本文選題：基層醫(yī)療市場 + 基層醫(yī)療機(jī)構(gòu)��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景隨著社會(huì)主義市場經(jīng)濟(jì)的迅速發(fā)展,醫(yī)療市場的逐步開放,社會(huì)上出現(xiàn)了多樣化的辦醫(yī)形式,在一定程度上滿足了人民群眾日益增長的醫(yī)療衛(wèi)生服務(wù)需求。但是,由于醫(yī)療衛(wèi)生體制改革中制度的不健全,一些單位或個(gè)人為追求經(jīng)濟(jì)利益而置病人的生命健康權(quán)益于不顧,無證行醫(yī)、超出核準(zhǔn)的診療科目執(zhí)業(yè)、使用非衛(wèi)生技術(shù)人員從事醫(yī)療衛(wèi)生技術(shù)工作、消毒不嚴(yán)格、醫(yī)療廢物處置不當(dāng)?shù)冗`法行為,極大地破壞了正常的醫(yī)療服務(wù)市場秩序,嚴(yán)重危害了人民群眾的健康權(quán)益及生命安全。基層醫(yī)療市場的主體為基層醫(yī)療機(jī)構(gòu)�；鶎俞t(yī)療機(jī)構(gòu)是各級(jí)各類醫(yī)療機(jī)構(gòu)的重要組成部分,承擔(dān)了大部分的基本醫(yī)療和基本公共衛(wèi)生服務(wù)任務(wù),直接關(guān)系到基層廣大人民群眾的身心健康�；鶎俞t(yī)療市場無證行醫(yī)的多寡,基層醫(yī)療機(jī)構(gòu)能否依法執(zhí)業(yè),與群眾切身利益息息相關(guān)。因此加強(qiáng)對(duì)基層醫(yī)療市場的監(jiān)督和管理,規(guī)范基層醫(yī)療機(jī)構(gòu)的執(zhí)業(yè)行為,對(duì)于規(guī)范醫(yī)療市場秩序、保障醫(yī)療安全等具有重要的意義。市級(jí)衛(wèi)生監(jiān)督機(jī)構(gòu)每年開展的醫(yī)療市場暗訪活動(dòng),是對(duì)轄區(qū)內(nèi)基層醫(yī)療市場存在的各類違法行為進(jìn)行監(jiān)督的有效手段。通過對(duì)醫(yī)療市場暗訪的數(shù)據(jù)進(jìn)行分析,找出當(dāng)前基層醫(yī)療市場存在的違法行為,各類違法行為在哪些場所或機(jī)構(gòu)多發(fā),據(jù)此探討出針對(duì)性的監(jiān)管對(duì)策,同時(shí),也為衛(wèi)生行政部門及衛(wèi)生監(jiān)督機(jī)構(gòu)調(diào)整醫(yī)療衛(wèi)生監(jiān)督政策、改進(jìn)監(jiān)管措施提供借鑒和參考。研究目的分析2013-2015年某市暗訪基層醫(yī)療機(jī)構(gòu)的違法情況;分析2013-2015年某市涉醫(yī)單位的違法情況;根據(jù)存在的問題,提出相應(yīng)的對(duì)策與建議。資料與方法資料來源于2013-2015年某市衛(wèi)生監(jiān)督所對(duì)所轄區(qū)范圍內(nèi)的基層醫(yī)療市場暗訪的登記歸檔資料。登記歸檔的暗訪基層醫(yī)療機(jī)構(gòu)和涉醫(yī)場所共303家。其中2013年72家,2014年84家,2015年147家。對(duì)存檔的暗訪資料進(jìn)行整理,將相關(guān)的數(shù)據(jù)輸入Excel表格,建立數(shù)據(jù)庫,利用SPSS進(jìn)行統(tǒng)計(jì)分析。統(tǒng)計(jì)學(xué)指標(biāo)采用了違法率和構(gòu)成比。為確保數(shù)據(jù)錄入準(zhǔn)確,采用兩人同時(shí)錄入,并逐一核對(duì)錄入數(shù)據(jù)。主要結(jié)果1.基層醫(yī)療服務(wù)市場中,無證行醫(yī)情況嚴(yán)重,無證行醫(yī)占到所有暗訪單位的48.8%。2.基層醫(yī)療機(jī)構(gòu)中,違法數(shù)量最多的是:村衛(wèi)生室、西醫(yī)診所、衛(wèi)生所(室),分別占 25.8%、18.1%、14.2%。3.使用非衛(wèi)生技術(shù)人員從事醫(yī)療衛(wèi)生技術(shù)工作的違法發(fā)生率高達(dá)48.4%,主要分布在衛(wèi)生所(室)、社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)、西醫(yī)診所、中西醫(yī)診所和口腔診所。西醫(yī)診所和社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)超范圍執(zhí)業(yè)問題最為嚴(yán)重,違法率均為28.6%。4.基層醫(yī)療機(jī)構(gòu)的處方書寫,除了衛(wèi)生院、醫(yī)療美容診所外,其他所有醫(yī)療機(jī)構(gòu)都存在違法,違法率高達(dá)68.4%以上。5.基層醫(yī)療機(jī)構(gòu)的消毒管理違法率高達(dá)82.6%,醫(yī)療廢物處置違法率為80.6%。村衛(wèi)生室、衛(wèi)生所是高發(fā)單位。6.無證行醫(yī)的涉醫(yī)場所中,口腔診所、推拿按摩場所數(shù)量最多,分別占 41.2%、11.2%。7.在涉醫(yī)單位中,普遍進(jìn)行了違法宣傳,藥店、生活美容場所、推拿按摩理療場所的違法率分別為100%、83.3%、82.3%。8.70.9%的無證行醫(yī)場所分布在鄉(xiāng)鎮(zhèn)。對(duì)策與建議1.以涉醫(yī)口腔診所、無證行醫(yī)多發(fā)的鄉(xiāng)鎮(zhèn)為監(jiān)督重點(diǎn),堅(jiān)持疏堵結(jié)合、打防并舉的工作方法。2.理順衛(wèi)生監(jiān)督機(jī)構(gòu)體制機(jī)制,合理配置衛(wèi)生監(jiān)督員。3.加強(qiáng)對(duì)基層醫(yī)療機(jī)構(gòu)消毒及醫(yī)療廢物的管理。4.以不良執(zhí)業(yè)行為記分管理為抓手,加強(qiáng)對(duì)重點(diǎn)違法行為、違法多發(fā)機(jī)構(gòu)的監(jiān)管。5.大力培訓(xùn)基層醫(yī)療機(jī)構(gòu)工作人員,強(qiáng)化依法執(zhí)業(yè)意識(shí)。6.嚴(yán)把審批許可關(guān),加強(qiáng)規(guī)范化診所建設(shè)和依法執(zhí)業(yè)公示臺(tái)工作。7.進(jìn)一步建立健全醫(yī)療衛(wèi)生法律法規(guī),盡快出臺(tái)衛(wèi)生基本法。8.加強(qiáng)醫(yī)學(xué)基本知識(shí)及醫(yī)療衛(wèi)生法律法規(guī)的宣傳與普及。
[Abstract]:With the rapid development of the socialist market economy, the gradual opening up of the medical market and the emergence of a diversified form of medical service in society, the research background has met the growing demand for medical and health services to a certain extent. However, some units or individuals are pursuing the unsound system in the reform of the medical and health system. With regard to the interests of the patients, the health rights and interests of the patients are ignored, the unlicensed practice of medicine, the practice beyond the approved medical treatment subjects, the use of non hygienic technical personnel to engage in medical and health technical work, unsterilizing and improper disposal of medical waste, have greatly destroyed the normal medical service market order and seriously endanger the people. Health rights and life safety. The main body of the medical market at the grass-roots level is primary medical institutions. Basic medical institutions are important components of all kinds of medical institutions at all levels. Most of the basic medical and basic public health services have been undertaken, directly related to the physical and mental health of the people at the grass-roots level. The basic medical market is unlicensed to practice medicine. Whether or not the grass-roots medical institutions can practise according to law is closely related to the vital interests of the masses. Therefore, it is of great significance to strengthen the supervision and management of the medical market at the grass-roots level and standardize the practice behavior of the grass-roots medical institutions, and to standardize the order of the medical market and ensure the medical safety. The medical market of the municipal health supervision institutions is dark every year. The visit is an effective means to supervise all kinds of illegal activities in the grass-roots medical market in the area. Through the analysis of the data of the medical market, we can find out the illegal behavior in the current medical market, and which places or institutions are more frequent in the illegal activities. For the health administration department and the health supervision organization to adjust the health supervision policy and improve the supervision measures to provide reference and reference. The purpose of this study is to analyze the illegal situation of the 2013-2015 years' visit to the grass-roots medical institutions in a city, and to analyze the illegal situation of the medical units in one city for the last 2013-2015 years, and put forward the corresponding countermeasures and suggestions according to the existing problems. Materials and methods were derived from the registration documents of the primary medical market in the area under the jurisdiction of a municipal health supervision institute in 2013-2015 years. The registered archived visits to grass-roots medical institutions and medical sites were 303. Among them, 72 in 2013, 84 in 2014 and 147 in 2015. Enter the Excel form, establish a database and use SPSS to carry out statistical analysis. The statistical index adopts the illegality rate and the ratio of composition. In order to ensure the accuracy of data entry, two people are recorded at the same time, and the data are checked and recorded one by one. The main result is that in the 1. basic medical service market, the unlicensed practice of medicine is serious, and the unlicensed medical service accounts for all the 48.8%. visiting units. 2. among the grass-roots medical institutions, the most illegal activities are: village health rooms, Western medical clinics, and health services (rooms), accounting for 25.8%, 18.1% respectively. The illegal occurrence rate of 14.2%.3. using non health technicians in medical and health technology is up to 48.4%, mainly in the health service (room), community health service, Western medical clinics, Chinese and Western medical clinics and oral cavity. Medical clinics, Western medical clinics and community health service institutions have the most serious problems. The illegal rate is written by the 28.6%.4. basic medical institutions. In addition to the health centers and the medical and beauty clinics, all other medical institutions are illegal, and the illegal rate up to 68.4% of the.5. medical institutions is up to 82.6%, The illegal rate of medical waste disposal is 80.6%. village health room, and the health institute is the place where the high incidence unit.6. does not permit medical treatment. The number of the oral clinics and massage places is the most, accounting for 41.2% respectively. In the medical unit, 11.2%.7. has generally carried out illegal propaganda, drugstores, living beauty places, and massage therapy places with 100%, 8 respectively. 3.3%, the unlicensed practice places of 82.3%.8.70.9% are distributed in the villages and towns. Countermeasures and suggestions 1. take the medical oral clinics, the villages and towns which have no evidence to have multiple medical treatment as the supervision key, adhere to the combination of dredging, and prevent the same work method.2. to straighten out the system mechanism of the health supervision institution, and rationally allocate the health supervisor.3. to strengthen the disinfection and medical waste to grass-roots medical institutions. The management of material management.4. takes the score management of bad practice behavior as the grasp, strengthening the key illegal behavior and the supervision of the illegal multiple agencies,.5. vigorously trains the staff of the grass-roots medical institutions, strengthens the practice consciousness of the law and strictly controls the approval of the examination and approval, strengthens the construction of standardized clinics and the work of the public demonstration station according to the law, and further establishes and improves the medical security. Health laws and regulations, the introduction of the basic law of health.8. as soon as possible, and strengthening the publicity and popularization of basic medical knowledge and laws and regulations.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1;D922.16

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