Medical Conditions and Treatments : What‘s the Best Way to Disinfect for Ringworm?
The progress that sanitation of our country medical services reforms reachs the main challenge that faces currently
Go up oneself the century begins at the beginning of 80 time, our country government is reformed to advance medical services sanitation in succession formulate a series of policy measure, basically include: Encourage medical services of social force initiate to serve an orgnaization, enhance medical services to defend the development vigor of life form oneself, execute agile income and expenses to allocate policy to wait. At the beginning of 90 time, the country begins exploration to build town worker primary medical services guarantees a system. 1996, the Party Central Committee, the State Council holds the wholesome plenary meeting of first time whole nation since new China holds water, make " the decision about wholesome reform and development " , making clear wholesome career is the social commonweal career that the government implements regular welfare policy, formulated the policy that new period sanitation works, ask wholesome job must hold to the purpose that serves for people heart and soul, handle the relation of social benefit and economic benefits correctly. 2002, the Party Central Committee, the State Council make again " the decision that works about strengthening rural sanitation further " , the requirement insists to attach most importance to a dot with the country, accelerate the development of rural wholesome enterprise. 2003 after beat back SARS, height of the State Council takes construction of communal and wholesome system seriously, the requirement is accelerated push new-style country cooperative medical services is pilot with development urban community sanitation serves a system.
Through the reform of this one phase, communal sanitation serves systematic construction to get strengthening, major epidemic control, break out construction of mechanism of lash-up of communal and wholesome incident to obtain apparent progress; Resource of medical services sanitation increases, service facilities condition is improved apparently, with compared 1980, the quantity had personnel of form of life of avant-courier of our country eye, wholesome technology and bed digit to increase substantially, average per capita has a quantity to already was in the front row of the developing country; Medical services ensures system construction to be advanced steadily, up to in June 2006, insurance of primary medical services covers town worker population already was amounted to 150 million, medical services of new-style country collaboration enclothes population to exceed 400 million; Overall level is on national health quality developing country front row, partial area and city already were achieved or approach developed country level.
In obtain result while, see service of our country medical services is managing the respect such as system, moving mechanism and service quality to still be put in many problems even, basically be: System of safeguard of social medical services is diseased, cover population little, a lot of farmers, go into town the medical services that children of the dweller that Wu is versed in personnel and town do not have permanent occupation, teenager still does not have any forms is safe; Public investment is inadequate, resource distributings not all; Medical sanitation manages system mechanism the requirement of incommensurate market economy; Wholesome administration function is dispersive, authority duty is not clear, efficiency is low, examine and approve again, small service, heavy industry development, light quality is superintended; "With medical filling medical service " manage run policy, already showed serious abuse below market economy condition; The production of the medicines and chemical reagents that serves as special commodity and current and complete by commercialize run, pursuit gain is the biggest change, the commonweal sex that serves with medical sanitation deviates from badly; Masses " see a doctor difficult, see a doctor expensive " the issue is outstanding, already became the one big heat of current society; Construction of wholesome legal system is not perfect, cause administrative disorder, resource shortage and the circumstance of a large number of waste coexist.
Characteristic of new period doctors and patients reachs rule of go to a doctor, practise medicine
The implementation in wanting to supervise the work in medical services sanitation " it is with the person this " , must understand above all " person " . In medical services, "Person " should be divided to be two respects, namely " need square " -- patient, "Offer square " -- medical personnel. This is two groups that characteristic and demand differ completely.
The patient hopes go to a doctor is convenient, cheap, quality has assure. Burden of psychology of among them heavy ill patient is heavy, the heart that demand medical service is cut and expectation cost is higher, but because lack medical sanitation common sense, often easy get misdirect. The rule in respect of go to a doctor is, most patient nearby sees a doctor, the patient with better economic atmosphere seeks the medical establishment with best quality to see a doctor.
Our country has what undertake technically in the light of medical personnel characteristic rarely before the investigation and study of bigger sample book. Recently, 6 provinces that we differ in economic progress level launch questionnaire investigation in city, held the informal discussion that urban large hospital, community and medical personnel of hospital of rural villages and towns attend technically still. Questionnaire findings shows: The quality of medical personnel is overall it is better. Show level, medical personnel hold industry appears " 4 tall " feature, namely " force of hi-tech, high pressure, high risk, high load " . The public health worker that feels actuating pressure is great occupies 79.06 ％ , the risk occupies 90.22 ％ greatly, negative sentiment often appears in the job occupy 23.09 ％ . The height of the person that these problems should cause wholesome administration takes seriously. The demand of medical personnel basically reflects in the following respects: It is to emphasize self-fulfilment, the person of 94.31 ％ regards the first demand as special skill of play oneself business; 2 it is to hope heavy work is paid can gain corresponding income, the person of 83.5 ％ thinks income should prep above society is average level; 3 it is to pay attention to working learning environment, the suffers inquirer to look forward to his working learning environment of 65.71 ％ has relatively substantially improvement.
Below market economy condition, tell from some kind of meaning, medical personnel is free profession person, rule of its practise medicine is had " individual, partnership or company are changed " and the characteristic with strong liquidity. Medical personnel is OK proper motion practice, combine open medical establishment or be hired by large hospital; A few people still can divide period of time to be nodded in many ground hold course of study. The medical establishment of most country and area on the world all is given priority to with run by the local people, the hospital of run by the local people of beautiful, law, heart, day is occupied respectively 76 ％ , 76 ％ , 63 ％ and 80 ％ . The proportion of run by the local people that basic level medical establishment is like clinic is higher, if Japan occupies 94 ％ . The sense that we need to update is, hospital of run by the local people is not to seek profits certainly sexual hospital. In other country, hospitals of a lot of run by the local people dispute seeks profits commonweal sex hospital of the gender. Be like the United States, Germany, blame of run by the local people seeks profits sexual hospital takes all hospital respectively 51.7% with 41% . A new idea that needs establish is, government " get from the kind with be not government sector or private branch to be able to be passed certain the effective medical services sanitation with opposite high quality serves, OK and more benefit reachs impoverished population " (policy of out world bank considers to report " well-advised defray -- buy medical services sanitation to serve for the poor " ) . Sanitation of medical services of a few international organizes the experience discovery that waits for 10 developing countries through summing up Kampuchea, Bangladesh, the government buys medical services sanitation to serve to blame government organization, "It is to enlarge medical services to serve limits, a when improve service quality efficient way " . Country of the great majority on the world, include a developing country inside, the doctor signs working agreement with many medical establishment commonly; Community doctor and dweller family sign service agreement, the government purchases a service to its by consultative amount. Grasp these practise medicine characteristics and pattern, conduce to the administrative principle that makes phasing answer and system.
In job of management of medical services, must study doctors and patients concerns. Show level, relationship of doctors and patients appears the following characteristic:
1. Below market economy condition, the clientage between proper doctors and patients gets other factor easily affect and translate into buying and selling serves a relation, affect medical services to serve quality thereby, make grow in quantity of dispute of doctors and patients. This investigation shows, the medical personnel of 9.64 ％ thinks doctors and patients concerns is business service concern, this is a kind of tendency that is worth to take seriously highly. 2. Information asymmetry is one of main factors that affect relation of doctors and patients. The patient belongs to weak force one party, this has higher moral level with respect to requirement medical personnel. In be being investigated this, medical personnel oneself thinks wind of medical ethics cure occupies 8.95 ％ poorly, the way that the specification already had partial public health worker and behavior deviated from industry hold principle of course of study, need to give processing is rectified as soon as possible. 3. Get society of period of economic system shunt the influence with sincere letter diseased system, patient easy generation feels to the distrust of medical personnel. 4. The characteristic of behavior of current medical services is technical difficulty the uncertainty of effect of big, diagnosis and services highlights tall, individual difference. Accordingly, need both sides of doctors and patients to be encouraged each other, assume medical services risk jointly.
Serve the reflection of reform about our country medical services
One, the principle of reform
1. Answer between doctors and patients, supply and demand with the patient, need to just be this. In medical services, all jobs are arranged all answer " it is a center with the patient " , arrive greatly the design of plan of diagnosis and services, carry out, small the installation that waits to an an a ward corridor armrest, link up with, seat, phone, what all should consider a patient is convenient with demand. Still should offer to the patient at the same time as far as possible much information, help its understand the doctor‘s specialty and technical ability, progressively implementation " doctor of ill choice of persons " concept of contemporary go to a doctor. From " demand medical service " to " choose doctor " change, it is a right reassign that the people maintains oneself health essentially at civilian, reflected truly " it is with the person this " spirit.
2. Wholesome system should is with medical personnel in interior management this. Medical personnel is the main body of medical services servive routine. Do not arouse the enthusiasm of medical personnel, fulfil impossibly well " it is a center with the patient " service concept, the goal that medical services reforms comes true impossibly. The research of haing Buddha university makes clear, employee satisfaction spends every to increase 3 percent, customer satisfaction is spent increase 5 percent accordingly. Accordingly, should try hard to accomplish in innovation of medical services: On sufficient understanding and the basis that understand medical personnel requirement, satisfy its reasonable requirement, accomplish " esteem person " ; Arouse its enthusiasm adequately, develop its subjective activity, accomplish " emancipatory person " ; Enhance its quality and technical ability, create innovation environment for its, accomplish " development person " , make the person‘s potential gets full-scale development, individual value gets coming true adequately.
3. Advance governmental function transformation, implementation from with " canal " give priority to, arrive with " service " the change that give priority to. The government sector is not the orgnaization that provides a service for the patient directly. The guiding principle that the medical services that the government makes serves, policy, measure, method must come true through medical establishment and medical personnel. Wholesome service and other government are relevant branch, outside removing the policy that makes medical services, policy, program, measure, basically answer to provide a service for broad medical personnel.
4. The fairness that promotes service of primary medical services is enjoyed. Healthy fairness is social fairness is main reflect. Accordingly, reform of sex of medical services fairness must notice to eliminate the discrimination of pair of any groups; Must pay close attention to social natural resources to configure the influence of fair to medical services sex; The rationality that must enhance system in order to make sure medical services is fair.
2, the measure of reform
1. Perfect legal system. The proposal is made as soon as possible " citizen health guarantees a standard " or " citizen health promotes byelaw " , the duty of government of specific different energy level and establish investment guarantees a system, manage medical services to serve quality and order of medical services environment lawfully, ensure healthy rights and interests of the citizen.
2. Improve management. Form current masses to see a doctor a of expensive issue very main reason is insurance of social medical services cover range small. Accordingly, should increase a government to be sure in social medical services the investment of the respect, expand as soon as possible cover a range, raise masses to resist the ability of medical services risk. Should aggrandizement medical personnel and the professional morality that cure gives birth to scientificly and service tenet education, establish " heart be cure this " and " it is a center with the patient " concept. Should reform the administrative pattern of public hospital medical personnel, from " unit person " manage to " social person " administrative change, pass through on executive international " the doctor is bit more hold industry government " . The advantage of this action depends on: It is government of service of normative medical services, change " take acupuncture point " it is those who have an organization to go out consultation, operation, make sure patient go to a doctor is safe thereby; 2 it is the expense burden that reduces the patient that weigh disease, the indirect economy burden such as the member that accompany especially, travelling expenses, accommodation; The 3 action that are resource of manpower of sufficient play hi-tech; 4 it is to be basic level medical establishment to groom directly personnel; 5 it is to encourage medical personnel to study business technique, actor fatigue actor proposes a toast.
3. Strengthen grass-roots unit. In vast a rural area, especially western wait for economy to owe develop area, the society does cure ability inadequacy. Accordingly, must by governmental fund, build public medical services to defend life form, offer convenient medical services sanitation to serve for masses. In the city, because the contain in the society is worn greater enthusiasm running medical service, and the society runs cure ability stronger, want a government to make proper favourable policy only, can bring medical personnel into play to invest initiate community sanitation to serve the enthusiasm of the orgnaization. This already came true in a lot of countries. Consult international experience, such doing, not only can make medical services sanitation throws gross to increase, and the development that makes the government has more force to consider country and career of impoverished area sanitation. Partial economy developeds, the city zone that do not have or does not have a rural area basically, also but by the government contributive build community sanitation to serve a system, execute distinction to treat, classification is directive. But go up in management, must use the new mechanism that pays attention to quality, benefit management, avoid " mess " malpractice.
4. Adjust a mechanism. Must cancel public medical establishment stage by stage " with medical filling medical service " mechanism, carry out " income and expenses two lines " management. Establish the lasting effect mechanism that solves problem of rural person with ability. Our country will be in very a paragraph long phase of socialistic initial stage is in inside period. Inside this one phase, urban and rural difference is impossible by eliminate very quickly. Be in our country urban and rural below the case with very big difference of each field requirement, the medical personnel that asks to have level of taller medical services lives for a long time in the country or settling down in the country is not actual. Accordingly, more feasible choice is, the government is contributive, expedite medical personnel by urban hospital, the hospital of villages and towns that assists to speak or sing alternately by turns works regularly. Our country western the countryside hospital of the area has 15 thousand, and city hospital of 2 class above also near 15 thousand, can realize man-to-man help basically. Every hospital expedites 3 medical personnel every year to work one year to countryside of recieve aid recieve aid, pay its salary fee by central finance, do not increase basic level burden. Via calculating, central finance needs every year to take out 1.2 billion yuan only, can solve problem of talent of medical services of underdeveloped area rural area. In develop province, first after rich area should be assisted rich area.
5. Stimulative competition. Want to encourage social natural resources to invest commonweal career, much channel runs medical service, form orderly competition situation, improve service quality. In the meantime, on the base that expands community sanitation to serve energetically, public to partial government hospital undertakes property right is transformed or can carry out state-owned civilian battalion, the Medical Protection that offers mutiple level, much position for the patient serves. Reform the assignment system inside medical establishment to spend, build sound performance to evaluate a system, union " doctor of ill choice of persons " , " the doctor is bit more hold industry government " make medical personnel income pulls open class, form benign competition.
6. Pay attention to fairness. Carry out medical services deliverance to difficult group. Difficult masses cannot the state of go to a doctor often happens, must build relevant system to give as soon as possible solve. Proposal by finance contributive, civil administration branch examines a patient to whether accord with deliverance condition, charge of make a diagnosis and give services of wholesome service examine and verify, a few teamwork work, ensure impoverished patient to enjoy the rights and interests that primary medical services. Safeguard enjoys service of primary medical services fairly, the area of Ying Xiangxi ministry such as governmental capital, project, to 4 kinds of counties (county of county of key of the job that help deficient up, minority county, overland border land and old quarter revive area county) tilt.
(this article is heart of Wang Long of vice secretary of leading Party group of Ministry of Public Health, undersecretary to be in " begging is " magazine 2007 the 5th period on published article)
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