“中国农村卫生服务筹资和农村医生报酬机制研究”基线调查断面调查的报告

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共调查2个试验县的县政府、县卫生局、县医院,12个试验乡的乡政府、乡卫生院、乡合作医疗管理委员会、乡干部、乡卫生院医生,36个试验村的村委会、村干部、村卫生室、乡村医生、1100名村民户主和4800户(不包括5%的复查数)家庭。调查了1994年县、乡、村的社会经济文化、卫生服务及其筹资(特别是合作医疗筹资),农村医生报酬现状,现有医疗保健制度(特别是合作医疗制度)等。初步分析结果显示:河南试验县落后的经济文化制约了个人、集体、政府对卫生的投入;试验县危害农村人口健康的主要疾病是感染性和传染性疾病;次均医疗费用超过了全国农村一、二类地区;乡卫生院服务效率较低;患者中的20~34%的应门诊者和58~71%的应住院者因经济困难而放弃就诊;试验县1994年合作医疗管理形式是乡办乡管,县、乡政府及各种企业对合作医疗基金的投人为0,农民个人投入占合作医疗基金的74~100%,以户为单位按人头收2~8元,补偿比为7%~20%;农村医生报酬机制中的主要问题表现是乡卫生院医生的报酬偏低,医生的卫生服务行为与报酬无直接关系。 A total of 2 county governments, county health bureaus, county hospitals, 12 township governments, township hospitals, rural cooperative medical management committees, township cadres, and township hospital doctors in 12 pilot counties and village committees in 36 pilot villages were investigated. Associations, village cadres, village clinics, village doctors, 1,100 village heads and 4,800 households (excluding 5% of the number of reviews). It investigated the socio-economic culture, health services and fundraising (especially the financing of cooperative medical care) of counties, townships, and villages in 1994, the status of remuneration for rural doctors, and the existing healthcare system (especially the cooperative medical system). The preliminary analysis shows that the backward economic and cultural conditions in Henan’s pilot counties have constrained individual, collective, and government investment in health; the main diseases that threaten the health of the rural population in pilot counties are infectious and infectious diseases; the average medical cost exceeds that of rural ones. , Class II areas; Township hospitals have low service efficiency; 20 to 34% of the patients and 58 to 71% of the patients in the hospital should be given up because of economic difficulties; the pilot county’s cooperative medical management form in 1994 was The rural government, county and township governments, and various enterprises invest 0 in cooperative medical funds, individual farmers’ inputs account for 74 to 100% of cooperative medical funds, and households receive 2 to 8 yuan per capita, with a compensation ratio of 7 % ~ 20%; The main problem in rural doctors’ remuneration system is that the doctor’s remuneration is low in the township hospitals, and there is no direct relationship between doctors’ health service behavior and remuneration.
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