Twenty years of reforms have led to irreversible changes in the social environment of rural medical work and health development. The market-oriented objectives of the rural economic system reform is very clear; family contract responsibility system is still the basis of rural economic organization; tax and fee system reform, the system regulates the government and the health sector of any well-intentioned behavior must be in line with the requirements of the legal system; the construction of small towns in rural areas, the requirements to re-adjust the system of rural health services and pattern of appropriate contraction of the spatial distribution of health resources, to achieve the economies of scale; rural residents Pastoralists tend to slow down the growth trend, restricting the development of rural medical services market space.?
Only by grasping the development trend of the rural economy and society, the reform of the rural health service system to the rural socio-economic development of the broader context, in order to further expand the idea of reform and adjustment, put forward to meet the reality of the rural development of health development initiatives, in order to make the rural health care from passive adaptation to the initiative to change the reform.?
From the perspective of adapting to the objective situation of rural social and economic transformation under the conditions of the market economy, the valuable experience gained in the past rural health work to be selectively inherited, the economic transition and social transformation of the rural health work of the greatest impact and influence of health welfare and public welfare policy on the redistribution of the rural population weakened, has become an indisputable fact. Therefore, the idea of restructuring the rural health service system should also be innovative, and should not respond to all changes by remaining unchanged, or even by holding on to the past. The rural health system should be in line with the requirements of the times and the market economy, close to the rural people and in line with their wishes. It is necessary to reconstruct the rural public **** health, medical services, medical security to
and health management system on the basis of the development of rural market economy.?
The focus of the restructuring of the rural health service system is to clarify the government's responsibility for rural public **** health and for organizing and coordinating rural health work, to highlight the social, public welfare and welfare nature of rural health work, and to appropriately shrink the government's role in the urban health sector and expand the government's main or leading role in rural health work. The government should ensure health supervision and law enforcement, provide or purchase public **** health services to rural residents, advocate or organize a medical security system, and give priority to the provision or development of basic medical services.?
Adjustment of the rural medical service system should give play to social forces. Guide the state, society, collectives and individuals *** to invest together and compete on an equal footing; adjust the scale and layout of rural medical services in accordance with social needs and the specific conditions of rural areas.
Differentiated policies suitable for different regions should be formulated. In economically and transportation developed areas, rural medical service provision can rely more on the market and social forces, medical security can be socialized, industrialized, non-profit ideas to promote, from the city to the countryside; in the relatively economically backward and inaccessible areas, emphasizing the role of the government in organizing, providing, and even including the protection of rural residents in the public **** health and basic medical services, give full play to the role of the financial transfer payments to support rural health work in these areas.?
V. Policy themes and measures chosen for the reform of township health centers?
Since the reform and opening up, the economic conditions and social factors supporting the rural health service system have undergone institutional changes, and the rural three-tier health service day has seen a relatively large upheaval. In other words, the challenges facing the rural health service system are holistic, county, township and village health organizations need to make adjustments. But limited resources and policies and the contradictions accumulated over the years can not be solved in a relatively short period of time all, must choose to focus on breakthroughs.?
In much the same order as the restructuring of agricultural production organizations, there has been a bottom-up restructuring of the three levels of rural health service organizations. With the changes in the structure of village-level production organizations, village-level health organizations are basically in a financial and policy vacuum of spontaneous adjustment, from the early four decades of the violent shock, to the 1990s basically adjusted to a relatively calm and hidden stage, basically maintaining a diversified organizational system based on the collective office. It is estimated that this structure will remain stable for some time if there are no further major adjustments in the organization of rural production. County-level health organizations, although also encountered economic difficulties, but in the financial and market support, but also can maintain normal operation.?
As the hub in the three-tier rural health care network, the organization of township health centers should be the first choice for adjusting the rural health service system. Township health centers in the rural health service system in the bottleneck role, not only in its bearing the function of the next, but also with the most difficulties it faces, the urgency of the adjustment is the strongest. Township health centers have neither accomplished the task of restructuring nor have robust support conditions. In the market competition, part of the market share of township health centers has been covered by county-level health organizations, part of it has been divided by village doctors, and the efficiency of the resource profit has been declining year by year. In line with the township and village production organizational changes, township health centers need to do major surgery and adjustments, hierarchical management of the financial system and township financial woes, basically making the township health centers lose the economic dependence of the planned operation, market-oriented is the inevitable choice of the township health centers.?
Adjustment of township health organizations, so that township health centers operate in the market, should reiterate the two prerequisites, first of all, the adjustment of the township two hospitals, is not to give up the government's responsibility. Rather, it is to redefine what is the responsibility of the government, which is the responsibility of the community, which belongs to the behavior of the individual, the community has to participate in the enthusiasm and not to the detriment of the interests of rural residents, the government does not have to intervene, has been involved in the gradual withdrawal should be done, the government should do is to make up for and correct the market defects. Secondly, the adjustment of township health centers should be mutually conditional with the adjustment of county-level medical institutions. As the technical and operational center of the rural health care network, the government should concentrate its efforts and financial resources on running non-profit county-level medical institutions. On the premise of strengthening county-level medical institutions, some township health centers can be adjusted...?
From a practical point of view, some township health centers are allowed to separate medical care and prevention, and some are also allowed to continue to operate according to the current model. The functions of health management, preventive health care and medical services in health centers are appropriately separated, and health management and preventive health care are government responsibilities and should continue to be provided or purchased by the government. If there are financial difficulties at the township level, they will be resolved through financial transfers. This is the last line of defense for rural health, and it cannot be backward...?
In relatively developed economic and transportation areas, after preserving the position of preventive health care, combined with the construction of small rural towns, the market supply of medical services is greater than demand, as well as the specific circumstances of Liaoning's rural transportation is developed, merging or withdrawing a number of health centers. Concentrate the government or collective financial resources and advantageous resources, focus on the children of the central significance of the central health center.
Social medical capital and private medical capital into the regional health planning, in the carousel of relatively concentrated areas, appropriate control of the overall scale of private hospitals, not only to encourage a variety of modes of medical care, play the role of multi-oceanic structure can promote the formation of a competitive situation, broaden the role of financing channels, but also to control the tempo of the rural health reform, the government must run a good county hospitals and the 200 center of the health hospitals (200 central health centers accounted for 1/5 of the province's township health center resources, accounting for 1/3 of the market share), to be in the framework of public ownership as the main body, to play the role of social capital and private capital in the active role of...?
In the face of diversification, diversified rural medical service system, the adjustment of rural health centers policy theme should be positioned in: poverty alleviation and promote excellence, consolidation and development. Specific measures are summarized as follows: institutional reform: improve the system, strengthen management, so open a little, consolidate a piece; development planning: combined with the provincial situation, adjusting the layout, seize the center, help the poor and far away; human resources: to the top of the system, reform the mechanism, promote mobility, strengthen the training; input focus: equipment and manpower, poverty-stricken border areas, highlighting the focus, the implementation of the batches; preventive health care: prevention-oriented, the government investment, strengthen the network, implement responsibility; medical services: optimize services, improve standards, strict access, supervision and monitoring.
Poverty alleviation and promotion of excellence: through the government's financial and policy support, to run or help 100 township health centers in poor areas; with the role of the market and the government's support, to promote the construction and development of the 200 central health centers, to strengthen the functions, expand the scope of services and market space.
Consolidation and development: the government's financial resources and policies must hold the bottom line of preventive health care and the construction of key township health centers in impoverished and remote areas; through the construction of 200 central health centers and 100 township health centers in impoverished areas, comprehensively promote the development of the province's township health centers; through the breakthrough of a link in the township health centers, comprehensively enhance the level of health work in the counties, townships and villages, as well as the rural medical security The construction of the system.
Institutional reform: the "system" referred to here includes the ownership system and includes the main body of the organization, the financial budget, personnel management system, etc. In the ownership system, adhere to the principle of public ownership, the financial budget, personnel management system. In the ownership system, adhere to the public system as the main body unswervingly, to explore and improve the public township health hospitals of the specific realization of the form; in the management system to play a relatively standardized operation of the county, the role of resources to adjust the room for manoeuvre and characteristics of the county, efforts to take over a part of the management rights, to re-give the county government to develop the responsibility of the township health undertakings; at the same time also to mobilize the township government to organize and support the community health undertakings. Activity. Strengthen the management, that is, to play the function of health industry management, the exercise of local government health decision-making behavior for appropriate guidance and necessary supervision; the local township health centers will be implemented, such as restructuring and other explorations into the province's reform of the overall consideration of the big picture; has been restructured or other explorations of the township health centers to strengthen the market supervision. Rural health work should be more prominent public welfare and social equity and other adjustments, the reform should be comprehensive, but for some of the temporary exploration is not allowed to try in the local, only a little bit to try to liberalize is not to give up the government's responsibility to consolidate the rural townships and townships to do a good job of health centers, so that the people with relatively low-cost to enjoy the relatively high-quality health care services is the real purpose of the reform of the townships and townships of the health hospitals.
Development planning:Combined with the high degree of urbanization in Liaoning Province, the accelerated pace of construction of small towns, the withdrawal of townships and townships, as well as townships through the asphalt highway and other provincial conditions, re-adjustment of the layout of the province's township health hospitals to ensure that all the townships of preventive health care on the basis of the play of the province, cities, counties, townships, and the initiative of the provincial and municipal levels of Mae government and the financial, focusing on the construction of the 200 centers of health hospitals to support the construction of the 100 poor and remote areas of township health hospitals. Remote areas of township health center construction, by focusing on planning the construction of 25% of the township health centers that the government focuses on investing in, to achieve the goal of covering 70% of the population, to drive and influence the participation of social capital and private capital in the rural health care resources close to the goal of social public welfare, and to strive for the realization of the higher social benefits of the health resources of the whole society.?
Human resources: the quality of personnel is not high, the human resources structure is unreasonable has become the township health center function to play and its own development of the reality of the problem, to the township management mode into a system with the management of the main, hold the township health center personnel access, reduce the number and proportion of non-health technical personnel. Reform the entry and employment mechanism under the current system, mobilize the enthusiasm of health technicians through the reform of the personnel and distribution system, and give full play to the positive role of the market mechanism on the basis of the government's planning and policy guidance, so as to promote the mobility of excellent urban health technicians to township health hospitals, and to promote the mobility of health technicians between urban and rural areas, townships and institutions, and to activate the internal competition mechanism of township health hospitals through the mobility of personnel. Through personnel mobility, further activate the internal competition mechanism of township health centers. On the basis of reforming the personnel distribution system? By means of the government appropriately raising the personnel entry threshold and investing guidance funds, health centers and health technicians are attracted to participate in lifelong education, and the quality of personnel in township health centers is comprehensively upgraded.
Input focus: In terms of the government's financial investment in township health centers, it is necessary to change the way of input in terms of beds or personnel, especially the use of the three rural construction funds, which should be focused on the configuration of basic medical equipment and personnel training, and should be focused on the township health centers in the poor and remote areas. With limited funds, the realization of limited objectives should be highlighted. Through the implementation in batches and rolling operation, in about five years, so that the province's township health centers have significantly improved the appearance and quality, basically can adapt to and meet the needs of rural residents.?
Preventive health care: prevention-oriented policy can not be moved, to provide or purchase preventive health care services for rural residents is the basic responsibility of the government, but also the last line of defense of government functions in the field of rural health, the government must be invested. The three-tier rural medical and preventive health-care network is an important measure for ensuring the health of China's rural residents, and an important feature of China's rural health work; the construction of the rural medical and preventive health-care network should not be neglected because of the role of the market and private capital; on the contrary, the more the market is brought into play, the more the construction of the rural medical and preventive health-care network should be strengthened. Health administrative departments should supervise and guide governments at all levels to fulfill
the responsibility of preventive health care for rural residents;?
Medical services:Optimize the allocation of resources in township health centers, so that their service functions are differentiated from and complementary to county hospitals and village health centers. It is imperative to improve the level of medical services and technology in township health centers, and to be able to develop the technical capacity in the routine handling of emergency and first aid and obstetrics services. In order to improve the level of service and oil painting services, it is necessary to make full use of the rapid development of medical education, and in a shorter period of time social conditions that may reserve a number of human resources for the rural medical industry within the same period of time, and appropriately raise the entry threshold for new human resources in township health centers. Under the conditions of market economy, for both government-organized township health centers, or by the participation of social capital in the medical institutions, the health administrative departments must strengthen the regulation and
monitoring of the medical market, purify the medical market, to maintain a competitive market environment, to ensure that the medical institutions in accordance with the law to practise medicine, so that the rural residents can get a relatively low cost to get relatively high-quality medical services.
Dedication to love into the countryside to pass the culture to promote harmony
-summer to Zhuanghe City, Dazheng Town, Jiangyao village social practice experience
We finally set foot on the train to Zhuanghe, began our summer social practice activities. As one of the main planners of this activity, I am full of infinite expectations and enthusiasm for this activity, because Zhuanghe is my hometown, and the elementary school we are going to donate is my alma mater, where there are memories of my childhood and my lovely folks.
In this social practice activity, we carried out a series of activities around the theme, such as the donation of love in Jiangyao village ten room elementary school, adolescent physical and mental health knowledge, health index measurement and cultural performances and other activities; in the village of Jiangyao Houyao Tuen we carried out a large-scale clinic activities, including blood pressure measurement, blood type, health index, medical consultation and questionnaire survey and other items. In addition to this, we visited the local village committee and medical institutions, and with the help of the villagers we consoled Wu Guihua, an old man living alone in Han Tun, and we used our rest time to tutor elementary school students and visit the clinic.
At noon on the 19th, we arrived at Shimafang Elementary School after lunch to prepare for our afternoon activities. Ten room room elementary school is a long history of elementary school, although in the government's help, the dilapidated school building can be refurbished, but the school's teaching force is very scarce, there are only seven teachers, each classroom teacher is responsible for all the classes of the class students, even the principal is a part-time classroom teacher, and the only English teacher is also two elementary school **** have. The children here can only have English classes on Tuesdays and Thursdays. In addition, music, sports, art, health and other courses that cultivate children's emotions and develop their character are basically unavailable. It is precisely because of this understanding that we feel the enormity and honor of this mission. Love donation is our earliest planning activities, as early as this year's "Lei Feng month" activities we carry out love donation and charity sales activities are prepared for it. We will students donated items with the sale of the way into the funds, so as to purchase the donation to the elementary school students school supplies. The introduction of physiological and psychological knowledge of puberty was mainly for the fourth, fifth and sixth graders. In view of the physiological changes that may occur during puberty and the psychological changes brought about by these changes, we combined the specialties of medical students to prepare this activity, which we hoped to give these children the right guidance to help them meet and face puberty with the right attitude. As a female speaker, I could feel the shyness of these girls, but I could sense their curiosity and eagerness, so I gradually inspired them through some small games and body language, so that they could grasp the correct knowledge through the human body wall charts, games and stories, and learn to face puberty with a scientific attitude. The children also loved the health index measurement and cultural performances. What we bring is not only school supplies and knowledge, more importantly, we are sowing love and hope, our power is limited, but our love is immeasurable, looking at their smiling faces, listening to their "thank you" full of sincerity, I really feel very happy, but at the same time, I feel the heavy burden on my shoulders, poverty! Poverty really makes these children lose a lot of things they should enjoy, in a way, they and their peers have already existed a gap, which needs them to make up for more hard work in the future. In the past 20 years of reform and opening up, people's thinking has improved greatly, and more and more people have realized the importance of education. In the course of interviews, we learned that 80% of families consider their children's education costs as their most important expenditure in the next few years. With funds more secure than in the past, we should support rural education not only in terms of financial resources, but also in terms of educational talents and concepts. What children need is not only knowledge, but also the reason to be a human being, the concept of adapting to the development of the times and the big picture. As a new era of college students, we have the responsibility and obligation to do our best to support rural education, so that we can realize social harmony, the motherland's rich and strong as soon as possible.
On July 20, we did more than three hours of free medical activities under the sun, and our move was well received by the villagers. We measured blood pressure, blood type, health index, answered medical inquiries, and did questionnaires, all of us had our own responsibilities and cooperated with each other. Although the sun was scorching our skin and sweat was flowing down our cheeks, I was really happy to see the villagers' appreciative gazes and to hear their approving words, and I felt even more proud to be a medical student. After the morning clinic, although we were already exhausted, after lunch, we moved again without stopping. Because we learned that some elderly people were not able to come to the clinic because of their legs and feet, in order not to leave with regrets and to make our activities better, we decided to take the form of door-to-door service for these special people. Through this clinic activity, we have a better understanding of the role of doctors, doctors only have the technology, responsibility and love to become a good doctor loved and respected by the patients, in order to live up to the patient's expectations of the doctor, in order to be able to stand up to the patient's life to the doctor's trust, in order to be able to stand up to the title of doctor. Seeing that so many people are suffering from various diseases, I feel that doctors have a long way to go, and this is our mission in the future, and our sacred duty in a few years. This clinic also prompted us to combine the theoretical knowledge we learned in the classroom with the actual operation in the production practice, we not only have a deeper understanding of the knowledge we learned in the classroom, but also experience the implementation of these concepts in the workplace and their advantages, so that we have a preliminary understanding of the medical work, which can also play a certain role in guiding us in our future work.
On July 21st, we arrived at Jiangyao Village Committee, where we were warmly received by Secretary Zhang Minghui, who introduced us to the progress of the local economy, education, family planning and rural cooperative medical care. Under Secretary Zhang's introduction, we learned that the main crop grown in the village is corn, and other vegetables, such as beans, tomatoes, and so on, and basically all by hand, with very little mechanical cultivation. Breeding industry is not developed, is in the initial stage, has not formed any scale, the main varieties are relatively single, such as: pigs, cows, chickens and other traditional varieties, special breeding is not yet. The price of agricultural products is low, and agricultural products bring little income to farmers. Although the price of agricultural products has risen in recent years, but the agricultural production materials are also rising, compared with agricultural investment, the price of agricultural products is relatively low, in the long run will be unfavorable to farmers. Analysis of the problem
According to the basic situation of the local government, due to the establishment of fewer factories and enterprises in the region, so the source of tax revenue is not much, in addition to the central implementation of the tax reform, the exemption of agricultural tax, the government's financial income is a certain problem. For the construction of water conservancy, transportation and other infrastructure needs a lot of capital investment, need to be backed up by strong funds, but the government also in the funding difficulties, although the village through the project such as the state allocates 50%, but the other 50% of the government is also unable to do anything, so it is difficult to carry out the construction of infrastructure. However, the difficulty of infrastructure construction will inevitably lead to the imperfection of infrastructure, and the imperfection of infrastructure will inevitably constrain the development of the economy, thus falling into a vicious circle. Therefore, in order to solve this problem, one of them should be solved first, i.e., either to spend a lot of effort on infrastructure construction and promote economic development, or to spend a lot of effort on the economy, which will lead to the construction of infrastructure. In addition, with the assistance of Secretary Zhang, we also visited the village health service station to learn about the progress of local health care and the health of the residents. It is understood that in the past, most of the villagers are sick to the nearest small clinic to buy medicine, if it is a serious illness will consider going to the county hospital or better hospitals, and very few residents to participate in the insurance, so if there is a serious illness in the family, it often brings a great financial burden to the family. However, since the government implemented the new rural cooperative medical care, villagers have indeed received great benefits and alleviated a lot of financial burdens. Now 98% of the local residents participate in the new rural cooperative medical insurance. In the afternoon, we brought our condolences to the home of Wu Guihua, an elderly person in Han Tun. Grandma Wu is nearly 80 years old, but her body is strong, she lives alone in a hut of long age, although she lives alone, she is very enthusiastic, optimistic, and usually helpful, and is loved by her neighbors and townspeople. Our arrival let her very surprised, but also let her very moved, looking at us a face full of concern, the old man even moved to tears. I think, as long as we all give a love, the world will really become full of sunshine, even if for us this love is very small, but for the need of people, this love is enough to shine on the earth, melting snow.
In the following time, we also learned the farmers' aunts to go down to the fields to break corn, to the pigsty to feed the pigs, and really experienced the fun and hardship of doing farm work. Every night after dinner, we would go outside the house to cool off and chat with the farmers' uncles and aunts, from whom we truly felt the simplicity and kindness of the rural people, as well as their expectations of their children and their wish for a better life.
We have been warmly welcomed by the local people wherever we went, which has produced a good social impact. We really enter the society, deep into the grassroots, to realize the knowledge to return to the people, with love to dedicate to the community's good wishes. For me, this summer social practice activities carried out very successful, his success does not lie in how much we do, or exactly how much benefit to others. Rather, it lies in my harvest, from which I received a great education and exercise, I feel that I really grew up a lot, especially this clinic activities, let me feel very y, I am very glad that I chose the doctor this sacred profession, in the future life, learning, I will work harder to improve themselves, with their own exquisite medical skills and noble medical ethics really shoulder the mission of saving lives and helping the wounded.