Semánová Csilla, Rurik Sarolta E, Dózsa Csaba, Jancsó Zoltán, Kolozsvári László R, Nánási Anna, Pfeiferová Markéta, Rurik Imre
Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary.
Independent Macroeconomic adviser, Budapest, Hungary.
Prim Health Care Res Dev. 2019 Sep 9;20:e121. doi: 10.1017/S1463423619000410.
The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations' expectation. Celebrating the 40th year's anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe.
To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former 'Soviet bloc' countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries.
Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed.
Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former 'Soviet bloc' countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries.
Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.
《阿拉木图宣言》是初级卫生保健发展进程中的一大步，它明确了主要任务以及民众的期望。庆祝《阿拉木图宣言》发表40周年是进行分析的良好契机。欧洲东部和西部初级卫生保健的发展并不平行。
概述前“苏联集团”国家医疗保健系统的社会经济状况、结构和财政变化，分析初级卫生保健（PHC）的提供情况，并找出各国经济发展与流行病学变化之间的关系。
比较流行病学数据、医疗保健支出与结构以及融资方案；进行系统的文献检索。
各国在人口健康、国民经济状况方面都有明显改善，医疗保健结构发生变化，对初级卫生保健的关注也更多。在前“苏联集团”国家中，观察到预期寿命有所提高，但各国之间差异较大，尽管这与医疗保健系统的发展没有明显关联。初级卫生保健的提供有所改善，但结构变化很少启动，通常只是作为一个项目或模式启动。单人执业仍然占主导地位。守门人制度通常薄弱；没有有效的举措来改善护士教育并拓宽其能力范围。劳动力向西方国家迁移对中东欧国家构成了现实威胁。
实践与跨学科合作之间缺乏协调被认为是结构进一步改善的主要障碍。
