国外基本卫生服务内涵、服务包与遴选原则研究  

Strategies to Develope an Essential Healthcare Package:De nition,Package and Criteria

作　　者：杨莉[1] 王静[1] 曹志辉[1] 孙佳[1] 高军[2] 许文英[1] 吴明[1] 

机构地区：[1]北京大学公共卫生学院卫生政策与管理系,北京100191 [2]卫生部统计信息中心,北京100044

出　　处：《中国循证医学杂志》2009年第6期599-609,共11页Chinese Journal of Evidence-based Medicine

基　　金：中国卫生政策支持项目(HPSP)知识管理领域资助

摘　　要：目的描述并分析各国基本卫生服务内涵、服务包内容及遴选原则。方法由主题专家和检索人员讨论并试验后确定检索词,共检索22个电子数据库、50个NGO及政府机构网站和搜索引擎Google,纳入全世界所有描述及评价已经实施的基本卫生服务内涵、服务包和遴选原则、实施背景、策略及效果的英文文献。用自行设计的数据提取表采集纳入文献的相关信息,而后进行描述和分析。结果共纳入166篇文献,其中104篇来自于中低收入国家的研究。其内容多是关于各国基本卫生服务包内容、遴选原则、实施背景与策略的描述(160篇),而涉及效果评价方面的文献极少(6篇)。评价策略的研究大部分为横断面研究(5篇),只有1篇是有干预的时间序列研究。结论由于各国政治、历史文化、经济背景以及政策目标的差异,基本卫生服务政策的内涵、内容和遴选原则也各不相同。基本卫生服务是各国政府根据其政治、经济和文化背景所采取的符合本国国情的公共筹资方式和实施策略,以达到人人可以公平享有的一揽子卫生服务项目。其服务包又可分为公共卫生服务和基本医疗服务两部分,其中针对常见病和多发病的基本医疗服务包随着各国社会经济发展水平的提高在不断扩大。基本卫生服务的内容需结合各国卫生体系和市场结构,以及供需双方的实际情况;同时结合复杂的财政分配体系,组织和机构特点,以及国家调控结构和能力,综合技术和社会价值两方面的考虑,来确定优先服务领域。转型国家的经验尤其值得借鉴。Objective To describe the criteria and procedure for defining an essential healthcare package in the developed and developing countries. Method Search words were chosen by both health policy experts and search coordinators after discussion and pilot. We searched electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develope an essential heahhcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result One hundred and sixty-six studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objective, 160 articles aimed to describe strategies, 6 articles aimed to evaluate effectiveness of strategies.Five studies evaluating effectiveness were crosssectionnary data, and one study was time series. Conclusion An appropriate package should be defined according to both technique criteria and social welfare criteria, considering each country＇s healthcare system and market structure, characteristics of the demander and provider, capacity of government＇s regulation. The experience in transition countries gives us more high lights.

关 键 词：基本卫生服务 服务包 遴选原则 系统评价 

分 类 号：R197.1[医药卫生—卫生事业管理] R969.3[医药卫生—公共卫生与预防医学]