pp2-1-何國平-中英對照-中澳老年癡呆社區(qū)護理的現(xiàn)狀與.ppt

1、,中澳老年癡呆社區(qū)護理的現(xiàn)狀與展望 中南大學(xué)護理學(xué)院 何國平,1,The status and progress of dementia in China and Australia Nursing School, CSU Guoping He,1,1.中國老年癡呆癥社區(qū)護理的現(xiàn)狀,2.澳大利亞老年癡呆癥社區(qū)護理的現(xiàn)狀,3.中國老年癡呆癥社區(qū)護理的展望,引言,2,1. The status of dementia in China,2. The status of dementia in Australia,3. The progress of dementia in China,Introd

2、uction,2,2010年中國城鄉(xiāng)老年人口狀況追蹤調(diào)查主要數(shù)據(jù)報告 指出老年人獨立居住比例呈上升趨勢，城鄉(xiāng)合計“空巢”老年人占49.3%。其中，城鎮(zhèn)“空巢”老年人比例過半，占54.0%；農(nóng)村“空巢”老年人占45.6%。年齡結(jié)構(gòu)上，6064歲占33.0%比例最多，6069歲之間的低齡老人超一半。截至2011年末，全國60歲及以上老年人口已達1.8499億，占總?cè)丝诘谋戎剡_13.7%。,引言,3,China data report points that the proportion of elderly independent living is rising, The Empty-neste

3、rs account for 49.3%. Among them, the proportion is more than half in the town , accounting for 54.0% , while it is 45.6 % in rural areas. The age structure of the 60-64 years old accounts for 33.0%, to a maximum of the young elderly, The age structure of the 60 to 69 years is of the ultra- half. At

4、 the end of 2011, the population of 60 years old and older has reached to 184.99 million, the proportion of the total population is 13.7%.,Introduction,3,2011年度湖南省老齡事業(yè)發(fā)展統(tǒng)計公報顯示，目前我省已經(jīng)進入老齡化社會，今后一個家庭供養(yǎng)4個甚至更多老人將會成為普通家庭的常態(tài)。省老齡委預(yù)計，到2015年末，我省60歲以上老年人口將達到1250萬，約占總?cè)丝诘?7%；2020年或超過1500萬。這意味著，不久的將來，每6個湖南人中將有一個是

5、老年人。,4,A report showed that Hunan province has entered the aging society and a family to support four or more elderly will be the normal in ordinary families, the Aging Development Statistics Bulletin at Hunan province said. Provincial Committee on Aging expects that the population in our province a

6、ged 60 or older will reach to 12.5 million by the end of 2015, accounting for 17% of the total population; and more than 15 million in 2020 . This means that in the near future, there will be one elderly in six persons in Hunan province.,4,澳大利亞和中國之間人口的比較（UN2008）,5,The comparisons of population betwe

7、en Australia and China （UN2008）,5,報告顯示，老年人男性占49.0%，女性占51.0%；隨年齡增高，女性比例呈加大的趨勢，80周歲及以上人口中，男性與女性比例為41.858.2。,6,The report shows that males account for 49.0% of the elderly, women account for 51.0%; as the age increases, the proportion of women tends to increase. Among the Population of 80 years old and

8、 above, the ratio of male and female is 41.8:58.2.,6,農(nóng)村、城鎮(zhèn)老年人擔(dān)憂問題比較,7,Issues of concern by the National Rural elderly,7,Issues of concern by the Ural elderly,7,根據(jù)2011下發(fā)的湖南省人民政府關(guān)于加快發(fā)展養(yǎng)老服務(wù)業(yè)的意見，到2015年，我省養(yǎng)老總床位數(shù)將發(fā)展到25萬張，實現(xiàn)平均每1000名老年人20張以上床位。,8,The basic situation of the elderly population in Hunan provin

9、ce,The population aged 60 and above ：9.9521 million Accounting for 15.09% of the resident population The population aged 66 and above：6.589 million Accounting for 9.99% of the resident population Population over the age of 80：1.2094 million Accounting for 12.15% of the total number of elderly Popula

10、tion over the age of 100：1615 people Male 307, female 1308, 97 people over the same period last year.,A report accelerates the development of pension services industry which is reported by the Hunan Provincial Peoples Government in 2011.The total number of beds for the aged in our province will be d

11、eveloped to 250 000 to achieve an average of 20 bed spaces per 1000 elderly in 2015.,8,社區(qū)護理的內(nèi)涵,1）利用了護理和公共衛(wèi)生中的諸概念和技術(shù)，通過廣泛和連續(xù)性的護理活動，以居民生活質(zhì)量的提高為最終目的 2）對象：社區(qū)內(nèi)每一個人、每一個家庭、 每一個團體 3）目標(biāo)：促進和維持健康，預(yù)防疾病與殘障，促進個體、家庭或團體達到全民健康的最佳水平 4）特點：連續(xù)性、動態(tài)性及全科性服務(wù),9,1. Make use of the conceptions and techniques of nursing and pub

12、lic health, through abroad and continuous nursing activities, in order to improve the life qualities of the residents. 2. Object :every person and every family and every party in the community 3. Goal : promote and maintain health, prevent diseases and physical disabilities, promote individual and f

13、amily or party to reach the best level of the peoples health. 4. Peculiarity: continuous and dynamic and the service of comprehensive department.,The connotation of community nursing,9,2005年，中國的老年癡呆癥的人數(shù)為554萬人，專家預(yù)測2050年將達到2700萬。我國60歲以上老人患病率達0.64%3.7%， 我國學(xué)者張明園等報道了上海社區(qū)老人中癡呆的年發(fā)病率，65歲以上的老年人年發(fā)病率為1.15%，70歲

14、以上的老年人為1.54%，75歲以上的老年人為2.59%，80歲以上的老年人為3.23%。,我國老年癡呆的現(xiàn)狀,張明園,等(上海市精神衛(wèi)生中心) ；中華全科醫(yī)師雜志， 2006; 5（6）,1.中國老年癡呆社區(qū)護理的現(xiàn)狀,10,In 2005, the number of dementia is 5.54 million in China. Experts predict that it will reach to 27 million in 2050. The prevalence rate of dementia aged 60 and above is 0.64% to 3.7%. Zh

15、ang Mingyuan reported the annual incidence of dementia in the community for the elderly in Shanghai. The annual incidence rate of 65 years old or older was 1.15%, 70 years old or older was 1.54% ,75 years old or older was 2.59% and over 80 years was 3.23%.,The status of dementia in China,Zhang Mingy

16、uan, et al. CHINESE JOURNAL OF GENERAL PRACTITIONERS,2006; 5（6）,1. The status of Dementia in China,10,我國老年人口基數(shù)大，社會老齡化程度加劇，老年癡呆癥威脅必將日益嚴(yán)峻，對長期專業(yè)護理和社區(qū)照料服務(wù)的需求迅速增加。按調(diào)查測算，我國社會養(yǎng)老機構(gòu)現(xiàn)有的床位數(shù)尚不足機構(gòu)養(yǎng)老床位潛在需求量1 /12。目前，國內(nèi)養(yǎng)老服務(wù)體系還未能真正建立健全起來。但老年疾病的發(fā)生隨著年齡的增長逐年增加。,現(xiàn) 狀,11,As the large base of Chinese elderly population, an

17、 aging society intensified the threat of dementia will increase seriously. Long-term care and community care services will increase rapidly. According to survey estimates, the existing number of beds in the Chinese social old-age care institutions was less than 1/12 of the potential demand. At prese

18、nt, social old-age care institutions is not really set up perfect rise. However, the occurrence of age-related diseases has increased year by year, increasing with age.,The Status :,11,以老年癡呆疾病為例，近年來，其發(fā)病率呈逐年上升趨勢，護理好患有老年癡呆的老人，不僅能減輕子女的擔(dān)憂，進而能促進社會的和諧穩(wěn)定。社區(qū)作為目前我國居民生活的基本組織形式，在護理老年癡呆患者上所起到的作用不容忽視。 有調(diào)查發(fā)現(xiàn)75.4%

19、的照顧者缺乏老年癡呆病人的護理知識與技能,93.8%的陪護者希望醫(yī)務(wù)人員來完成。護士在社區(qū)老年癡呆護理中的作用顯得尤為重要。,現(xiàn) 狀,12,For example, In recent years, the dementia s incidence rates showed an increasing trend. Caring the elderly people with dementia can not only alleviate the concerns of children, and thus can promote social harmony and stability. C

20、ommunity, as the basic organizational form of living, plays an important role in caring patients with dementia. The survey finds that 75.4 percent of the caregivers lack the knowledge and skills about dementia patient care. 93.8% of the accompanies hope that the medical personnel to complete the car

21、e. The nurses role is particularly important in community-based dementia care.,The Status :,12,蔣瑞輝等調(diào)查發(fā)現(xiàn)，醫(yī)護人員對該癥的一般了解和一般關(guān)注程度分別為65.2% /55.6%和64.6% /60.7% , 提示醫(yī)護人員對該癥的了解和關(guān)注還很不夠。研究還發(fā)現(xiàn)醫(yī)生對該癥的診斷知識認(rèn)知率（70.4%）高于護士（46.7%）, 而護士對護理知識的認(rèn)識（ 46.7% ）要高于醫(yī)生（33.5%）。,社區(qū)護士在癡呆照護方面存在的問題,蔣瑞輝：北京解放軍總醫(yī)院，中國臨床保健雜志，2009 ，12（02）：19

22、4-195,13,Jiang Ruihui found that the general understanding and the general degree of concern about the disease between the doctors and nurses were 65.2% / 55.6% and 64.6% / 60.7%, suggesting that the understanding and concern of the medical staff about the disease are not enough. The study also foun

23、d that doctors cognition of disease diagnosis knowledge (70.4%) is more than nurses (46.7%). Nurses in the nursing knowledge (46.7%) is higher than that of the doctors (33.5%).,Problems of Dementia care in community nursing,Jiang Ruihui, et al. Chin J Clin Health, 2009; 12(02): 194-195,13,與國外相比, 我國社

24、區(qū)衛(wèi)生服務(wù)發(fā)展較晚, 社區(qū)護理相對落后, 社區(qū)護士目前只能承擔(dān)最基本的角色功能, 我國社區(qū)護士所承擔(dān)的角色仍以照顧者和教育者為主, 對于倡導(dǎo)者、研究者、管理者等其他角色功能涉及較少。 調(diào)查還發(fā)現(xiàn)，自我效能是影響護理人員生活滿意度的重要指標(biāo)。對女性護理員而言，經(jīng)常性技能培訓(xùn)、相對低的護理員對患者比率、較強的同事情感支持等，都有助提高自我效能，從而提升她們的生活滿意度。,社區(qū)護士在癡呆照護方面存在的問題,14,Compared with foreign countries, our community health service started later. Community nursing

25、is relatively backward and community nurses can only undertake the primary function of role. The roles of our community nurses undertake are mainly caregivers and educators, and barely involve advocates, researchers, managers and other role functions. The survey also finds that self-efficacy is an i

26、mportant indicator of the impact of nurses life satisfaction. To female nurses, regular skills training, a relatively low ratio of care workers to patient and strong colleague emotional support can help to improve self-efficacy, and improve their life satisfaction accordingly.,Jiang Ruihui, et al. C

27、hin J Clin Health, 2009; 12(02): 194-195,Problems of Dementia care in community nursing,14,丁艷萍等研究表明我國老年癡呆的社會福利機構(gòu)人員配備還不能滿足老年患者的需要, 護理工作還停留在流水作業(yè)式的功能制護理, 這種護理模式使老年癡呆患者缺少與人情緒和情感的溝通與交流, 缺少心理上的撫慰, 老人精神日漸頹廢, 依賴性增強, 嚴(yán)重影響了自我照顧的主動性, 同時也增加了家庭的經(jīng)濟負(fù)擔(dān)。 老年癡呆護理員的壓力較大, 特別是社會壓力。護理員的性別、自覺健康狀況及社會支持是影響護理員壓力的相關(guān)因素。,社區(qū)護士在癡呆

28、照護方面存在的問題,丁艷萍, 等（中國醫(yī)科大學(xué)高職學(xué)院)實用護理雜志2003; 19（10）: 10-11,15,Ding Yanpings and other studies have shown that Chinas Dementias social welfare agencies staffing can not meet the needs of the elderly patients, nursing is still stuck in functional nursing of assembly-line style. In this mode, Dementia patie

29、nts lack of emotional communication and exchange, lack of psychological comfort. The spirit of elderly is decadent increasingly, the dependence enhances, which impact the initiative of self-care seriously, and also increase the financial burden of families. The caregivers of dementia have huge press

30、ure, especially social pressure. The gender of caregivers, perceived health status and social support are related factors affecting the pressure of caregivers.,Ding Yanping, et al. Journal of Practical Nursing ,2003; 19（10）: 10-11,Problems of Dementia care in community nursing,15,目前我國1.8499億老年人中 , 老

31、年性癡呆患者達600萬人, 每年新發(fā)病率為1.2%, 這將成為我國實現(xiàn)可持續(xù)發(fā)展的不利因素, 因此,首先應(yīng)提高臨床醫(yī)護人員對該癥的認(rèn)識和關(guān)注度, 惟其如此才能提高整個社會對此癥的認(rèn)知水平和關(guān)注率, 從容應(yīng)對銀發(fā)大潮的到來, 真正做到老有所醫(yī)、老有所養(yǎng)。,社區(qū)護士在癡呆照護方面存在的問題,16,At present,in the 1.8499 million elderly patients ,the population of senile dementia has reached to 600 million, and the annual incidence rate is 1.2%, w

32、hich will be unfavorable factors for achieving sustainable developing in China. Therefore, we should improve the clinical staff understanding and attention about the disease at first. Only this can we improve the society cognitive level and attention rate of this disease so that we can deal with the

33、 arrival of the silver-haired calmly, and the elderly can be raised .,Problems of Dementia care in community nursing,16,澳大利亞的癡呆癥患病率和發(fā)病率,患病率： 2010 年： 1.2% (257,275人) 2050年將達2.9% (1,130,691人) 影響10%的65歲以上老年人和50%的85歲以上老年人 CALD組：2010年：35,549人；2050年：119,582人 發(fā)病率: 2010年新增75,336例 2050年將新增385,176例 CALD組：2010

34、年：9,169 例；2050年將為 35,318 例,2.澳大利亞老年癡呆社區(qū)護理的現(xiàn)狀,17,Prevalence and incidence of dementia in Australia,Prevalence: 1.2% (257,275 persons) in 2010； will be 2.9% (1,130,691) in 2050； affect 10% of people over age 65 and 50% over age 85 CALD groups: 35,549 in 2010 and 119,582 in 2050 Incidence 75,336 new ca

35、ses in 2010； will be 385,176 new cases in 2050； CALD groups : 9,169 in 2010 and 35,318 in 2050；,2. The status of Dementia in Australia,17,癡呆癥的花費(Brodaty 2011, Access Economic for Alzheimers Australia 2009),$AU billion澳元 十億,老年護理的花費,資源存取控制設(shè)施的花費,18,Costs of dementia (Brodaty 2011, Access Economic for A

36、lzheimers Australia 2009),$AU billion澳元 十億,Cost of aged care (HACC,community care, RACF),Number of RACF places,18,政府的應(yīng)對,鼓勵活動和獨立老齡化 關(guān)注預(yù)防保健 授權(quán)知情選擇 致力于社會包容 提供多樣，綜合，靈活的護理程序 政府補貼：能夠負(fù)擔(dān)得起,19,The governments response to dementia,Encouragee active and independent ageing Focusing on preventative health Enabli

37、ng informed choices Committing to social inclusion Providing diverse, comprehensive and flexible care programs Government subsidies: affordable for users,19,政府對癡呆癥的應(yīng)對,研究 服務(wù) 培訓(xùn) 勞動力 預(yù)防 提高癡呆癥患者的生活質(zhì)量 減少激動 以患者為中心的護理 幽默療法 減少照顧者的沮喪，提高生活質(zhì)量,20,The governments response to dementia (Brodaty 2011),Research Serv

38、ices Training Workforce Prevention Improve quality of life of people with dementia Decrease agitation Person centred care Humour therapy Decrease carer depression, enhance QoL,20,政府對癡呆癥的應(yīng)對,政府補貼治療:減少老年癡呆癥的癥狀并且減慢疾病進程 政府補貼療法:用來迎合社會心理需要及提高生活質(zhì)量 政府補貼照顧:家庭照顧，暫息護理和居家老年護理 保健津貼 質(zhì)量控制:資格認(rèn)可,警察檢查,使用者的權(quán)利,投訴,虐待老人的責(zé)

39、任通報,建筑證明,21,The governments response to dementia,Government subsidised treatment: reduce symptoms and slowing the progress of AD Government subsidised therapies: designed to meet social-psychological needs and improve quality of life Government subsidised care: home care, respite care and residentia

40、l aged care Care allowanceQuality assurance: accreditation, police check, users rights, complaints, mandatory report of elder abuse, building certification ,21,護理方案 (DOHA, 2008),暫歇護理 社區(qū)養(yǎng)老護理 擴大的社區(qū)養(yǎng)老護理 擴大的社區(qū)老年癡呆癥護理 過渡期照顧 養(yǎng)老院,22,Care Programs (DOHA, 2008),Respite care Community aged care packages Exten

41、ded aged care at home Extended aged care at home-dementia packages Transition care Residential aged care,22,社區(qū)養(yǎng)老護理,家庭援助 運送到家 維護和修改 護理 輔導(dǎo) 以社區(qū)為基礎(chǔ)的暫歇護理 （主要為日托）,23,Community aged care packages,Domestic assistance Transport to home Maintenance and modifications, Nursing care Counselling Community-based r

42、espite care (mostly day care),23,24,擴大的社區(qū)養(yǎng)老護理,臨床護理 個人協(xié)助 預(yù)備飯菜 排便節(jié)制管理 治療服務(wù) 居家安全及修改,Extended aged care at home packages,Clinical care Personal assistance Meal preparation Continence management Therapy services Home safety and modification,24,擴大的社區(qū)老年癡呆癥護理,預(yù)防措施：早期介入和對癡呆癥照顧者的特殊訓(xùn)練 癡呆癥行為管理咨詢服務(wù)，臨床支持，指導(dǎo)，以及行為管

43、理建議 澳大利亞的老年癡呆癥：全國癡呆癥支持計劃,25,Extended aged care at home-dementia packages,Prevention initiatives: early intervention and dementia specific training for carers Dementia Behaviour Management advisory services, clinical support, mentoring, and behaviour management advice Alzheimers Australia: the Nation

44、al Dementia Support Program,25,1.加強社區(qū)護理隊伍建設(shè) 完善任職資格制度，制訂聘用辦法，加強崗位培訓(xùn)； 制定傾斜政策，吸引高級護理人才進社區(qū)； 加強高等醫(yī)學(xué)院校的社區(qū)護理學(xué)科教育建設(shè)； 采取多種形式鼓勵和組織大中型醫(yī)院、預(yù)防保健機構(gòu)、計劃生育技術(shù)服務(wù)機構(gòu)的高、中級護理人員定期到社區(qū)衛(wèi)生服務(wù)機構(gòu)提供技術(shù)指導(dǎo)和服務(wù)。,社區(qū)護理實踐的發(fā)展方向,3.中國老年癡呆社區(qū)護理的展望,26,1.Strengthen community nurses troop construction Consummate position qualifications system , ma

45、king engage means, strengthen position training； Constitute favorable policy to attract advanced nurses to enter community； Strengthen the construction of community nursing education in higher medical colleges and universities. Encourage and organize large and middle scale hospitals, prevention and

46、health care institutions,high or middle level nurses in birth control technical service organizations to regularly provide technical guidance and services to the community health service organizations.,The developmental direction of community nursing practice,3. The progress of dementia in China,26,

47、2.發(fā)揮社區(qū)衛(wèi)生服務(wù)在醫(yī)療保障中的作用,將符合條件的社區(qū)衛(wèi)生服務(wù)機構(gòu)納入城鎮(zhèn)職工基本醫(yī)療保險定點醫(yī)療機構(gòu)的范圍, 推動社區(qū)首診制度試點，以提高人們對社區(qū)衛(wèi)生服務(wù)的利用率,確保社區(qū)護理的持續(xù)發(fā)展。,3.逐步建立起較為系統(tǒng)、完善的社區(qū)護理體系,家庭病床 康復(fù)護理 家庭臨終關(guān)懷 健康教育,27,2.Give full play to community health service in medical safeguard,Bring the qualified community health service organizations into line with the cities work

48、ers basic medical insurance fixed medical institution, impel the community first diagnose and treat system experiment unit, increase the using ratio of community health service, guarantee the continuous development of community nursing.,3.Establish a systematic, perfect community nursing system grad

49、ually,Household sickbed Rehabilitation nursing Family-based hospice care Health education,27,社區(qū)護理實踐發(fā)展關(guān)鍵問題,1.落實“雙向轉(zhuǎn)診”制度 首先要解決好四大瓶頸問題： 瓶頸一，社保規(guī)定成攔路虎，因社保的區(qū)域性非常強，轉(zhuǎn)診住院報銷受影響； 瓶頸二，患者就醫(yī)觀念存在誤區(qū)，對社區(qū)醫(yī)護人員不信任，擔(dān)心影響治療效果； 瓶頸三，化驗檢查結(jié)果難互認(rèn)，重復(fù)檢查，多花錢，傷身體； 瓶頸四，就醫(yī)逐利，醫(yī)院、社區(qū)各有說法,28,1.Carry Out Mutual Referral System First must

50、be solved four bottleneck problems： Bottleneck one，The provisions of social insurance get in the way，Because of regional characteristic of social insurance is very distinct, hospital transfer reimburses is affected; Bottleneck two，The patients idea about see a doctor is wrong, distrust the community

51、 medical personnel, worry about influence treatment result； Bottleneck three，Check-up result is difficult to recognize mutually, repetitive inspection lead to spend more and is harm to body; Bottleneck four，Providing health care service or making profit, the hospital and community has different pers

52、pectives.,The key questions of community nursing practice development,28,2.改革社區(qū)衛(wèi)生服務(wù)收支制度 建立新的社區(qū)衛(wèi)生服務(wù)運行模式，實行“收支兩條線管理” 明確了社區(qū)衛(wèi)生服務(wù)機構(gòu)是政府主辦的公益性事業(yè)單位 探索新的考核分配機制 ：按崗定酬、按任務(wù)定酬、按居民滿意度定酬、按解約醫(yī)療費用定酬等,29,2. Innovate income and expense system of community health service Establish new community health service movement

53、pattern, implement the separating management system of the revenue and expenditure Definite community health service organization is the public welfare institution which the government sponsors. Explore new check assignment mechanism: Decide reward according to the type of work, decide reward accord

54、ing to task,decide reward according to inhabitant degree of satisfaction,according to terminate an agreement of the medical expense to decide the reward and so on,29,3.強化政府管理 （1）必須明確政府有義務(wù)和責(zé)任保證每個公民的社會權(quán)利和健康權(quán)利 （2）政府在醫(yī)療衛(wèi)生領(lǐng)域應(yīng)以公益性為目標(biāo)，使人們都能相對平等地享受健康保健的權(quán)利。 （3）政府要建立建全適應(yīng)社區(qū)衛(wèi)生改革與發(fā)展需要的衛(wèi)生標(biāo)準(zhǔn)管理體制，將社區(qū)衛(wèi)生標(biāo)準(zhǔn)納入法制化、規(guī)范化的管

55、理軌道，提高參與國家衛(wèi)生標(biāo)準(zhǔn)工作的能力。,30,3.Intensify the management of the government （1）Must be clear about government have the duty and the responsibility to guarantee each citizens social right and health right. （2）Government should take the public welfare as a goal in the medical health domain, enable people to

56、enjoy the right of health care equally. （3） Government must establish and perfect health standard management system which meets community health reform and developmental demand, brings community health standard into line with the legalized, standardized management track,improve the ability of partic

57、ipate in national health standard work.,30,醫(yī)改新方案 社區(qū)新契機,醫(yī)改“一二三四五”策略 一個目標(biāo) 即建立惠及全體國民的衛(wèi)生體系，保障每個人獲得基本衛(wèi)生服務(wù)，提高全國人民的健康水平。 兩層服務(wù)體系 包括以公共衛(wèi)生和基本醫(yī)療服務(wù)為主的初級衛(wèi)生保障體系，以及解決急危重（大病治療）為主的二三級醫(yī)療機構(gòu)體系。,31,New project of medical reform New turning point in community,Medical reform“one two three four five” strategy One goal Esta

58、blish a health system which benefit all the people of our nation ,ensure each person obtain basic health service, improve all the peoples healthy level. Two service system Including primary medical safeguard system which takes the public health and basic medical service as center , as well as second

59、 or third class medical institution system which treat emergent, serious and dying patients(grave sickness treatment)primarily.,31,三重保障制度 基本醫(yī)療服務(wù)保障制度；社會醫(yī)療保險制度；商業(yè)醫(yī)療保險。 四項實施策略 加快衛(wèi)生基本法的立法工作；保障衛(wèi)生投入；完善公立醫(yī)療醫(yī)療衛(wèi)生機構(gòu)的運行機制；衛(wèi)生行政管理體重改革。 五個關(guān)鍵問題 包括公私合作伙伴關(guān)系、支付制度、基本藥品、管制、發(fā)揮中醫(yī)藥作用。,32,Three safeguard systems Basic medical service safeguard system; Social medical insurance system; Commercial medical insurance. Four implemental strategies Speed up legislative work of hygienic fundamental law; ensure health investment; Consummate therunning mechani