应对前苏联的流行病学转变：俄罗斯卫生系统与公共卫生改革策略
Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.
作者信息
Tulchinsky T H, Varavikova E A
机构信息
School of Public Health Hadassah-Hebrew University, Jerusalem, Israel.
出版信息
Am J Public Health. 1996 Mar;86(3):313-20. doi: 10.2105/ajph.86.3.313.
OBJECTIVES
This paper reviews Russia's health crisis, financing, and organization and public health reform needs.
METHODS
The structure, policy, supply of services, and health status indicators of Russia's health system are examined.
RESULTS
Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic.
CONCLUSIONS
The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.
目标
本文回顾了俄罗斯的健康危机、融资、组织以及公共卫生改革需求。
方法
对俄罗斯卫生系统的结构、政策、服务供给及健康状况指标进行了研究。
结果
预期寿命在下降；心血管疾病和创伤导致的死亡率很高且呈上升趋势；孕产妇和婴儿死亡率很高。疫苗可预防疾病再次以流行形式出现。营养状况存在问题。
结论
这场危机与俄罗斯的经济转型有关，但也深入到了前苏联的卫生系统。通过增加服务数量来应对从以传染病为主向非传染病为主的流行病学转变。卫生系统缺乏流行病学或经济分析机制以及对公众的问责机制。政策和资金更倾向于医院而非门诊护理，更倾向于个人常规检查而非以社区为导向的预防方法。自1991年以来的改革主要围绕国家医疗保险和服务的分散管理。建议制定一项国家卫生战略来解决基本的公共卫生问题。
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