1433, 51%) than physicians (n = 1370, 49%). State support-for-service programs remains an important source of financial assistance for those willing to make service commitments in underserved areas. Moreover, these programs continue to increase in size, even amidst the economic malaise, and provide an obligated primary care workforce in underserved areas.

Evaluating the average access to care and continuity of care patients in Tehran teaching hospitals

Background: Standards of Joint Commission International emphasize on the organizational performance level in basic functional domains including patient right, patient care, medical safety and infection control. These standards are focused on two principles: expectations of the actual organizational performance and assessment of organizational capabilities to provide high quality and safe health care services. The aim of this study is to evaluate the possibility of improvement in Access to Care and Continuity of Care for patients (ACC) in teaching hospitals of Tehran University of Medical Sciences. Methods: This cross-sectional study was conducted in hospitals affiliated to Tehran University of Medical Sciences during 2012. Data collection was performed using author-designed questionnaire of “Access to Care and Continuity of Care patients” based on JCI standards (2013). A total of 171 questionnaires were sent to 26 hospitals and 154 (90%) questionnaires were successfully completed and used for data analysis. The questionnaire was reviewed by experts and the Cronbach’s alpha was calculated to be 0.967. The effects of the two variables of hospital type (general, specialty) and the number of beds on mean scores of ACC standards and each of its domains were analyzed using T-test or Mann-Whitney test depending on the distribution due to Kolmogorov-Smirnov test result. Results: In general, the mean of ACC standards was found comprehendible and applicable by 82.3 (SD = 11) of the respondents. The highest and lowest mean scores of ACC questions belonged to hospitals H21 (90 ± 6) and H14 (67 ± 12), respectively. There were not any significant effects of hospital type and the number of beds on the ACC scores. Conclusion: There was not any important effect of hospital type and bed numbers on ACC, although there was a 9%-15% possibility of improvement in accreditation scores of ACC standards in hospitals of Tehran University of Medical Sciences. A complete accreditation score in this domain didn’t seem achievable in these hospitals. However, it is proposed that future managerial planning of the studied hospitals lead to a complete accreditation score.

Effective Medical Creation (EMC) <br/>—A New Approach to Improvement of Patient Management in the Standpoint of Hospital Room Environment

Effective Medical Creation (EMC) is a kind of campaign to implement a team healthcare that can provide the most efficient and effective intensive care units (ICUs) by improving hospital room environment for not only patients and their family but also healthcare providers. This campaign was based on the concept of the “Art of Medicine”, which provides everyone a comfortable ICU environment of meditation and feeling with the five senses of sight, hearing, touch, smell, and taste. EMC can provide a healthcare environment that is not restricted by existing and traditional verse rules or style and aims to always provide better healthcare by working on the five senses. Provision of facilities for aromatherapy massage at an ornamental hospital room and landscape through a false window has been the ongoing activity of the EMC at Nara Medical University. These seemed effective in reducing a patient’s stress response in the ICU. However, the effect of EMC on the outcomes of critically ill patients has not been determined. EMC might be one of the promising measures to create environments that positively affect both patients and healthcare providers. In this review article, the concept of EMC and practice of EMC at Nara Medical University Hospital are presented.

基于主成分分析和TOPSIS模型的我国各省份医疗水平评价研究

背景 在新型冠状病毒感染(COVID-19)疫情全国流行期间,我国医疗资源的空间集聚效应凸显,各省份医疗水平存在明显差异,目前,国内学者多运用定量方法对当前全国各省份医疗水平进行评价,应用综合方法评价全国各省份医疗水平者较少。目的 了解我国各省份在医疗卫生事业发展水平上的差异,以期为医疗卫生事业决策者提供参考。方法 于2022年11月,计算机检索中国知网、万方数据知识服务平台和Web of Science数据库,检索有关医疗水平评价的文献。在借鉴现有研究成果的基础上,选取相对指标和平均指标来构建评价指标体系。以《2022中国卫生健康统计年鉴》为数据源,提取/计算各评价指标数据。运用主成分分析法和TOPSIS模型,对我国31个省份(未将中国香港特别行政区、中国澳门特别行政区、中国台湾地区纳入统计范畴)的医疗水平进行综合评价。结果 共检索出合格文献6篇,从医疗资源、医疗服务、医疗保障3个方面选取13个相对指标和平均指标构建评价体系。KMO值为0.733,Bartlett's球形检验结果显示,χ^(2)=346.908、P<0.001,提示数据适用于主成分分析;按照特征根>1.000的标准可提取4个主成分,分别为医疗资源规模和医疗服务质量(F1)、医疗机构工作效率(F2)、传染病控制能力(F3)、其他因素(F4),4个主成分的累积方差贡献率为84.012%。根据主成分得分系数矩阵建立各主成分线性模型后,基于4个主成分的方差贡献率得到可用于评价医疗水平的综合评价模型:Y=0.439 85×Y1+0.158 54×Y2+0.154 40×Y3+0.087 34×Y4。医疗水平综合得分位列前3位的省份分别为北京市(151.908分)、上海市(124.379分)、天津市(78.673分)。TOPSIS贴近度排名结果显示,北京市和上海市处于靠前水平(贴近度分别为0.767、0.646),以贴近度0.400和0.201为节点,可以将31个省份分为3个梯队,第1梯队有北京市、上海市和天津市3个省份,第2梯队有浙江省、四川省等25个省份,第3梯队包括河北省、宁夏回族自治区和西藏自治区3个省份。结论 中国的医疗水平存在明显的省际发展不平衡问题,31个省份医疗水平分布整体呈现“中间大、两头小”的橄榄型结构特征。政府应加大对河北省等医疗水平排名靠后省份的政策倾斜力度,发挥区域卫生规划的统筹协调作用,利用远程医疗和医疗大数据实行定点帮扶。

基于公办与民办差异视角的养老机构医养结合服务质量评价研究

背景近几年,关于我国医养结合服务模式、影响因素等的研究报道较多,但关于养老机构医养结合服务质量的研究报道较少,且缺乏对不同类型养老机构医养结合服务质量差异的比较研究。目的评价公办与民办养老机构医养结合服务质量。方法2020年10月—2021年9月,采用分层随机抽样方法在内蒙古自治区包头市、陕西省西安市、湖北省宜昌市、浙江省绍兴市共4个地区进行问卷调查,共选取25家养老机构老年人1106名。通过SERVQUAL模型构建包含可靠性、及时性、保障性、规范性、移情性5个维度和15项二级指标的医养结合服务质量评价指标体系,结合熵权法与模糊综合评价法分别计算公办、民办养老机构医养结合服务质量评分并进行比较。结果公办、民办养老机构老年人对医养结合服务质量满意度综合评价值分别为41.66、38.82分,其中公办养老机构15项二级指标评分均在40.00分以上,民办养老机构13项二级指标评分在40.00分以下。结论公办与民办养老机构老年人对医养结合服务质量满意度综合评价结果存在一定差异,其中规范性、移情性维度评分差异较大,可靠性、及时性、保障性维度评分差异较小,这为发现不同维度下医养结合服务存在的问题、促进养老机构医养结合服务高质量提供了参考。

基于医院信息系统的患者服务功能优化研究

目的以患者为中心,围绕“改善就医感受,提升患者体验”优化医院信息系统(HIS)中的患者服务流程,提升服务效能。方法围绕诊前、诊中、诊后3个环节进行应用优化、技术优化和管理优化,实现智能预问诊、自助预约、自助点餐、床旁结算、智能语音随访等功能优化。结果诊前服务方面,“挂错号”和“乱挂号”现象显著减少,改善了患者就医体验;诊中服务方面,自助检查预约人均节省40 min~50 min,自助点餐120余万次,床旁结算26479人次,提高了患者就医满意度;诊后服务方面,出院随访约67.4万人次,提升了患者康复质量。结论以患者为中心优化医院信息系统功能是提升患者就医获得感的重要举措,是推进医院信息化建设、促进公立医院高质量发展的重要支撑。

医养结合机构老年慢性病人群中医药服务获得感评价研究

目的:了解医养结合机构老年慢性病人群中医药服务获得感现状及其影响因素,为提升中医药服务获得感提供借鉴和参考。方法:于2023年7月,将HONGYY等编制的《社区老年人中医药服务获得感量表》转化为相应的问卷条目;于2023年8~9月,运用典型抽样法、简单随机抽样法在我国东、中、西部地区三家医养结合机构抽取690名60岁及以上患有慢性病老年人进行问卷调查;于2023年10月,采用统计描述、卡方检验、二元Logistic等统计学方法,对医养结合机构老年慢性病人群中医药服务获得感及影响因素进行分析。结果:共发放调查问卷690份,有效回收637份,有效回收率为92.32%(637/690)。医养结合机构老年慢性人群中医药服务获得感平均得分为3.99±0.58分,其中有效度、满意度和回应度及其8个条目得分均低于4分。获得感主要受户籍、患慢性病数量、接受中医药服务的情况、主要解决的健康问题等因素的影响,P<0.05。结论:医养结合机构老年慢性人群中医药服务获得感总体处于较高水平,今后应进一步加强有效度、满意度、回应度相关内容的工作力度,促进获得感五个维度的均衡发展。

深化医疗卫生体制改革,实施专科医师培养与准入制度

目前,我国正处于深化医疗卫生体制改革的关键时期,该文从我国医疗卫生市场现状入手,分析了我国发展专科医师培养与准入制度的必要性,并从四个方面论述了我国实施专科医师培养与准入制度所需开展的重点工作。

用传统的经济学理论解析“看病难”、“看病贵”的原因和解决方案

用传统的经济学理论分析了"看病难"、"看病贵"产生的原因,用经济学方法得出卫生资源公平配置的策略,指出新医改方案中提出的措施如果能得到落实,那么"看病贵","看病难"将得到有效缓解,卫生资源配置公平性问题才得以有效实施,政策制定中的效率、公平、稳定三原则才能统一起来。

湖南省老年人就医难现状及对策研究

目的探讨湖南省老年人就医难现状及不同类别老年人"就医难"的差异及影响因素。方法根据经济社会发展水平不同,采用多阶段分层整群抽样法,抽取湖南省株洲市、衡阳市、湘西自治州3个地区作为样本,对调查地区60岁及以上老年人进行问卷调查。共发放问卷600份,回收有效问卷589份。所有数据通过SPSS 22.0进行录入处理,对统计分析结果进行多元有序Logistic回归分析。结果老年人年龄越大,就医方便性越差;农村老年人就医方便性(85.3%)显著低于城市(94.7%)。在95%的置信水平下,老年人就医满意度受到年龄和文化程度两个因素的显著影响。"认为自己病得不严重"(41.2%)和"去医院太花钱"(28.2%)是湖南省老年人"就医难"的关键影响因素。结论医保报销政策适当向老年群体倾斜,关注独居老人健康和就医,推进医养一体化,以缓解老年人"就医难"的问题。

美国医疗改革及对我国的启示

医疗费用持续高涨、卫生可及性和卫生公平性等问题一直困扰着美国政府,2009年的金融危机更是使美国的医疗体制雪上加霜,这也进一步坚定了奥巴马政府实施医疗改革的决心。美国医疗改革的主要措施为:扩大医疗保险的覆盖面,制订有利于弱势群体的医疗保险政策;扩大筹资范围,缩减不必要的医疗费用开支;提高医疗服务质量等。然而,在经济环境的恶化以及来自利益集团的多重压力下,美国的医疗改革不可能解决医疗体制中存在的根本性问题。美国的经验告诉我们,一个国家的经济发展水平不是卫生公平的必要条件,构建一个医疗资源分配合理、医疗保险制度完善、医疗服务质量与效率高、医疗费用合理的公共医疗服务体系才是公民平等享有健康权利的关键。

美国医疗保障制度改革的先行者——马萨诸塞州医改综述

马萨诸塞州2006年医改被视为2010年奥巴马美国医改的原型和模板,研究马州医改进展和效果,有助于推断美国医改可能取得的成绩及问题。2006年马州医改主要通过以下方式扩大医疗保险覆盖范围,提高医疗服务可及性。一是增加政府投入,扩大面向低收入人群的马州医疗援助计划覆盖范围,新建资助中低收入人群参保的公民健康保障计划,从而提高中低收入人群的参保能力;二是新建医疗保险交易局管理新建计划,干预私营医疗保险市场,新建致力于医疗保险标准化、面向高收入人群的公民健康选择计划;三是强制个人参保,要求雇主为雇员提供保险。综合现有文献,马州医改已取得许多成就,但也存在一定问题。一方面,无保障人群数量不断缩小,居民医疗服务可及性提高,可负担性也有所改进;另一方面,医疗支出快速上升影响了改革的可持续性,制度设计的一些缺陷影响了部分人群的医疗服务可及性,同时安全网计划资金的消减也可能影响医改效果。我国可借鉴马州经验建立商业健康保险管制机构,促进我国商业健康保险市场发展;同时需准备面对全民医保覆盖后的医疗费用快速增长问题,还需警惕全面覆盖后的"参保却不享有"问题。

互助医疗改善卫生服务可及性的效果评价

卫生服务可及性差是目前我国卫生工作中的主要问题之一。我国农村互助医疗是根据我国西部农村问题设计的一套综合解决措施,也可以认为是新型农村合作医疗的模式之一,其实施效果有待检验。利用项目2005年度的随访家庭入户调查资料,采用国际较为流行的倾向得分匹配法对互助医疗改善卫生服务实现的可及性进行效果评价。结果表明,互助医疗有效地改善了门诊就诊情况,同时,对住院服务利用也产生了一定程度的正向影响,基本达到了项目预期目标。

缓解群众看病难问题的政策建议

医疗资源总量不足、配置不均衡是导致群众看病难的重要原因,医院内部管理水平不高则加重了群众看病难的感受。缓解群众看病难问题必须多管齐下,扩充优质医疗资源总供给,建立上下联动的分工协作机制,优化诊疗流程,推进体制机制综合改革。

《北京市“十四五”中医护理发展规划》解读

2022年7月13日北京市中医管理局印发《北京市“十四五”中医护理发展规划》(以下简称《规划》)。《规划》明确了“十四五”期间北京中医护理事业发展的指导思想、基本原则、建设目标、重点任务和保障措施等内容,是“十四五”时期北京中医护理发展的蓝图和纲领性文件。

实行按病种付费利弊探讨

作为目前缓解"看病贵、看病难"矛盾的一种策略,按病种付费方式仿佛让人们看到一丝曙光。低廉的价格,对维持医院正常的运营挑战不小。按病种付费可否成为解决问题的一帖良药,人们拭目以待。

新医改形势下看病难、看病贵的表现形式、根源与对策

看病难看病贵因国家形态、历史时期、社会阶层的不同而呈现不同的表现形式。看病难源于医疗服务供给总量不足与结构失衡;看病贵源于医疗服务价格的扭曲与医疗保险体系的残缺,看病难看病贵的感受差异根源于社会阶层的高低。解决看病难与看病贵的治本之策是通过公共卫生与健康管理控制医疗服务的需求;治标之策是扩大供给总量、调整供给结构与提高医疗保险的保障水平与保障范围。中国未来的看病难、贵主要体现为特需医疗服务的看病难、贵,必须从特需医疗服务供给与商业医疗保险建设两个方面加以解决。