城乡医疗卫生资源配置公平化的伦理分析.pdf

http:Enullmail:SDChineseMedicalEthicsnull2011M2Feb.2011null241Vol.24No.1城乡医疗卫生资源配置公平化的伦理分析*卢丹萍,王晓萍(DBD,nullnull325000)qK1rnull从伦理学角度研究与探讨医疗卫生资源分配中存在的问题,为优化城乡医疗卫生资源配置提供可行性对策bZEnull通过对温州苍南a永嘉a龙湾a双屿a平阳5个县(区)的957名农民的抽样调查和数据分析,探讨我国城乡医疗卫生资源分配现状bTnull我国城市和农村在医疗保障资金a医疗设施a医护人才等方面都存在巨大差距bnull卫生资源配置中的伦理缺失现象,是导致城乡医疗保障差距,使得城乡居民卫生服务利用的公平性严重受损的重要因素b应积极采取措施优化城乡医疗卫生资源配置bq1oMr城乡医疗卫生；资源配置；公平性；伦理分析qms|rR-052nullnullnullnullqDSMrAnullnullnullnullqcI|r1001-8565(2011)01-0114-03nullEthicalAnalysisontheEquitableAllocationofHealthResourcesbetweenUrbanandRuralAreasLUDan-ping,WANGXiao-ping(TheFirstAffiliatedHospitalofWenzhouMedicalCollege,Wenzhou325000,China)Abstract:Object:Toresearchtheproblemsexistedintheallocationofhealthresourcesfromtheethicaldinullrectionandprovidefeasiblecountermeasuresforoptimizingtheallocationofhealthresourcesbetweenurbanandrunullralareas.Methods:Bymeansofsamplinginvestigationof957farmersfromWenzhouinZhejiangprovince,arenullsearchisconductedonthestatusquooftheallocationofhealthresourcesbetweenurbanandruralareasinChina.Result:Hugegapsexistedintermsofmedicalsecurityfund,medicalinstallationsandmedicaltalentsbetweenurnullbanandruralareasinChina.Conclusion:Defficiencyofmedicalethicsexistedintheallocationofhealthresourcesistheimportantfactorwhichleadstoallocationgapsbetweenurbanandruralhealthresourcesandmakestheequityofusingmedicalservicebyurbanresidentsandruralfarmersseriouslydamaged.Moreeffectivemeasuresshouldbetakentooptimizetheallocationofhealthresources.Keywords:UrbanandRuralHealth；ResourcesAllocation；Equity；EthicalAnalysisnullnullDs5,；B65,9B5bsD3,1s6?Z,18CBN|_b1D3aasD1p|1D3YDS/?Z,1rBmrBb21nullTD3sC2005MS39n8659.9a,3n9n72.6%,jh27.4%；STgsY9,S2/3jh1/439n,71/33/439nb3Z,jh3,2006Md9V,S$g3/3.59,7$jgThD331.11,S(biO,jh3A3/,jh3vrS.b!Z,T3!eQ,?e),9aP89nullqnullb3T(T,TrB9iYb12005Mjh8q2.4,jhq2.5b4,5F2aAaCa4E(u)#957(?b1000z,lr957z)jAU,11.49%h!h3iu3b7Or76.91%u37ZrB8_B,7ZrBa.haraMrsY11.08%a11.91%a6.69%6.48%,57Z1.25%b,5-u3,sY58.73%44.83%-u3iaflac5-7TD3s(1yBT=aTlaZ3jy,7ybjDp5n5B5,81VTDp(yb2.1null重效率轻公平rq65,9T3VNSbN6?Zy,nullrq5aY$nullZ/,#g6pKv,jhg3HVCrq,j,/V_gb7jh?j3,$!y!ajhpZg,jhp+YDpy!gbnullrqanull3,TDp1yb2.2null对农村医疗保障的定位a定性的价值偏离S6a?ZTVsj69,7D3Y=Y?Zjb)Vsp69qaGDPl9S,i|N,a6%IS,71S$bZ)GDPalSI/,1KjhDg,/3g,3sb82.3null城市医院盲目扩张BsDYVvf,YVvFD3!LC6rmbC1?3gbygD,vD,6/Hqz,Fgga6M?raD3?Op,#vnaDZsi,g+Dg,F3_gb7jhD,Th),0a/,g,Fjh6?ZjD3?p,43f,v/!4LCb9,g6Hq/tT6HqsT,FT3snullrnullb2.4null制度实施过程中的伦理缺失%jD35,SV2003M7SS8gukwjhTD,i2006M,Fv,2010MLCjhTDjhSb#vj,%jyhayhR5V,iBtu,.kTLa?5PjYjrB5,?j*|),sj,Bjm,YjrBb3nullT3n!Ev,1FyyTp8,p3bydT?ZDp8,Sp?ZVAb)D1FvlTDp3,yQjhDp8,+Y1jD8b3.1null促进卫生公平3；6?ZSB,96?ZHqb2007Mo3Matlinq,B8SNSE3d,ySSf；,BSEZ3p,N3d1yb4S3YBmY,1pA4T34pb1jhDpg513,e35,FvSEjhD3YMb3.2null加强乡镇卫生院建设T3jh31Fs,3,84arD,isE)3,*u=35?,ZLjDapjrB?Tb)AFyT3D3!y!B,Fvg5DN!,T3THq3Hq,T33?b3.3null鼓励高素质人才就职基层卫生院3Dm,4D3rqa,Qap1b9SEaZ|rna3/a5-T(h)3(),V7Mjh3M,jh3Y?ZbkBt,|T3BE)DdB5,9D；9D5*T3YaaZLB85TbT3D39DdB5,YVVsD,T3?D3,/CT37A,jDp,46rmrmb3.4null建立健全双向转诊机制_BzK3as43rqb103ynull115nullhttp:Enullmail:SDChineseMedicalEthicsnull2011M2Feb.2011null241Vol.24No.1MLVTZ,dB?/a5aS,HyZu38vDD,_rLbN$,gvDV1&5,nullYinullnull?nulllDT3T1-s,V7_jh4D)bDvDs1FT,7OVYT,Dib3.5null多渠道筹集农村医疗保障资金5SjhDpy!5bSjhgaSEK,1y8ajDp,LSECLb1pB,YVZTDpbSEV?jhrBpOjhrBp,SOlBjhrBp,|zjhrBp,VFv,DB1bH,1yr,Zvaxa_a,9aa3FS5,_,S#Ha-P5fbqIDr1null高丽敏.试论医疗经济活动中的伦理道德标准和价值取向J.中国卫生资源,2006,9(3):102-103.2null董振贵.医疗卫生资源分配的医学伦理要求J.中国医院管理,1987,7(3):14-18.3null袁蓓蓓.优化城乡卫生资源配置的经济学分析J.卫生软科学,2007,21(5):419-422.4null夏新斌.科学发展观与城乡卫生资源统筹发展nullnullnull建国60年我国卫生事业发展战略反思J.卫生经济研究,2009,(10):5-7.5null刘金伟.城乡卫生资源配置的null倒三角null模式及其成因J.调研世界,2006,(3):22-25.6null张秋雁.我国城乡医疗保障存在差距的原因及应对策略J.陕西行政学院学报,2008,22(2):43-45.7null吴雯,王玲,张翔.浅议新医改形势下农村基本公共卫生服务均等化问题J.医学与社会,2010,23(5):33-35.8null周麟.当前中国农村医疗保障制度的伦理思考J.中国医学伦理学,2006,19(4):68-69.9null张书昌,郑亚东.卫生人力资源配置对医疗服务公平性影响的伦理思考J.中国医学伦理学,2009,22(5):79-81.10null陈佳,黄淇敏,崔勇,等.大医院开展双向转诊的研究J.中国医院,2008,12(6):16-20.qlnull2010-08-31rqnull2010-10-21rq编nullnull辑null李恩昌r(110:)T?b3V5DTBv,)bMQ,7,TsuHv,#HafaZ4aA1HhuHvVb4B?3DY#p,ZA1-VpbuHv?8CX,8ZmbuHvL,Dt,3Dv,3,baoaLDt)E9H94:t,-,D,D3zbYBZ,D3smb1Qy:tyDD37v)ZSv_?-yDY#?DyD1,D?D3zDy!r?3,y1D3,%T,3,vb)DtSE_D3,BZms,bqIDr1null卢顺珍,陈惠良.医疗纠纷调解机制研究J.牡丹江大学学报,2009,18(8):82.2null陈惠良.论医疗免责条款的法律规制J.中国卫生事业管理,2007,(6):399.3null中华人民共和国国务院.医疗事故处理条例EB