我国西部地区劳教场所卫生服务供给与需求研究
发布时间：2018-07-13 17:22
【摘要】： 研究背景和目的 2005年底,全世界监狱等监管场所里大约收押着800—1000万囚犯,而由于周转速度快,每年经历过监狱生活的人数是这一数字的4—6倍。美国、中国、俄罗斯三国羁押了大约全世界50%的囚犯。由于被羁押前社会地位低、贫困、受教育程度低等原因,以及违法犯罪所致的精神紧张、漫长的司法审理过程和羁押生活,使得被监管人员的身体、精神健康都受到负面影响,导致健康状况比一般社会人群差。 劳动教养是我国特有的一项政治制度,是为维护社会治安,预防和减少犯罪,对轻微违法犯罪人员实行的一种强制性教育改造的行政措施,劳动教养的期限为1—3年。收容、管理劳动教养人员的场所称为劳动教养所,是一类特殊的监管场所。 我国政府高度重视对包括劳教人员在内的各类被监管人员健康权的保护,采取各种积极有效措施开展被监管人员的健康保护和健康促进工作,明确政府对被监管人员医疗保健的责任,保障其依法获得基本卫生服务。我国劳教人员的医疗卫生服务由司法行政部门所属的劳教所负责组织提供,接受卫生部门的指导。 从20世纪70年代开始,由于认识到保障囚犯的健康权的必要性和囚犯健康对公共卫生所具有重要影响,西方国家开始越来越多的关注囚犯的卫生问题,开展了多方面的研究。但在我国,监狱、劳教所的卫生问题较少受到公共卫生部门的关注。本研究的主要目的是通过描述劳教人员健康状况和劳教所卫生服务供给体系,分析劳教人员的卫生服务利用状况,发现劳教人员卫生服务保障工作中存在的主要问题,提出关于劳教所卫生服务组织提供模型的建议,为政府有关部门决策提供参考和依据。 研究方法 本研究设计为描述性研究,客观描述劳教所卫生服务需求、供给、利用的基本情况,并分析其基本特点。研究资料主要来自现有文献和政策文件的收集,样本劳教所的问卷调查,劳教人员问卷调查和关键人物访谈等四个方面。本研究在广西、重庆和云南三省(区、市)的12个劳教所开展调查,采用随机抽样的方法确定并调查了1721名劳教人员,与75名关键人员进行了访谈。资料收集工具利用了研究人员设计的调查表、访谈提纲,山东大学卫生管理与政策研究中心的老师、研究生和当地医学院校的在校学生在2007年7月20日至8月8日期间进行了现场资料收集。采取定性分析与定量相结合的方法进行分析,包括内容分析法、单因素、多因素分析等。本研究充分考虑到了被监管人员的特殊性,调查过程中注重尊重劳教人员的知情权和保护其隐私权。 主要结果 劳教所是我国政府对轻微违法犯罪人员实施强制性教育改造的场所,由警察具体负责管理。全国共有348个劳教所,5.6万名警察,200年以来在所劳教人员数量保持在20万人以上。劳教人员在劳教所内的各种活动受警察管理,必须接受各种教育、参加生产劳动,生活规律。警察依据劳教人员的表现给予不同的处遇,表现好的劳教人员可以放假回家。 劳教人员健康高危行为,如吸烟、饮酒、吸毒、多性伴、纹身等发生率高。接受调查的1721名劳教人员中有94.8%吸烟,有超过半数(54.9%)的劳教人员入所前有饮酒的习惯。 1721名劳教人员中,1580人(91.8%)有吸毒的经历,开始吸毒的年龄平均为22.5岁,吸毒时间平均为11.5年,即平均34年的人生历程中约1/3是在吸毒的陪伴下度过的。吸食毒品的种类以海洛因为主,且有12%的吸毒人员存在多药物滥用现象。88.3%的吸毒者采取注射方式吸毒,45.5%注射吸毒者曾经发生过至少1次因吸毒过量导致昏迷。 94.5%的劳教人员曾经与其他人发生性行为,且84%都有2个以上的性伴。在曾经发生性行为的1584名劳教人员中,平均每人曾与17.5个异性发生性关系,在发生性行为时,49.8%从来不使用安全套,仅有7.1%总是使用安全套。 1721名接受调查的劳教人员中,有638人(37%)认为自己健康状况“好”或“很好”.其中云南高于广西和重庆,年龄越小比例越高,吸毒人群比例低于非吸毒人员。以10分为满分,劳教人员自评健康得分为平均6.2分。相对于1年前的健康状况,28.1%认为好于1年前,而42.3%认为1年来健康状况呈下降趋势。 劳教人员中结核病、艾滋病、肝炎、性病等传染性疾病患病率较高。接受调查的人员中有71人现患结核病,患病率为4126/10万,艾滋病、肝炎、性病、心脑血管疾病患病率分别为2.9%、9%、6.9%和4.4%。有5%的劳教人员曾经在此次劳教期间曾想到过自杀,有8.3%曾经有过自伤或自残的想法。 劳教所的卫生服务提供由司法行政部门负责组织管理,而不是由卫生行政部门负责。各省司法厅(局)劳教局、各劳教所内设生活卫生职能部门,具体负责医疗卫生工作。劳教系统从事卫生管理工作的人员专业化水平低,负责卫生工作的劳教局机关、劳教所机关干部很少具有卫生背景。 对广西、重庆7个劳教所的测算结果显示,每个劳教所平均年支出2300万,其中卫生支出为71.5万元,占3.1%。卫生经费中,劳教人员医疗费为31.7万元,占卫生支出的44%。劳教人员年人均卫生支出为373元,其中医疗费165元。 劳教所医生同时也是警察,具有双重身份。在劳教所工作的医务人员与社会一般医院的医务人员相比,人员少工作量大、技术水平低、发生职业暴露的危险性大。 司法部对如何组织开展劳教所的医疗卫生工作提出了较为明确和具体的规定。对12个样本劳教所的调查发现,劳教所采取多种方式为劳教人员提供卫生服务,包括入所体检、常规体检、健康教育、巡诊、因病伤就诊、住院、送社会医院就诊、所外就医等。公共卫生部门对劳教系统提供了一定的支持和协助,对劳教所医疗卫生工作提供技术支持、资金支持,对重大疾病的防治给予指导和帮助。 劳教所卫生服务供给具有强制性、非独立性、免费性、总体水平低等特点。影响劳教所提供卫生服务的因素包括:劳教所设定的目标、工作的规定和上级要求、劳教人员健康状况、财政保障水平、医疗服务成本、市场价格、所外就医政策等。 81%的劳教人员都曾接受过医生单独的诊断或治疗,平均每人每年接受5.1次。33%的劳教人员报告曾出现过有病不主动就医的情况,主要原因包括怕麻烦、效果不好、需要花钱等。 75%的劳教人员认为在需要的时候,能够获得劳教所提供的卫生服务,且有36%的劳教人员认为在劳教所比在社会上更容易获得卫生服务。75%的劳教人员认为劳教所的治疗效果不如社会医院好。 影响劳教人员对卫生服务利用的因素包括两个方面,其中供方因素决定了可利用资源的数量、质量,是重要的影响因素。 建议 建议政府有关部门进一步明确劳教人员具有获得卫生服务的权利,并充分认识到劳教所是社会公共卫生、疾病控制的良好机遇,明确劳教卫生是卫生部门、司法行政部门共同的责任。 建议提高劳教所卫生服务提供的能力,促进劳教所对卫生工作的投入,规范劳教所卫生服务机构的设置和管理,加强卫生机构建设,规范劳教所医务人员管理,建立劳教所医务人员激励和制约机制。继续开展入所体检、健康教育、健康档案、定期体检、巡诊、所内门诊、住院、专家会诊、所外就医等各项工作,并完善各项制度,保障病有所医。对病重且无法办理所外就医的劳教人员,应允许劳教人员及其家属从所外购买医疗服务。 建议促进与卫生部门的合作,加强对重大疾病的预防控制。建议来自卫生领域的专家与监管场所领域的专家合作,继续深入开展研究。
[Abstract]:Background and purpose of research
At the end of 2005, there were about 800 to 10 million prisoners in the prison and other regulatory sites around the world, and the number of people who had lived in prison every year was 4 to 6 times as fast as they had been working. The United States, China, and Russia have detained about 50% of the world's prisoners. Because of the mental tension caused by the illegal crimes, the long judicial process and the detention life, the physical and mental health of the supervised personnel have been negatively affected, and the health situation is worse than the general population.
Reeducation through labor is a special political system in our country. It is an administrative measure for the maintenance of social security, prevention and reduction of crime and a compulsory education reform for minor offenders. The period of reeducation through labor is 1 to 3 years. All of them.
The government of our country attaches great importance to the protection of the health rights of all supervised personnel, including labor and education personnel, and takes various active and effective measures to carry out the health protection and health promotion of the supervised personnel, clear the responsibility of the government to the health care of the supervised personnel and guarantee its basic health services according to law. The medical treatment service is provided by the reeducation through Labor Department of the judicial administrative department and is subject to the guidance of the health department.
Since 1970s, since the need for the protection of the right to health of prisoners and the important impact of the health of prisoners on public health, more and more attention has been paid to the health problems of prisoners in western countries, but in our country, the health problems of prisons and labour institutions are less closely related to the public health sector. The main purpose of this study is to analyze the health service utilization status of the workers and find out the main problems in the work of health service guarantee in labor education personnel through describing the health status of the workers and the health service supply system of the Labor Education Institute. The decision provides reference and basis.
research method
This research is designed as a descriptive study, which objectively describes the basic conditions of the demand, supply and utilization of the health service, and analyzes its basic characteristics. The research materials are mainly from the collection of existing literature and policy documents, the questionnaire survey of sample labour education, the survey of the questionnaire and the interview of key figures in the four aspects. This study is in Guangxi 12 labor education institutes in Chongqing and Yunnan provinces (district and city) conducted a survey, adopted random sampling methods to determine and investigate 1721 workers in labor education and interviewed 75 key personnel. The data collection tools used the questionnaire designed by the researchers, the interview outline, the teacher of the Shandong University health management and Policy Research center, the graduate student, and the graduate student. The local medical college students were collected from July 20, 2007 to August 8th. The method of combining qualitative analysis and quantitative analysis was carried out, including content analysis, single factor, multi factor analysis, etc. This study fully took into account the particularity of the supervised personnel, and paid attention to respect for labor education in the process of investigation. The right to know and to protect the right to privacy.
Main results
The Institute of labour education is a place for the government to carry out compulsory education reform for minor offenders. The police are in charge of the management. There are 348 labor education institutes and 56 thousand police officers in the country. The number of workers in the labour education has been maintained over 200 thousand people over the past 200 years. The various activities of the workers in the labor education institute are managed by the police and must be taught all kinds of teaching. In accordance with the performance of reeducation staff, the police give different treatment, and the reeducation workers who perform well can go home on vacation.
The rate of health and high risk behavior, such as smoking, drinking, drug use, sexual partners, and tattooing, was high. 94.8% of the 1721 workers surveyed were smoking, and more than half (54.9%) of the workers had a habit of drinking.
Of the 1721 workers, 1580 (91.8%) had the experience of drug abuse, the average age of drug taking was 22.5 years old and the average time of drug use was 11.5 years. That is, about 1/3 was spent on the average of 34 years of life. The types of drug addicts were mainly heroin, and 12% drug addicts had the phenomenon of multi drug abuse.88.3%. Drug users took drugs by injection, and 45.5% injecting drug users had at least 1 cases of coma due to overdose.
94.5% of the workers had sex with other people, and 84% had more than 2 sex partners. Among the 1584 workers who had sex, the average person had sex with 17.5 heterosexual persons. In the case of sexual behavior, 49.8% never used condoms and only 7.1% always used condoms.
Of the 1721 workers surveyed, 638 (37%) believed that their health was "good" or "good". Yunnan was higher than Guangxi and Chongqing. The higher the age was, the higher the age, the proportion of the drug addicts was lower than that of non drug users. 10 was a full score, and the self-assessment health score of the workers was 6.2. 28. compared to 1 years ago, 28. 1% thought it was better than 1 years ago, while 42.3% thought it was a downward trend in 1 years.
The prevalence rates of infectious diseases such as tuberculosis, AIDS, hepatitis and venereal disease were higher among the workers. Among the people surveyed, 71 people were suffering from tuberculosis, the prevalence rate was 4126/10 million, AIDS, hepatitis, venereal diseases, and cardiovascular and cerebrovascular diseases were 2.9%, 9%, 6.9% and 4.4%., 5% of the workers who had thought of suicide during the period of the labor education. 8.3% had thought about self injury or self disability.
The health service provided by the labor education institute is organized and managed by the administrative department of the judiciary, not by the Department of health administration. The Department of labor and education of the Provincial Department of Justice (bureau) and the living health functional departments of the various labour institutions are in charge of medical and health work. The staff of the labor education system are engaged in health management workers with low professional level and responsible for the work of health work. There are few hygienic backgrounds in the educational institutions and the cadres of the reeducation institutions.
In Guangxi and Chongqing, the results of 7 labor education institutes in Chongqing showed that the average annual expenditure of each labor education was 23 million, of which the health expenditure was 715 thousand yuan, and that of 3.1%. health expenditure, the medical expenses of the workers were 317 thousand yuan, and the annual per capita health expenditure of the workers in the health expenditure was 373 yuan, of which the medical expenses were 165 yuan.
The doctor of labor education is also a police and has a dual identity. Compared with the medical staff in the general hospital, the medical staff working in the Labor Education Institute have a large amount of work, low technical level and a great risk of occupational exposure.
The Ministry of justice has made clear and specific provisions on how to organize the medical and health work of the Institute of labor education. A survey of 12 samples of the Labor Education Institute found that the Labor Education Institute provided a variety of ways to provide health services for the workers, including medical examination, routine physical examination, health education, inspection, medical treatment, hospitalization, and medical treatment in a social hospital. The public health department has provided some support and assistance to the labor education system. It provides technical support to the medical and health work of the Labor Education Institute, funds support, and gives guidance and help to the prevention and treatment of major diseases.
The health service supply of the Labor Education Institute has the characteristics of compulsory, non independent, free and low overall. The factors that affect the health service provided by the labor education are: the objectives set by the labor education, the regulations and the higher requirements of the work, the health status of the workers, the level of financial security, the cost of medical services, the market price, and the policy of medical treatment outside.
81% of the workers had received a doctor's own diagnosis or treatment. The average person received 5.1.33% workers per year to report that there had been a case of diseased and non active medical treatment. The main reasons include the fear of trouble, the bad effect, and the need to spend money.
75% of the staff members think that when they need it, they can get the health services provided by the labor education, and 36% of the workers think that the workers who are more likely to get health service.75% in the society than in the society think that the treatment effect of the labor education institute is not as good as the social hospital.
The factors affecting the utilization of health service personnel include two aspects, in which the supplier factors determine the quantity and quality of the available resources, which are important factors.
proposal
It is suggested that the relevant government departments should further clarify the right to obtain health services, and fully realize that the Institute is a good opportunity for social public health and disease control. It is the common responsibility of the health department and the administrative department of the judiciary to clarify that the health education is a good opportunity for Disease control.
It is suggested to improve the capacity of the health service provided by the Labor Education Institute, promote the investment in the health work of the Labor Education Institute, standardize the establishment and management of the health service institutions of the Labor Education Institute, strengthen the construction of the health institutions, standardize the management of the medical staff in the Labor Education Institute, and establish the medical personnel of the labor education institute to encourage and restrict the machine system. Regular physical examination, inspection, clinic, hospitalization, expert consultation, and outside medical treatment and so on, and improve the system to ensure the medical treatment. For the workers who are ill and unable to handle the medical treatment outside, the workers and their families should be allowed to purchase medical services from outside.
It is suggested that cooperation with the health sector should be promoted to strengthen prevention and control of major diseases. Experts from the field of health are advised to cooperate with experts in the field of regulatory areas to continue to carry out in-depth research.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：D926.8
本文编号：2120159
[Abstract]:Background and purpose of research
At the end of 2005, there were about 800 to 10 million prisoners in the prison and other regulatory sites around the world, and the number of people who had lived in prison every year was 4 to 6 times as fast as they had been working. The United States, China, and Russia have detained about 50% of the world's prisoners. Because of the mental tension caused by the illegal crimes, the long judicial process and the detention life, the physical and mental health of the supervised personnel have been negatively affected, and the health situation is worse than the general population.
Reeducation through labor is a special political system in our country. It is an administrative measure for the maintenance of social security, prevention and reduction of crime and a compulsory education reform for minor offenders. The period of reeducation through labor is 1 to 3 years. All of them.
The government of our country attaches great importance to the protection of the health rights of all supervised personnel, including labor and education personnel, and takes various active and effective measures to carry out the health protection and health promotion of the supervised personnel, clear the responsibility of the government to the health care of the supervised personnel and guarantee its basic health services according to law. The medical treatment service is provided by the reeducation through Labor Department of the judicial administrative department and is subject to the guidance of the health department.
Since 1970s, since the need for the protection of the right to health of prisoners and the important impact of the health of prisoners on public health, more and more attention has been paid to the health problems of prisoners in western countries, but in our country, the health problems of prisons and labour institutions are less closely related to the public health sector. The main purpose of this study is to analyze the health service utilization status of the workers and find out the main problems in the work of health service guarantee in labor education personnel through describing the health status of the workers and the health service supply system of the Labor Education Institute. The decision provides reference and basis.
research method
This research is designed as a descriptive study, which objectively describes the basic conditions of the demand, supply and utilization of the health service, and analyzes its basic characteristics. The research materials are mainly from the collection of existing literature and policy documents, the questionnaire survey of sample labour education, the survey of the questionnaire and the interview of key figures in the four aspects. This study is in Guangxi 12 labor education institutes in Chongqing and Yunnan provinces (district and city) conducted a survey, adopted random sampling methods to determine and investigate 1721 workers in labor education and interviewed 75 key personnel. The data collection tools used the questionnaire designed by the researchers, the interview outline, the teacher of the Shandong University health management and Policy Research center, the graduate student, and the graduate student. The local medical college students were collected from July 20, 2007 to August 8th. The method of combining qualitative analysis and quantitative analysis was carried out, including content analysis, single factor, multi factor analysis, etc. This study fully took into account the particularity of the supervised personnel, and paid attention to respect for labor education in the process of investigation. The right to know and to protect the right to privacy.
Main results
The Institute of labour education is a place for the government to carry out compulsory education reform for minor offenders. The police are in charge of the management. There are 348 labor education institutes and 56 thousand police officers in the country. The number of workers in the labour education has been maintained over 200 thousand people over the past 200 years. The various activities of the workers in the labor education institute are managed by the police and must be taught all kinds of teaching. In accordance with the performance of reeducation staff, the police give different treatment, and the reeducation workers who perform well can go home on vacation.
The rate of health and high risk behavior, such as smoking, drinking, drug use, sexual partners, and tattooing, was high. 94.8% of the 1721 workers surveyed were smoking, and more than half (54.9%) of the workers had a habit of drinking.
Of the 1721 workers, 1580 (91.8%) had the experience of drug abuse, the average age of drug taking was 22.5 years old and the average time of drug use was 11.5 years. That is, about 1/3 was spent on the average of 34 years of life. The types of drug addicts were mainly heroin, and 12% drug addicts had the phenomenon of multi drug abuse.88.3%. Drug users took drugs by injection, and 45.5% injecting drug users had at least 1 cases of coma due to overdose.
94.5% of the workers had sex with other people, and 84% had more than 2 sex partners. Among the 1584 workers who had sex, the average person had sex with 17.5 heterosexual persons. In the case of sexual behavior, 49.8% never used condoms and only 7.1% always used condoms.
Of the 1721 workers surveyed, 638 (37%) believed that their health was "good" or "good". Yunnan was higher than Guangxi and Chongqing. The higher the age was, the higher the age, the proportion of the drug addicts was lower than that of non drug users. 10 was a full score, and the self-assessment health score of the workers was 6.2. 28. compared to 1 years ago, 28. 1% thought it was better than 1 years ago, while 42.3% thought it was a downward trend in 1 years.
The prevalence rates of infectious diseases such as tuberculosis, AIDS, hepatitis and venereal disease were higher among the workers. Among the people surveyed, 71 people were suffering from tuberculosis, the prevalence rate was 4126/10 million, AIDS, hepatitis, venereal diseases, and cardiovascular and cerebrovascular diseases were 2.9%, 9%, 6.9% and 4.4%., 5% of the workers who had thought of suicide during the period of the labor education. 8.3% had thought about self injury or self disability.
The health service provided by the labor education institute is organized and managed by the administrative department of the judiciary, not by the Department of health administration. The Department of labor and education of the Provincial Department of Justice (bureau) and the living health functional departments of the various labour institutions are in charge of medical and health work. The staff of the labor education system are engaged in health management workers with low professional level and responsible for the work of health work. There are few hygienic backgrounds in the educational institutions and the cadres of the reeducation institutions.
In Guangxi and Chongqing, the results of 7 labor education institutes in Chongqing showed that the average annual expenditure of each labor education was 23 million, of which the health expenditure was 715 thousand yuan, and that of 3.1%. health expenditure, the medical expenses of the workers were 317 thousand yuan, and the annual per capita health expenditure of the workers in the health expenditure was 373 yuan, of which the medical expenses were 165 yuan.
The doctor of labor education is also a police and has a dual identity. Compared with the medical staff in the general hospital, the medical staff working in the Labor Education Institute have a large amount of work, low technical level and a great risk of occupational exposure.
The Ministry of justice has made clear and specific provisions on how to organize the medical and health work of the Institute of labor education. A survey of 12 samples of the Labor Education Institute found that the Labor Education Institute provided a variety of ways to provide health services for the workers, including medical examination, routine physical examination, health education, inspection, medical treatment, hospitalization, and medical treatment in a social hospital. The public health department has provided some support and assistance to the labor education system. It provides technical support to the medical and health work of the Labor Education Institute, funds support, and gives guidance and help to the prevention and treatment of major diseases.
The health service supply of the Labor Education Institute has the characteristics of compulsory, non independent, free and low overall. The factors that affect the health service provided by the labor education are: the objectives set by the labor education, the regulations and the higher requirements of the work, the health status of the workers, the level of financial security, the cost of medical services, the market price, and the policy of medical treatment outside.
81% of the workers had received a doctor's own diagnosis or treatment. The average person received 5.1.33% workers per year to report that there had been a case of diseased and non active medical treatment. The main reasons include the fear of trouble, the bad effect, and the need to spend money.
75% of the staff members think that when they need it, they can get the health services provided by the labor education, and 36% of the workers think that the workers who are more likely to get health service.75% in the society than in the society think that the treatment effect of the labor education institute is not as good as the social hospital.
The factors affecting the utilization of health service personnel include two aspects, in which the supplier factors determine the quantity and quality of the available resources, which are important factors.
proposal
It is suggested that the relevant government departments should further clarify the right to obtain health services, and fully realize that the Institute is a good opportunity for social public health and disease control. It is the common responsibility of the health department and the administrative department of the judiciary to clarify that the health education is a good opportunity for Disease control.
It is suggested to improve the capacity of the health service provided by the Labor Education Institute, promote the investment in the health work of the Labor Education Institute, standardize the establishment and management of the health service institutions of the Labor Education Institute, strengthen the construction of the health institutions, standardize the management of the medical staff in the Labor Education Institute, and establish the medical personnel of the labor education institute to encourage and restrict the machine system. Regular physical examination, inspection, clinic, hospitalization, expert consultation, and outside medical treatment and so on, and improve the system to ensure the medical treatment. For the workers who are ill and unable to handle the medical treatment outside, the workers and their families should be allowed to purchase medical services from outside.
It is suggested that cooperation with the health sector should be promoted to strengthen prevention and control of major diseases. Experts from the field of health are advised to cooperate with experts in the field of regulatory areas to continue to carry out in-depth research.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：D926.8
【引证文献】
相关硕士学位论文 前1条
1 陈春辉;我国劳教场所与卫生部门合作机制研究[D];山东大学;2010年
，本文编号：2120159
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