根据专家观察，这样的理论和现象都是值得各位作者朋友深思学习的，所以希望大家多做研究学习，争取总结出更多更好的经验!

【摘要】 研究背景和目的2005年底,全世界监狱等监管场所里大约收押着800—1000万囚犯,而由于周转速度快,每年经历过监狱生活的人数是这一数字的4—6倍。美国、中国、俄罗斯三国羁押了大约全世界50%的囚犯。由于被羁押前社会地位低、贫困、受教育程度低等原因,以及违法犯罪所致的精神紧张、漫长的司法审理过程和羁押生活,使得被监管人员的身体、精神健康都受到负面影响,导致健康状况比一般社会人群差。劳动教养是我国特有的一项政治制度,是为维护社会治安,预防和减少犯罪,对轻微违法犯罪人员实行的一种强制性教育改造的行政措施,劳动教养的期限为1—3年。收容、管理劳动教养人员的场所称为劳动教养所,是一类特殊的监管场所。我国政府高度重视对包括劳教人员在内的各类被监管人员健康权的保护,采取各种积极有效措施开展被监管人员的健康保护和健康促进工作,明确政府对被监管人员医疗保健的责任,保障其依法获得基本卫生服务。我国劳教人员的医疗卫生服务由司法行政部门所属的劳教所负责组织提供,接受卫生部门的指导。从20世纪70年代开始,由于认识到保障囚犯的健康权的必要性和囚犯健康对公共卫生所具有重要影响,西方国家开始越来越多的关注囚犯的卫生问题,开展了多方面的研究。但在我国,监狱、劳教所的卫生问题较少受到公共卫生部门的关注。本研究的主要目的是通过描述劳教人员健康状况和劳教所卫生服务供给体系,分析劳教人员的卫生服务利用状况,发现劳教人员卫生服务保障工作中存在的主要问题,提出关于劳教所卫生服务组织提供模型的建议,为政府有关部门决策提供参考和依据。研究方法本研究设计为描述性研究,客观描述劳教所卫生服务需求、供给、利用的基本情况,并分析其基本特点。研究资料主要来自现有文献和政策文件的收集,样本劳教所的问卷调查,劳教人员问卷调查和关键人物访谈等四个方面。本研究在广西、重庆和云南三省(区、市)的12个劳教所开展调查,采用随机抽样的方法确定并调查了1721名劳教人员,与75名关键人员进行了访谈。资料收集工具利用了研究人员设计的调查表、访谈提纲,山东大学卫生管理与政策研究中心的老师、研究生和当地医学院校的在校学生在2007年7月20日至8月8日期间进行了现场资料收集。采取定性分析与定量相结合的方法进行分析,包括内容分析法、单因素、多因素分析等。本研究充分考虑到了被监管人员的特殊性,调查过程中注重尊重劳教人员的知情权和保护其隐私权。主要结果劳教所是我国政府对轻微违法犯罪人员实施强制性教育改造的场所,由警察具体负责管理。全国共有348个劳教所,5.6万名警察,200年以来在所劳教人员数量保持在20万人以上。劳教人员在劳教所内的各种活动受警察管理,必须接受各种教育、参加生产劳动,生活规律。警察依据劳教人员的表现给予不同的处遇,表现好的劳教人员可以放假回家。劳教人员健康高危行为,如吸烟、饮酒、吸毒、多性伴、纹身等发生率高。接受调查的1721名劳教人员中有94.8%吸烟,有超过半数(54.9%)的劳教人员入所前有饮酒的习惯。1721名劳教人员中,1580人(91.8%)有吸毒的经历,开始吸毒的年龄平均为22.5岁,吸毒时间平均为11.5年,即平均34年的人生历程中约1/3是在吸毒的陪伴下度过的。吸食毒品的种类以海洛因为主,且有12%的吸毒人员存在多药物滥用现象。88.3%的吸毒者采取注射方式吸毒,45.5%注射吸毒者曾经发生过至少1次因吸毒过量导致昏迷。94.5%的劳教人员曾经与其他人发生性行为,且84%都有2个以上的性伴。在曾经发生性行为的1584名劳教人员中,平均每人曾与17.5个异性发生性关系,在发生性行为时,49.8%从来不使用安全套,仅有7.1%总是使用安全套。1721名接受调查的劳教人员中,有638人(37%)认为自己健康状况“好”或“很好”.其中云南高于广西和重庆,年龄越小比例越高,吸毒人群比例低于非吸毒人员。以10分为满分,劳教人员自评健康得分为平均6.2分。相对于1年前的健康状况,28.1%认为好于1年前,而42.3%认为1年来健康状况呈下降趋势。劳教人员中结核病、艾滋病、肝炎、性病等传染性疾病患病率较高。接受调查的人员中有71人现患结核病,患病率为4126/10万,艾滋病、肝炎、性病、心脑血管疾病患病率分别为2.9%、9%、6.9%和4.4%。有5%的劳教人员曾经在此次劳教期间曾想到过自杀,有8.3%曾经有过自伤或自残的想法。劳教所的卫生服务提供由司法行政部门负责组织管理,而不是由卫生行政部门负责。各省司法厅(局)劳教局、各劳教所内设生活卫生职能部门,具体负责医疗卫生工作。劳教系统从事卫生管理工作的人员专业化水平低,负责卫生工作的劳教局机关、劳教所机关干部很少具有卫生背景。对广西、重庆7个劳教所的测算结果显示,每个劳教所平均年支出2300万,其中卫生支出为71.5万元,占3.1%。卫生经费中,劳教人员医疗费为31.7万元,占卫生支出的44%。劳教人员年人均卫生支出为373元,其中医疗费165元。劳教所医生同时也是警察,具有双重身份。在劳教所工作的医务人员与社会一般医院的医务人员相比,人员少工作量大、技术水平低、发生职业暴露的危险性大。司法部对如何组织开展劳教所的医疗卫生工作提出了较为明确和具体的规定。对12个样本劳教所的调查发现,劳教所采取多种方式为劳教人员提供卫生服务,包括入所体检、常规体检、健康教育、巡诊、因病伤就诊、住院、送社会医院就诊、所外就医等。公共卫生部门对劳教系统提供了一定的支持和协助,对劳教所医疗卫生工作提供技术支持、资金支持,对重大疾病的防治给予指导和帮助。劳教所卫生服务供给具有强制性、非独立性、免费性、总体水平低等特点。影响劳教所提供卫生服务的因素包括:劳教所设定的目标、工作的规定和上级要求、劳教人员健康状况、财政保障水平、医疗服务成本、市场价格、所外就医政策等。81%的劳教人员都曾接受过医生单独的诊断或治疗,平均每人每年接受5.1次。33%的劳教人员报告曾出现过有病不主动就医的情况,主要原因包括怕麻烦、效果不好、需要花钱等。75%的劳教人员认为在需要的时候,能够获得劳教所提供的卫生服务,且有36%的劳教人员认为在劳教所比在社会上更容易获得卫生服务。75%的劳教人员认为劳教所的治疗效果不如社会医院好。影响劳教人员对卫生服务利用的因素包括两个方面,其中供方因素决定了可利用资源的数量、质量,是重要的影响因素。建议建议政府有关部门进一步明确劳教人员具有获得卫生服务的权利,并充分认识到劳教所是社会公共卫生、疾病控制的良好机遇,明确劳教卫生是卫生部门、司法行政部门共同的责任。建议提高劳教所卫生服务提供的能力,促进劳教所对卫生工作的投入,规范劳教所卫生服务机构的设置和管理,加强卫生机构建设,规范劳教所医务人员管理,建立劳教所医务人员激励和制约机制。继续开展入所体检、健康教育、健康档案、定期体检、巡诊、所内门诊、住院、专家会诊、所外就医等各项工作,并完善各项制度,保障病有所医。对病重且无法办理所外就医的劳教人员,应允许劳教人员及其家属从所外购买医疗服务。建议促进与卫生部门的合作,加强对重大疾病的预防控制。建议来自卫生领域的专家与监管场所领域的专家合作,继续深入开展研究。

【Abstract】 Background and ObjectivesBy the end of 2005,over 9 million people were held in every kind of penal institutions throughout the world,however,those who experienced a prison life in a year would be 4-6 times than that figure because of high rate of turnover.Prisoners usually have bad health compared to general population,the low social-economic status,criminal/legislation procedures and custody are main reasons.Re-education through labour is a special political system of CHina,re-education centers are designed to held minor criminals for 1-3 years.Chinese government attaches great importance to thehealth of every kind of prisoners including those in re-education centers.Effective measures having been taken to protect and promote prisoners’ health.In China,health services are provided by Justice Department rather than Health Department inside the government.Since 1970’s,western countries recognized that prisoners having the rights of to-be healthy and that good prisoners’ health is part of good social public health,they concerned more and more about the prisoner’s health issues,carded out many researches in various aspects.However,few such researches had been done in China.The main purpose of study are to describe health status and health delivery system of Re-education system,to analyze health utilization,and to raise suggestion for decision makers to improve prisoners’ health.Methods This study is designed to be a describing one.Data resources includes existed literature and policy documents,data collected through questionnaire prepared for prisoners,data collected through questionnaire prepared for institutions and key informants interview.Considering social economic development level and geographical distribution,12 reeducation centers in Guangxi,Chongqing and Yunnan provinces were selected, 1721 prisoners and 75 key informants were interviewed.The field works for data collection were conduceted from July 20 to August 8,2007 by experts and students of Shandong University.Both qualitative and quantitative methods are employed for data analysis.The study took into full account the specialty of the prisoners,privacies and other rights were greatly protected.Main resultsThere are 348 re-education centers in China,remaining more than 200,000 people at a point of time since the year 2000.Policemen manage every aspects of prisoners’ life inside re-education centers.Before they came into re-education centers,prisoners had high incidence of high-risk behaviours,such as smoking,drinking and drug abuse,sexual and tattoo.1,721 surveryed inmates including 94.8%smokers,54.9%having drinking habits,91.8% had experienced drug addiction,84%have more than two sexual partners.Among 1,721 inmates,638(37%) thind that their health state be "good" or "very good",their average score of self-estimate of health status is 6.2.Rates of TB,AIDS, hepatitis,sexually transmitted diseases are high among prisoners.Health expenditure of each re-education center was 715000 RMB yuan in 2005, accounting for 3.1%of total expenditure of the center.For each prisoner,health expenditure was 373 RMB yuan including 165 yuan for medical expenditure.Ministry of Justice had identified health regulations for prisoners,including physical check,health education,out-patients and in-patients,etc.Public health sector provides supports to re-education centers.Health services in re-education centers have several characteristics,including being mandatory,non-independence,free of charge,low level and quality,etc.Factors that impact provision of health services include:not being priority,rules and regulations, health status of inmates,financial level,costs and prices,etc. 81%of the inmates had received doctors’ diagnosis or treatment,an average of 5.1 times each year for each prisoner.75%of the inmates told that they had access to health services when needed.SuggestionsThe government should make it clear that inmates have the right of access to health services,fully aware that prison be a good opportunity for disease control.Health Sector and Justice Sector should responsible for prisoners’ health.The study suggest that to improve capacity of providing more and better health services to prisoners,a scientific collaboration relationship be established between Justice and Health sector inside the government,to regulate health institution and health workers in Re-education,and to control TB,HIV,Hepatitis inside the wall. The study also suggest further research works be conducted by health-background experts.

【关键词】 劳教人员； 山东大学； 卫生服务需求； 健康状况； 医务人员； 博士学位论文； 卫生部门； 艾滋病； 劳动教养； 结核病；