基于慢性病轨迹的我国慢性病干预研究

发布时间：2018-06-08 07:57

本文选题：慢性病轨迹 + 慢性病干预　；参考：《南京大学》2017年硕士论文

【摘要】：随着工业化、城市化的发展,医疗水平的提升,人均寿命的延长,疾病谱已发生改变,以心脑血管疾病、癌症、糖尿病以及慢性呼吸道疾病为主的慢性病成为人类死亡的第一主因。对个人而言,慢性病不仅是对健康的巨大威胁,也是导致贫困的重要原因,贫困人口往往更容易陷入贫困与慢性病的恶性循环;对于国家而言,慢性病对劳动力的侵蚀、导致的巨大医疗负担等都对国家经济造成了极大的损害,对国家的可持续发展造成巨大威胁。在此背景下,WHO号召各成员国加强对慢性病的重视和干预,并出台了《全球慢性病行动计划》以指导各国的慢性病防控工作。我国作为世界第一人口大国,在人口老龄化背景下的慢性病形势日益严峻,慢性病患病率呈逐年上升趋势,慢性病造成的疾病负担日益加重,不仅对医疗保险基金的可持续造成了威胁,也是造成贫困的重要原因之一,此外其严重削弱了患者的劳动效率,对我国劳动力的侵蚀直接影响到了国家的经济发展,因而是我国急需解决的重点民生问题之一。尽管我国已经开始构建覆盖城乡的慢性病防控体系,其具体实践以县(区)级行政单位为统筹,不同地区之间差异较大,且干预仍然以特定病种和特定阶段为主,此外,我国的医疗保障政策仍然以消极的收入补偿为主,这很大程度上影响了我国慢性病保障的公平性和慢性病干预效果。基于此,本文的目的在于探索适应全国、适用所有慢性病病种、贯穿全程的慢性病干预政策,实现慢性病保障政策从消极的收入补偿向积极的社会支持的转变。本文在了解我国慢性病干预研究现状的基础上,通过社会投资理论、公共卫生理论和健康管理理论分析了慢性病干预的理论基础,并从我国慢性病现状、我国慢性病干预现状和加强我国慢性病干预的必要性分析了慢性病干预的现实基础。慢性病遵循特定的发展轨迹,本文将其划分为病前阶段、病始阶段和病情持续发展阶段,依据不同阶段的特点出发实行相应的干预是实现有效的慢性病防控的必然要求。因而,本文从慢性病轨迹出发,对比分析了慢性病不同阶段的干预方式,为加强我国的慢性病干预提供借鉴;最后基于上述分析并结合我国慢性病干预面临的机遇,为加强我国慢性病干预提出了政策建议。首先是构建贯穿慢性病全程的慢性病干预模式,病前阶段通过国家政策—媒体宣传—重点场所干预实施对慢性病危险因素的干预;病始阶段通过面向慢性病高发年龄段(35岁以上)人群的健康体检筛查出慢性病危险人群并实施分级管理,包括职工健康检查和城乡居民免费健康检查;病情持续发展阶段通过社区医生首诊—专科医生或住院治疗—社区后续管理的路径对所有慢性病患者提供慢性病管理。其次是完善我国慢性病干预的支持体系,政策方面,逐步实现国家慢性病政策从保障向投资的转变,并且通过确保资金支持以及将慢性病政策融入所有社会政策中来为慢性病干预营造积极的政策环境;此外,利用互联网技术来构建以电子健康档案为突破口的动态共享信息系统,以此来为慢性病决策提供支持;在医疗保障方面,通过构建更加完善的慢性病医疗保障政策来消除慢性病患者的后顾之忧,从而缓解因慢性病致贫的现象;针对医疗管理服务的提供,本文提出要加强对全科医生、全科护士和健康管理人员的培养,提升基础医疗卫生机构的服务水平,确保慢性病相关服务的可及性和专业性;同时通过激励政策动员各方参与慢性病干预的积极性。
[Abstract]:With the development of industrialization, urbanization, the improvement of medical level, the prolongation of the life expectancy, the disease spectrum has changed. Chronic diseases with cardiovascular and cerebrovascular diseases, cancer, diabetes and chronic respiratory diseases have become the first major cause of human death. For individuals, chronic diseases are not only a huge threat to health, but also poverty. The important reason is that the poor people tend to be more vulnerable to the vicious cycle of poverty and chronic diseases. For the country, the erosion of the labor force and the huge medical burden caused by the chronic diseases have caused great damage to the national economy and a great threat to the sustainable development of the country. In this context, WHO calls on the member countries to strengthen the right With the attention and intervention of chronic diseases, the global chronic disease action plan has been introduced to guide the prevention and control of chronic diseases in various countries. As the first population in the world, the chronic disease situation is becoming increasingly severe in the background of population aging, the prevalence rate of chronic diseases is increasing year by year, and the burden of chronic diseases is increasing, not only to medical treatment, but not only for medical treatment. The sustainability of the insurance fund has caused a threat and one of the important causes of poverty. In addition, it seriously weakens the labor efficiency of the patients. The erosion of the labor force has a direct impact on the economic development of the country. Therefore, it is one of the key issues of the people's livelihood, which is urgently needed to be solved in our country. Although China has begun to build a slow coverage of urban and rural areas in China. The system of prevention and control of venereal diseases takes the administrative units of the county (District) level as an overall plan, the difference between different regions is larger, and the intervention is still dominated by specific diseases and specific stages. In addition, our country's medical security policy is still dominated by negative income compensation, which greatly affects the fairness of the chronic disease security and the chronic diseases in China. Based on this, the purpose of this paper is to explore the adaptation policy of chronic diseases to adapt to all chronic diseases and to realize the change of chronic disease guarantee policy from negative income compensation to positive social support. This article is based on the social investment theory and public investment theory on the basis of understanding the status of chronic disease intervention in China. The theoretical basis of chronic disease intervention is analyzed by common health theory and health management theory, and the practical basis of chronic disease intervention is analyzed from the current status of chronic diseases in China, the status of chronic disease intervention in China and the necessity of strengthening the intervention of chronic diseases in China. It is an inevitable requirement for effective chronic disease prevention and control to carry out the corresponding intervention according to the characteristics of different stages. Therefore, this paper, starting from the chronic disease trajectory, contrasts and analyzes the intervention methods at different stages of chronic diseases, and provides reference for strengthening the intervention of chronic diseases in China; finally, based on the above analysis and combination, The opportunity for chronic disease intervention in China has been proposed in order to strengthen the intervention of chronic diseases in China. First, it is to establish a chronic disease intervention model throughout the whole process of chronic diseases. The intervention of the risk factors of chronic diseases through the intervention of national policy media publicity and key sites in the pre disease stage; the beginning of the disease through the year of high incidence of chronic diseases. The health check-up of the age group (over 35 years of age) screened out the risk population of chronic diseases and carried out classification management, including health examination of workers and free health examination of urban and rural residents. The continuous development stage provided chronic diseases for all chronic patients through the path of community doctor first consultation, specialist or hospitalization treatment and community follow-up management. The second is to improve the support system of chronic disease intervention in our country, and to gradually realize the transformation of national chronic disease policy from security to investment, and to create a positive policy environment for chronic disease intervention by ensuring financial support and the integration of chronic disease policies into all social policies; in addition, the use of Internet technology to construct the policy. Building a dynamic sharing information system with electronic health archives as a breakthrough to provide support for chronic disease decision-making; in medical security, by building a more perfect chronic medical insurance policy to eliminate the worries of chronic disease patients, thus alleviating the phenomenon of poverty caused by chronic diseases, and providing medical management services. It is proposed to strengthen the training of general practitioners, general practitioners and health managers, to improve the service level of basic health care institutions, to ensure the accessibility and professionalism of chronic diseases related services, and to mobilize all parties to participate in the intervention of chronic diseases through incentive policies.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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