| 曹广文,张必翔,陈孝平.关于我国医疗卫生体系提升公共卫生应急管理能力的思考与建议[J].中华流行病学杂志,2020,41(10):1588-1594 |
| 关于我国医疗卫生体系提升公共卫生应急管理能力的思考与建议 |
| Consideration on improving public health emergency management ability of current medical health system |
| 收稿日期:2020-03-01 出版日期:2020-10-27 |
| DOI：10.3760/cma.j.cn112338-20200304-00247 |
| 中文关键词: 新型冠状病毒肺炎 医疗卫生体系 趋利性 公共卫生 优化 |
| 英文关键词: COVID-19 Health service system Profit-seeking Public health Rebuild |
| 基金项目:中国科学院学部咨询评议项目 |
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| 摘要点击次数: 3237 |
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| 中文摘要: |
| 新型冠状病毒肺炎疫情已成为国际重大公共卫生事件。全球疫情形势严峻，直接经济损失远超2003年的重症急性呼吸综合征。疫情早期出现的问题包括未能及时准确研判疫情、疫情报告滞后、医院内感染向社区扩散及早期公共卫生防控措施不力等。人群发病率可反映公共卫生预防效果，而患者病死率反映临床疗效。武汉市集中了国内优秀的医疗资源和来自全国各地的医护人员及大量医疗物质的支援，但病死率一直维持在全国最高水平，说明针对发病机制尚不明确的新发病毒性传染病，临床治疗效果有限；中央政府及时采取的非常规公共卫生措施如暂时关闭离汉通道等在控制疫情中发挥了决定性作用。近年我国医疗系统趋利性打乱了医疗卫生事业中医疗和预防布局的平衡，促进了“重医疗、轻预防”的恶性循环，损害了常规公共卫生行使其功能的基础，形成了突发公共卫生危机偶然性中的必然性。提升我国卫生系统应对突发公共卫生事件能力应考虑以法律形式定位公共卫生事业是政府公共服务的主要职责、大力提升公共卫生机构的职能和水平，以满足人民群众日益增长的健康需求；还应打破由趋利性导致的“重医疗、轻预防”恶性循环，加强对公共卫生事业的投入并优化国家卫生体系。 |
| 英文摘要: |
| COVID-19 is a Public Health Emergency of International Concern (PHEIC). Direct economic loss is expected to be much more than that of SARS outbreak in 2003. The risk factors of COVID-19 epidemic at the early stage included the misjudgment of the epidemic, delay in reporting this emerging infectious disease, nosocomial infection-caused transmission of the virus into local communities, and weak public health interventions. The infection rate (or the incidence) reflects the prophylactic effect in population. Case fatality reflects the therapeutic effect of clinical intervention. There were sufficient medical resources at the national top levels accumulated in Wuhan. Furthermore, medical professionals and sufficient medical supplies from other provinces have been assigned to join in the fighting against the epidemic in Wuhan. However, the case fatality in Wuhan has been kept the highest in China, indicating that clinical treatment for this virus-caused emerging infectious disease, whose pathogenesis remains to be elucidated, with limited effect in controlling this epidemic. The unusual, extremely costly public health interventions including the temporarily city quarantine and transportation ban issued by the central government are crucial in controlling this epidemic. The control of epidemic indicates the importance of public health measures but also reflected its insufficient capacity in China. Recently, profit-seeking mechanism run in Chinese health service system disorganized the balance of clinical service and public health service patterns in China, promoting the vicious circle of “attaching importance to clinical treatment and despising disease prophylaxis”, damaging the infrastructure of public health capacity, thus contributing to the formation of the inevitability in various fortuities of public health emergency. To strength the capacity of our medical service system to respond to public health emergency efficiently, two key issues should be considered. First, public health service, which should be fixed as the health section of the governments' public services by the law, must be greatly improved to meet the increasing health needs of the publics. Second, the vicious circle of profit-seeking-caused “attaching importance to clinical treatment and despising disease prophylaxis” should be immediately broken to optimize the national health service system in China by increasing the investment in public health service. |
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