安徽省卫生系统反应性研究
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摘要
人类跨入21世纪，经济全球化进程日趋加快，促进经济发展，推动社会进步，提高人们生活水平，增进人们健康，日益成为各国政府和人们的共同心愿。WHO在《2000年世界卫生报告》中，利用健康结果、反应性和筹资公平性对各国卫生系统绩效进行评价和排序。首次将反应性(responsiveness)作为评价卫生系统整体绩效的重要指标，中国的反应性排名偏后，引起了国内的广泛关注。
本研究依据WHO提供的卫生系统反应性理论和测算方法，利用卫生系统反应性家庭调查问卷(包括家庭成员个人基本情况及门诊和住院的反应性信息)对样本点进行了实地调查。测算出安徽省卫生系统反应性水平指数为7.34(门诊服务)和7.19(住院服务)，人群反应性分布指数分别是0.706(门诊服务)和0.675(住院服务)(α=2，β=0)。表明安徽省卫生系统反应性总体水平较好，大部分患者对就诊医院比较满意，安徽省卫生改革注重病人的反应性，取得了一定的效果。在反应性水平八个部分打分中，门诊服务尊严分值最高，7.85分，住院服务保密性分值最高，7.77分。门诊和住院服务选择性分值最低，分别是6.24和6.29分。较低的选择性分值说明患者能够自由选择医院和医护人员的比例还不高。
从研究者角度出发提出如下建议：卫生系统应该从非医疗因素方面关注人们的期望，注意保护和提高基本人权；转变医务人员观念，重视医德医风教育；加强人群健康教育；进一步深化医疗保障制度和医疗卫生体制改革，真正以病人为中心，考虑不同特征病人的需求，提高服务质量和效率，切实增进卫生系统工作绩效。
With the mankind strides into the 21st century, the economic globalization process is accelerated day by day. Bringing about an advance in economy and outfitting people become the common wishes of government and the people of various countries. In 2000 World Health Report, based on health, responsiveness and fairness of financial contribution, WHO had appraised to and arranged in an order the performances of health system of the countries all over the world in view of the above and regard responsiveness as the important index of appraising whole performance of health system for the first time. After the responsiveness rank of China is partial, it has caused the domestic extensive concern.
According to WHO offers method of calculating, this subject utilize family's household's questionnaire of responsiveness to carry on the on-site inspection to some samples, we find the level of responsiveness of health system of Anhui Province for 7.34 (serve in clinic) and 7.19 (serve in hospital). Index of crowd's responsiveness distribution of accepting the service in clinic is 0.706 and index of the crowd's responsiveness distribution of accepting the service in hospital is 0.675. It shows the systematic overall level and distribution of responsiveness of health system of Anhui Province better, most patients are relatively satisfied with in the hospital. Health system have paid attention to the patient's responsiveness in health reform of Anhui Province and made certain result! Giving a mark of eight parts of responsiveness level, the value of dignity of serve in the clinic hospital are highest, 7.85 fen; The value of confidentiality of serve in hospital are highest, 7.77 fen. The value of alternative ar
e the lowest, it is 6.24 and 6.29 fen separately. Lower value of alternative proves that the proportions of the patient choosing the hospital and medical personnel yet not to be high freely.
This paper proceeds from researcher angle and puts forward the following suggestion: The health system should pay attention to the people's expectation from the non-medical factor and protecting and improving basic human rights; change the doctors' ideas and pay attention to their medical ethics and atmosphere to educate; strengthen crowd's health education; deepen medical insure and health care system reform further, really regard patient as the center, consider different characteristic patients' demand, improve service quality and efficiency, promote the working performance of the health system conscientiously.
本研究依据WHO提供的卫生系统反应性理论和测算方法，利用卫生系统反应性家庭调查问卷(包括家庭成员个人基本情况及门诊和住院的反应性信息)对样本点进行了实地调查。测算出安徽省卫生系统反应性水平指数为7.34(门诊服务)和7.19(住院服务)，人群反应性分布指数分别是0.706(门诊服务)和0.675(住院服务)(α=2，β=0)。表明安徽省卫生系统反应性总体水平较好，大部分患者对就诊医院比较满意，安徽省卫生改革注重病人的反应性，取得了一定的效果。在反应性水平八个部分打分中，门诊服务尊严分值最高，7.85分，住院服务保密性分值最高，7.77分。门诊和住院服务选择性分值最低，分别是6.24和6.29分。较低的选择性分值说明患者能够自由选择医院和医护人员的比例还不高。
从研究者角度出发提出如下建议：卫生系统应该从非医疗因素方面关注人们的期望，注意保护和提高基本人权；转变医务人员观念，重视医德医风教育；加强人群健康教育；进一步深化医疗保障制度和医疗卫生体制改革，真正以病人为中心，考虑不同特征病人的需求，提高服务质量和效率，切实增进卫生系统工作绩效。
With the mankind strides into the 21st century, the economic globalization process is accelerated day by day. Bringing about an advance in economy and outfitting people become the common wishes of government and the people of various countries. In 2000 World Health Report, based on health, responsiveness and fairness of financial contribution, WHO had appraised to and arranged in an order the performances of health system of the countries all over the world in view of the above and regard responsiveness as the important index of appraising whole performance of health system for the first time. After the responsiveness rank of China is partial, it has caused the domestic extensive concern.
According to WHO offers method of calculating, this subject utilize family's household's questionnaire of responsiveness to carry on the on-site inspection to some samples, we find the level of responsiveness of health system of Anhui Province for 7.34 (serve in clinic) and 7.19 (serve in hospital). Index of crowd's responsiveness distribution of accepting the service in clinic is 0.706 and index of the crowd's responsiveness distribution of accepting the service in hospital is 0.675. It shows the systematic overall level and distribution of responsiveness of health system of Anhui Province better, most patients are relatively satisfied with in the hospital. Health system have paid attention to the patient's responsiveness in health reform of Anhui Province and made certain result! Giving a mark of eight parts of responsiveness level, the value of dignity of serve in the clinic hospital are highest, 7.85 fen; The value of confidentiality of serve in hospital are highest, 7.77 fen. The value of alternative ar
e the lowest, it is 6.24 and 6.29 fen separately. Lower value of alternative proves that the proportions of the patient choosing the hospital and medical personnel yet not to be high freely.
This paper proceeds from researcher angle and puts forward the following suggestion: The health system should pay attention to the people's expectation from the non-medical factor and protecting and improving basic human rights; change the doctors' ideas and pay attention to their medical ethics and atmosphere to educate; strengthen crowd's health education; deepen medical insure and health care system reform further, really regard patient as the center, consider different characteristic patients' demand, improve service quality and efficiency, promote the working performance of the health system conscientiously.
引文
1．赵郁馨．2000年世界卫生报告带给我们的新启示．中国卫生资源，2001，4(1)：6-7
2. Murray CJL&Frenk J. A WHO framework for health system performance assessment. GPE Discussion Paper No. 6. Geneva, WHO, 1999.
3．胡善联等．卫生经济学．上海．复旦大学出版社：2002
4. WHO: Round table: addressing the major challenges to health systems. Fifty-Third WHA. 10 Apr. 2000.
5．世界卫生组织：世界卫生的趋势和挑战．日内瓦，2000．
6. Valentine N, De Silva A&Murray CJL. Estimating responsiveness level and distribution for 191 countries: methods and results GPE Discussion Paper No. 22. Geneva, WHO, 2000.
7. De Silva A, Valentine N. Measuring responsiveness: results of a key informant survey in 35 countries. GPE Discussion Paper No. 21. Geneva, WHO, 2000.
8．江芹、胡善联、李国红等．上海市卫生系统反应性初探．中国卫生事业管理，2002，18(6)：324-325
9．李士雪、曲江斌、王兴洲等．卫生系统反应性——概念与测量．中国卫生经济，2001，20(2)：44-46
10. Amala de Silva A Framework For Measuring Responsiveness. Geneva: World Health Organization, GPE Discussion Paper No. 32, 1999.
11．李国红、胡善联、陈志兴等．上海市病人反应性的分析．中华医院管理，2002，18(5)：312-314
12．施学忠、谢婧、贾松树等．河南省卫生系统反应性模糊综合评价．中国卫生统计，2002，19(4)：99-101
13．江芹、胡善联．对．WHO卫生系统绩效评价的几点商榷意见．中国卫生政策，2002，6(8)：17-192
2. Murray CJL&Frenk J. A WHO framework for health system performance assessment. GPE Discussion Paper No. 6. Geneva, WHO, 1999.
3．胡善联等．卫生经济学．上海．复旦大学出版社：2002
4. WHO: Round table: addressing the major challenges to health systems. Fifty-Third WHA. 10 Apr. 2000.
5．世界卫生组织：世界卫生的趋势和挑战．日内瓦，2000．
6. Valentine N, De Silva A&Murray CJL. Estimating responsiveness level and distribution for 191 countries: methods and results GPE Discussion Paper No. 22. Geneva, WHO, 2000.
7. De Silva A, Valentine N. Measuring responsiveness: results of a key informant survey in 35 countries. GPE Discussion Paper No. 21. Geneva, WHO, 2000.
8．江芹、胡善联、李国红等．上海市卫生系统反应性初探．中国卫生事业管理，2002，18(6)：324-325
9．李士雪、曲江斌、王兴洲等．卫生系统反应性——概念与测量．中国卫生经济，2001，20(2)：44-46
10. Amala de Silva A Framework For Measuring Responsiveness. Geneva: World Health Organization, GPE Discussion Paper No. 32, 1999.
11．李国红、胡善联、陈志兴等．上海市病人反应性的分析．中华医院管理，2002，18(5)：312-314
12．施学忠、谢婧、贾松树等．河南省卫生系统反应性模糊综合评价．中国卫生统计，2002，19(4)：99-101
13．江芹、胡善联．对．WHO卫生系统绩效评价的几点商榷意见．中国卫生政策，2002，6(8)：17-192