Russia. In Russia general practitioners are prevalent in the thinly populated rural areas. Pediatricians deal with children up to about age 15. Internists look after the medical ills of adults, and occupational physicians deal with the workers, sharing care with internists.
Teams of physicians with experience in varying specialties work from polyclinics or outpatient units, where many types of diseases are treated. Small towns usually have one polyclinic to serve all purposes. Large cities commonly have separate polyclinics for children and adults, as well as clinics with specializations such as women's health care, mental illnesses, and sexually transmitted diseases. Polyclinics usually have X-ray apparatus and facilities for examination of tissue specimens, facilities associated with the departments of the district hospital. Beginning in the late 1970s was a trend toward the development of more large, multipurpose treatment centres, first-aid hospitals, and specialized medicine and health care centres.
Home visits have traditionally been common, and much of the physician's time is spent in performing routine checkups for preventive purposes. Some patients in sparsely populated rural areas may be seen first by feldshers (auxiliary health workers), nurses, or midwives who work under the supervision of a polyclinic or hospital physician. The feldsher was once a lower-grade physician in the army or peasant communities, but feldshers are now regarded as paramedical workers.
Japan. In Japan, with less rigid legal restriction of the sale of pharmaceuticals than in the West, there was formerly a strong tradition of self-medication and self-treatment. This was modified in 1961 by the institution of health insurance programs that covered a large proportion of the population; there was then a great increase in visits to the outpatient clinics of hospitals and to private clinics and individual physicians.
When Japan shifted from traditional Chinese medicine with the adoption of Western medical practices in the 1870s. Germany became the chief model. As a result of German influence and of their own traditions, Japanese physicians tended to prefer professorial status and scholarly research opportunities at the universities or positions in the national or prefectural hospitals to private practice. There were some pioneering physicians, however, who brought medical care to the ordinary people.
Physicians in Japan have tended to cluster in the urban areas. The Medical Service Law of 1963 was amended to empower the Ministry of Health and Welfare to control the planning and distribution of future public and nonprofit medical facilities, partly to redress the urban-rural imbalance. Meanwhile, mobile services were expanded.
The influx of patients into hospitals and private clinics after the passage of the national health insurance acts of 1961 had, as one effect, a severe reduction in the amount of time available for any one patient. Perhaps in reaction to this situation, there has been a modest resurgence in the popularity of traditional Chinese medicine, with its leisurely interview, its dependence on herbal and other "natural" medicines, and its other traditional diagnostic and therapeutic practices. The rapid aging of the Japanese population as a result of the sharply decreasing death rate and birth rate has created an urgent need for expanded health care services /or the elderly. There has also been an increasing need for centres to treat health problems resulting from environmental causes.
Other developed countries. On the continent of Europe there are great differences both within single countries and between countries in the kinds of first-contact medical care. General practice, while declining in Europe as elsewhere, is still rather common even in some large cities, as well as in remote country areas.
Реферат опубликован: 11/11/2009