2013-2015年某市基层医疗市场违法情况分析及对策研究

发布时间：2018-07-12 11:05

本文选题：基层医疗市场 + 基层医疗机构　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景随着社会主义市场经济的迅速发展,医疗市场的逐步开放,社会上出现了多样化的办医形式,在一定程度上满足了人民群众日益增长的医疗卫生服务需求。但是,由于医疗卫生体制改革中制度的不健全,一些单位或个人为追求经济利益而置病人的生命健康权益于不顾,无证行医、超出核准的诊疗科目执业、使用非卫生技术人员从事医疗卫生技术工作、消毒不严格、医疗废物处置不当等违法行为,极大地破坏了正常的医疗服务市场秩序,严重危害了人民群众的健康权益及生命安全。基层医疗市场的主体为基层医疗机构。基层医疗机构是各级各类医疗机构的重要组成部分,承担了大部分的基本医疗和基本公共卫生服务任务,直接关系到基层广大人民群众的身心健康。基层医疗市场无证行医的多寡,基层医疗机构能否依法执业,与群众切身利益息息相关。因此加强对基层医疗市场的监督和管理,规范基层医疗机构的执业行为,对于规范医疗市场秩序、保障医疗安全等具有重要的意义。市级卫生监督机构每年开展的医疗市场暗访活动,是对辖区内基层医疗市场存在的各类违法行为进行监督的有效手段。通过对医疗市场暗访的数据进行分析,找出当前基层医疗市场存在的违法行为,各类违法行为在哪些场所或机构多发,据此探讨出针对性的监管对策,同时,也为卫生行政部门及卫生监督机构调整医疗卫生监督政策、改进监管措施提供借鉴和参考。研究目的分析2013-2015年某市暗访基层医疗机构的违法情况;分析2013-2015年某市涉医单位的违法情况;根据存在的问题,提出相应的对策与建议。资料与方法资料来源于2013-2015年某市卫生监督所对所辖区范围内的基层医疗市场暗访的登记归档资料。登记归档的暗访基层医疗机构和涉医场所共303家。其中2013年72家,2014年84家,2015年147家。对存档的暗访资料进行整理,将相关的数据输入Excel表格,建立数据库,利用SPSS进行统计分析。统计学指标采用了违法率和构成比。为确保数据录入准确,采用两人同时录入,并逐一核对录入数据。主要结果1.基层医疗服务市场中,无证行医情况严重,无证行医占到所有暗访单位的48.8%。2.基层医疗机构中,违法数量最多的是:村卫生室、西医诊所、卫生所(室),分别占 25.8%、18.1%、14.2%。3.使用非卫生技术人员从事医疗卫生技术工作的违法发生率高达48.4%,主要分布在卫生所(室)、社区卫生服务机构、西医诊所、中西医诊所和口腔诊所。西医诊所和社区卫生服务机构超范围执业问题最为严重,违法率均为28.6%。4.基层医疗机构的处方书写,除了卫生院、医疗美容诊所外,其他所有医疗机构都存在违法,违法率高达68.4%以上。5.基层医疗机构的消毒管理违法率高达82.6%,医疗废物处置违法率为80.6%。村卫生室、卫生所是高发单位。6.无证行医的涉医场所中,口腔诊所、推拿按摩场所数量最多,分别占 41.2%、11.2%。7.在涉医单位中,普遍进行了违法宣传,药店、生活美容场所、推拿按摩理疗场所的违法率分别为100%、83.3%、82.3%。8.70.9%的无证行医场所分布在乡镇。对策与建议1.以涉医口腔诊所、无证行医多发的乡镇为监督重点,坚持疏堵结合、打防并举的工作方法。2.理顺卫生监督机构体制机制,合理配置卫生监督员。3.加强对基层医疗机构消毒及医疗废物的管理。4.以不良执业行为记分管理为抓手,加强对重点违法行为、违法多发机构的监管。5.大力培训基层医疗机构工作人员,强化依法执业意识。6.严把审批许可关,加强规范化诊所建设和依法执业公示台工作。7.进一步建立健全医疗卫生法律法规,尽快出台卫生基本法。8.加强医学基本知识及医疗卫生法律法规的宣传与普及。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;D922.16

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