社会与医学.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,社会卫生状况与医疗保障制度,社会卫生状况概念、评价,医疗保障制度,公共卫生面临的问题,1,社会卫生状况概念,社会卫生状况：,指人群的健康,以及影响人群健康的社会因素,2,社会卫生状况评价意义,管理者：科学管理的基础工作,政策制定者：制定卫生政策与计划提供依据,研究者：用于探索卫生状况变化与发展趋势,3,社会卫生状况评价指标,-,人群健康状况指标,传统人群健康评价:,单一型指标：以出生、疾病和死亡为主要内容的群体健康评价,6,主要健康指标,平均期望寿命,婴儿及5岁以下儿童死亡率,孕产妇死亡率,2009年卫生统计公报数据解读,一是居民健康水平逐步提高。,国际上一般用婴儿死亡率、孕产妇死亡率和人均期望寿命反映居民的健康状况。公报数据显示。,7,8,婴儿死亡率是反映社会经济、文化教育、,卫生保健事业发展的综合和敏感的指标之一。,9,不同地区婴儿死亡率比较,10,主要健康指标,传统人群健康评价:,复合型指标：,减寿人年数：potential years of life lost(PYLL),无残疾期望寿命：disability free life expectancy(DFLE),活动期望寿命:activity life expectancy(ALE),伤残调整生命年:disability adjusted life years(DALY),健康期望寿命年:health life expectancy(HALE),11,影响健康的因素指标,人口、自然环境、社会环境指标,卫生服务指标：需求指标，利用指标，预防保健指标,卫生服务资源指标：人力资源，物质资源，财政投入,12,人口指标,规模，性别比，居住地,密度,年龄结构,年龄中位数,抚养比指数,。,13,人口指标,年份,0-14,岁人口,比重（,%,）,65,岁及以上,人口比重（,%,）,老少比,（,%,）,年龄中位数,（岁）,1953,36.3,4.4,12.2,22.7,1964,40.7,3.6,8.8,20.2,1982,33.6,4.9,14.6,22.9,1990,27.7,5.6,20.1,25.3,2000,22.9,7.0,30.4,30.8,资料来源：根据五次人口普查资料计算,14,人口指标,15,人口指标,16,人口指标,引自：2009年度中国老龄事业发展统计公报,17,人口指标,引自：2009年度中国老龄事业发展统计公报,18,人口指标,引自：2009年度中国老龄事业发展统计公报,19,影响健康的因素指标,20,影响健康的因素指标,21,2009年卫生统计公报数据解读,一是居民健康水平逐步提高。,二是医疗服务利用增加，“有病不医”状况正在改善。,三是医疗服务效率提高，医疗机构发展活力增强。,四是公共卫生服务范围扩大，疾病预防控制取得新成效。,五是卫生资源配置总量增加，基层卫生机构得到加强。,引自：卫生部网站,22,医疗保障制度,医疗保健系统,医疗保障制度的历史变迁,目前医疗保障制度,23,医疗保健系统组织结构图,24,Health Care System,The organization structure of Chinese health Care system,State Department,Government of Provincial,Municipal,Autonomous Region,Prov Dept of Health,Local Dept.of Health,Chinese Academy of Medical Science,Chinese Academy of Preventive Medicine,Medical Colleges and Universities,Drug and Bioengineering Product Research Institute,The Ministry of Health,General and Specialized hospital,Epidemic Prevention Station,Maternity and Children Health Care Hospital(Clinic),Drug Inspection Station,Regional Administrative Office,General and Specialized hospital,Epidemic Prevention Station,Maternity and Children Health Care Hospital(Clinic),Drug Inspection Station,Government of Municipal,County,District,Township hospital(clinic),District hospital,Outpatient clinic,Municipal(District)hospital,County hospital,Epidemic Prevention Station,Endemic Disease Prevention Station,Maternity and Children Health Care Hospital(Clinic),Secondary Health School,Township government,Subdistrict Office,Villagers committee,Neighborhood residents committee,Village health station,Red Cross health station,District department of Health,Three tiered prevention and health care system,25,County Hospital,Agencies:2008,Workers:487684,Township hospital(Clinic),Agencies:47928,Workers:1163700,County Maternity and,Child Health Hospital,Agencies:1387,Workers:49313,Village hospitals,Agencies:693518,Workers:1282310,Health Network of Three Tiered in Rural Area,County Epidemic,Prevention Station,Agencies:1657,Workers:87468,26,医疗保障制度的历史变迁,27,医疗保障制度的历史变迁,1949-1976,城镇医疗保险制度：劳保医疗，公费医疗,农村合作医疗,28,医疗保障制度的历史变迁,29,Chinas Health Care System,“This system is characterized by widely distributed,relatively inexpensive,technologically simple health services and by a lack of orientation toward hospital care and more sophisticated alternatives for those who can or may be willing to pay for medical care.”,-Robert Blendon,NEJM 1979,30,医疗保障制度的历史变迁,1978,-,1998,政府投入减少,医疗机构企业化经营,农村合作医疗自行解体,两江试点,31,Chinese National Health Expenditure as%of Total Health Expenditures,Blumenthal D,Hsaio W,Privatization and Its Discontents,The Evolving Chinese Health Care System.,NEJM.Volume 353:1165-1170(11),32,返回,33,医疗保障制度的历史变迁,1998,-,至今,1998年：城镇职工基本医疗保险制度,2002年：新型农村合作医疗试点,2003年：农村医疗救助试点,2005年：城市医疗救助制度试点,2007年：城镇居民基本医疗保险试点,34,国外医疗保障模式,社会医疗保险模式,以德国为例,全民健康服务制模式,以英国为例,商业性医疗保险模式,以美国为例,储蓄医疗保险模式,以新加坡为例,35,36,中国“三纵三横”的医疗保障体系,补充层,个人、组织、社会,商业健康保险,社会慈善捐助,主干层,个人、组织、政府,城镇职工基本医疗保险,城镇居民基本医疗保险,新型农村,合作医疗,托底层,政府,城镇医疗救助,农村医,疗救助,补充保险,37,公共卫生面临的问题,38,人口老龄化,39,人口老龄化,-出生预期寿命,total population:74.51 years,male:72.54 years,female:76.77 years(2010 est.),From:www.cia.gov,40,人口年龄结构,0-14 years:17.9%(male 128,363,812/female 109,917,641),15-64 years:73.4%(male 501,987,034/female 474,871,442),65 years and over:,8.6%,(male 55,287,997/female 59,713,369)(2010 est.),From:www.cia.gov,41,卫生投入,经济发展与健康的投入不成比例,42,资源分配,43,疾病谱的改变,44,疾病谱,传染病与慢性非传染病的双重压力,新的传染病：甲流。,慢性传染病：乙肝，结核，HIV/AIDS,45,疾病谱,46,疾病谱,47,疾病谱列举,-中国,每5个成人中就有一个有心血管病，每10秒钟就有一个死于心血管病,每16个人就有一个残废,地球上每诊断3个肺癌就有一个在中国，在过去的30年里肺癌的死亡率增加了5倍,地球上每3个乙肝病毒携带者就有一个在这里,活动性肺结核人数世界排名第二,精神和心理疾病人数世界排名第一。,来源：“21世纪国人健康要管理”，黄建始,48,生活方式列举,烟民世界排名第一,喝酒的人数世界排名第一,约每3个大人就有一个胖子或准胖子,约每5个大人就有一个高血压,约每5个大人就有一个高血脂,约每3个成年男人有两个抽烟,应征男兵体检合格不到一半，女兵体检合格不到4成；,来源：“21世纪国人健康要管理”，黄建始,49,环境污染,50,工作环境与职业病,51,流动人口生存状况,52,交通安全,53,行为危险因素：吸烟,54,行为危险因素：吸烟,55,1973-2005 中国肺癌死亡率趋势,吸烟,56,行为危险因素：吸烟,57,Source:China Statistical Yearbook2003,白酒,58,白酒,59,超重与肥胖,60,食品安全,三聚氰胺,61,SARS 的警示,62,SARS 的警示,63,SARS 的警示,64,SARS 的警示,65,SARS 的警示,66,SARS 的警示,67,SARS 的警示,-总结,健全的公共卫生系统,处理突发事件的预案,生活方式,68,The organization structure of Chinese health system,State Department,Specialized Hospital,Local CDC,MCH Hospital(Clinic),Drug Inspection Station,Medical college or university,Specialized hospital,Anti-epidemic station,MCH Hospital(Clinic),Drug Inspection Station,Township hospital(clinic),District health center(outpatient clinic),MCH care center,General Public Hospital,Anti-epidemic Station,Endemic Disease Prevention Station,MCH Care Center(Clinic),Secondary Health School,Township government,Sub-district Office,Villagers committee,Neighborhood residents committee,Village health station,Red Cross health station,Three tiered prevention and health care system,Government of Municipal,County,District,The Board(department)of Health,The Board of Health,Regional Administrative Office,Government of Provincial,Municipal,Autonomous Region,The Ministry of Health,The Bureau of Health,CAMS,China CDC,FDA,PUMC,69,我国公共卫生面临的挑战,-机构臃肿,70,