对农村医疗卫生服务网底的伦理困惑研究.pdf

nullnull2352010M10SDChineseMedicalEthicsVo.l23No.5Oc.t2010对农村医疗卫生服务网底的伦理困惑研究nullnullnullgHuL4s*王晓燕,吕兆丰*,彭迎春,彭null炜(nDSv35,n35,null100069)K1!针对农村医疗卫生服务网底的道德现状,分析了在社会发展和转型中出现的道德困惑及原因:村医年老体衰和执业水准偏低的现状与农民日益增长的医疗卫生服务需求存在比较大的距离,造成医疗卫生事业的公平和可及受到挑战；村卫生室乡村医生和农村社区卫生服务中心(站)的医务人员承担着相同的医疗卫生的义务与责任,但相同的使命不同的待遇和境遇使村医的心理出现了不平衡,即村医的待遇和境遇受到挑战；随着社会经济的转轨,村医失去了原有的经济保障(集体经济后盾),村落中由血缘地缘建构的以亲情乡情为基础的道德关系,因为金钱的介入而面对考验,村民的健康利益和村医个人的生存利益成为道德矛盾的结点,村医的信誉和信任受到挑战b1oM!农村医疗卫生服务网底；实地观察；道德困惑；村医ms|!R-052nullnullnullDSM!AnullnullnullcI|!1001-8565(2010)05-0066-03ResearchontheEthicalConfusionoftheBasicLevelofRuralHealthServiceSystemnullnullnullBasedonFieldObservationinHDistrictinBeijingWANGXiao-yan,LVZhao-feng,PENGYing-chun,PENGWei(SchoolofHealthAdministrationandEducation,CapitalMedicalUniversity/CapitalResearchCenterofHealthManagementandPolicy,Beijing100069,China)Abstract:Basedontheethicalstatusquoofthebasiclevelofruralhealthservicesystem,thispaperanalyzedmoralconfusionsandcauses,includingthebiggapbetweenthelowqualificationofruralmedicalstaffandtheeverincreasingneedforhealthserviceofruralresidentswhichchallengetheequalityandacceccibilityofhealthserviceinruralareas.Besides,theruraldoctorsandmedicalstaffinruralcommunityhealthcentressharethesameobligationsandresponsibilitiesofhealthservice,butgetquitedifferentpaymentsandcircumstances,whichleadtoruraldoctorsnullpsychologicalimbanlance.Asthetransformationofsocialeconomicmode,lruraldoctorslosttheiroldeconomicguarantee(guaranteeofthecollective-ownedeconomy),andtheoldregionalbloodrelationship-basedmoralityhasbeenchallengedbytheinterventionofmonetaryrelationship,whichmakesruralresidentsnullhealthinterestsandthepersonalinterestofruraldoctorsconflictedwitheachother,andruraldoctorsnullcreditandtrustbechallegened.Keywords:BasicLevelofRuralHealthServiceSystem；FieldObservation；MoralConfusion；RuralDoctornullnullhDhW1h371bL=,Sjh,NBhaDhDAhb?ZM,jD3p9?3M,jhT7W1hGg+y1pbL4?C,h4Z414h3iD0(nV1)bVVVA,h4uD/|4h3iuD2,Z4h3i17|uD2bL=,h4Dyy(86Q)a6y(48Q)a/y(41Q),yN,h3iL6hZ4nb,4?C,+EMhhDbMg34jD3Svm,V2002M7Sk2004M7wjhTD,2009MXLC100%h；jqV2004M74.69%62009M95.67%；jM6,2010M(Sr520；jaq4(2009Mj50%,30%)；12005M:Lgjh3Sy!#1486.hiaa=4i#T$_y!%q*,h3iSy!；2007Mg31yrThD3!Bpin%(?2007null66null*:gn9#7y!9(PHR200906118)；gS9(SZ200910025006)YTnullk,:jhD3CnullnullnullgHuL4s63|),2vThD3h)3h)nh?,|#ZTsYa,800,ZThDB3bV,t13nD3ZjZsL,)jhD3iZhD,-)B4:BZTfTf,?hD3pj7n,1；6BZh3ijhD388=,D?,jhTDgS,L50%d,q0l#800TD3ibV1nullhDZ44f1DCTBQQhEhNhShBhKhY94Z44Z44Z44Z44Z44Z44Z44Z44Z43i2211113311212221u3_221133T/33333433332333344uD1144222222111112g)D35nullnull1nullV#sG1jhLCV#,1Fvg,h3i!S,1h4D3bV-jhD3jrB#ohDCjm9D3pi1v,P#D3YB18C(sm5,3V#sGb1.1null年老体衰的农民健康#守门人4?C,-HujhvjhD,vWBaEM#D3b1999MSD=E%41pD1|D=D=b,442hDYVSEh086,ThD3(D3)v$H,)871%3a1,?CCPhDM-t,7Os9,b4,5hhDNp,#hD?Ah5,81.1%$hsh.7nh,hDIh?A4.7%,10.4%$hhDIhAb6,8a3i6rmpyY,hDhrB?.Xb4,?C,Mh3y46,jrB9C5bjJ9a,2008M,75ha#ha0?XHuy-b,bOjrBsFb6,M,g3M14y|zY/,jhR7ZjyrB,BqvzY,shD8,rBTcbyN,46hDs%v5b2nullsG4?C,jhD3rB#o,tVl3h,hyM7h38aJ8a8ih4hD,+MuCu3_(eu_)D3,hDMD3l3,MPPhDCbM,#u3QTw$Th,#h#uTQPb,-jhL=38,T/3/h3i；CT/3+Bu30,0B*,/sYh3iuusY2030s=V#+h0Wyu_bLYp,V_,vu_y!,u_B!+h0Wh,7OL8lHT,；ZL9yPu_?vu|h；6,u_9PB#L$bgM1q1p,jhuu32000g1!SD3auVr1,u_L9/9?12lH7?TH,vE5?8lH(/89:)null67nullnullFnull0,:B_T|#*5TD5nullnullnullEgD,H,D?Z7,5aZED?ZbID!1null卢妙云,黎庆芬,郑定容.妇产科门诊#一站式服务模式的实施J.家庭护士,2008,6(4):912-913.2null胡建伟,方佩英,谢卫星.现代化多功能#一站式服务中心J.中华医学研究杂志,2003,3(11):1054-1055.3null李佳,仁长海,向红星.医院#一站式服务模式的探讨J.现代医院,2005,5(2):65-66.4null梁志翔.综合医院开展#一站式服务的实践与效果J.中国护理管理,2006,6(1):28-29.5null郑大喜.基于人文关怀的医院绩效管理与薪酬激励J.中国医学伦理学,2009,22(4):42-44.Te!F0(1973-),o,E,9=,VbZ_:5blnull2010-06-02!null2010-08-03!编nullnull辑null张null茜!(67:)T,Bu_1!|J,N-vsu_VC7b5,u_hDh3ihD#B,h3ihD9600/M,_hD24000/Mb6,u_u3,$,jhTDgSb7hDSE800,L50%d,q0TlbyN,hDQ#,u_D33M#|300!VU,QKhhDVU,VDA,4D3；VA,X；#h3i?ZypH,4hDl$3,VDBa?YhD6p(86)713iH,hyTfTf$1,y+7Ib,D1$,$,hD1yP7CbBZ,T8,1-3i?Z1,m；6BZ,T,8i?Z1,8mbV7Pm1C88+bmZ4i,75)m1,AB5bVBhD-C,hrBm3imbhDh+EMTrhrB,BrB,3iMaiM,MjhD3,P9B1w,1-)jhD3K-,h1hDb6H,hDD3PhM,44.3%$h9E1-?ShDb,hD3i,iC9VjCLb4?C,31phD050%,q0,h3id,q060%P(hD),L=V?；h3id,q01,7,q0M,Ph?d,q0b6,hD4D3Z,3Li,=Q33h3i,61.8%hDVU,4310%40%,32.4%hDVU50%；BhhDVU60%bH,3rIT,thD&3H,1bAh03ob,h,9hh3i0VUP,hDVUbtCi,YhD,YhhDh1bVCd,VjbID!1null北京市卫生宣传中心.关爱农民健康,共保农民健康nullnullnull北京市新农合参合率达到96%EB/OL./news.do?dispatch=readById&id=29071#,2010-01-11.2null北京市人民政府办公厅.北京市人民政府办公厅转发市卫生局等部门关于建立健全乡村医生社会养老保险制度与基本待遇保障机制意见的通知Z.京政办发200763号.3null陈竺.在2010年全国卫生工作会议上的工作报告EB/OL./publicfiles/business/htmlfiles/mohzcfgs/s3582/201002/45911.htm,2010-02-12.4null中华人民共和国执业医师法Z.中华人民共和国主