本文關(guān)鍵詞： 農(nóng)村衛(wèi)生 衛(wèi)生人力 倫理 對策　出處：《中國全科醫(yī)學(xué)》2014年31期 　論文類型：期刊論文

【摘要】：目的了解鄉(xiāng)村衛(wèi)生人力資源配置中存在的倫理問題并探討解決對策。方法于2011年5月,采用分層隨機抽樣方法,在北京市抽取5個區(qū)縣的25個鄉(xiāng)鎮(zhèn)的75個行政村進行現(xiàn)場調(diào)研。采用問卷調(diào)查5類利益相關(guān)者:鄉(xiāng)鎮(zhèn)衛(wèi)生院管理者、鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)務(wù)人員、村醫(yī)、村民、村干部共計1 719人;同期在5個區(qū)縣采取目的抽樣法,訪談各類關(guān)鍵知情人:區(qū)縣政府主管衛(wèi)生的領(lǐng)導(dǎo)、衛(wèi)生行政部門管理者、鄉(xiāng)村醫(yī)務(wù)人員和村民共計35人,了解鄉(xiāng)村衛(wèi)生人力資源配置中存在的倫理問題并探討相應(yīng)對策。結(jié)果鄉(xiāng)鎮(zhèn)衛(wèi)生院管理者認為,目前鄉(xiāng)鎮(zhèn)衛(wèi)生院人才隊伍建設(shè)面臨的主要問題依次為:高素質(zhì)衛(wèi)生人才匱乏(35人次);福利待遇對優(yōu)秀衛(wèi)生人才的吸引力小(30人次);人員專業(yè)結(jié)構(gòu)不合理(22人次);適宜農(nóng)村的衛(wèi)生人才培養(yǎng)不足(22人次);中青年衛(wèi)技人員流失嚴重,面臨人才斷層問題(18人次);工作人員以非專業(yè)、低素質(zhì)人員為主(5人次)等。鄉(xiāng)鎮(zhèn)衛(wèi)生院管理者認為,鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)務(wù)人員將來的合適人選依次為:定向培養(yǎng)"鄉(xiāng)來鄉(xiāng)去"的大學(xué)生(39人次);醫(yī)學(xué)院校畢業(yè)的普通大學(xué)生(34人次);上級醫(yī)療機構(gòu)對口支援的醫(yī)務(wù)人員(19人次);定向培養(yǎng)"鄉(xiāng)來鄉(xiāng)去"的中專生(13人次)等。關(guān)于將來的村醫(yī)人選,村民選擇結(jié)果排序前三位的依次為:衛(wèi)生院下派的醫(yī)生(562人次);定向培養(yǎng)的大專生或大學(xué)生(546人次);本村懂醫(yī)術(shù)的人(488人次)。村醫(yī)選擇結(jié)果排序前三位的依次為:定向培養(yǎng)的大專生或大學(xué)生(46人次),定向培養(yǎng)的中專生(38人次),衛(wèi)生院下派的醫(yī)生(36人次)。結(jié)論基于公平可及的視角,鄉(xiāng)村衛(wèi)生人力資源配置中存在以下倫理問題:鄉(xiāng)村衛(wèi)生人力資源的執(zhí)業(yè)環(huán)境影響其服務(wù)行為和服務(wù)的公平可及;鄉(xiāng)村衛(wèi)生人力資源的準入標準影響后繼人才的補充和隊伍的可持續(xù)發(fā)展;鄉(xiāng)村衛(wèi)生人力資源的診治能力影響農(nóng)民的健康意識和就醫(yī)流向。應(yīng)合理界定鄉(xiāng)村兩級醫(yī)療機構(gòu)的功能定位,滿足農(nóng)民就診時的差異化需求;擴大新農(nóng)合報銷的村級醫(yī)療機構(gòu)覆蓋范圍,提高鄉(xiāng)村衛(wèi)生人力資源的層級配置效率;建立本土化的農(nóng)村衛(wèi)生人才培養(yǎng)體系,保障鄉(xiāng)村衛(wèi)生人力資源的有效供給。
[Abstract]:Objective to understand the ethical problems existing in the allocation of rural health human resources and to explore the countermeasures. Methods in May 2011, stratified random sampling was used. A questionnaire survey was conducted in 75 administrative villages in 25 villages and towns in 5 districts and counties in Beijing. Five types of stakeholders were investigated: managers of township health centers, medical staff of township hospitals, village doctors, villagers, village cadres, a total of 1,719 people. During the same period, the purpose sampling method was adopted in 5 districts and counties to interview all kinds of key insiders: leaders of district and county government in charge of health, managers of health administration departments, rural medical personnel and villagers, a total of 35 people, To understand the ethical problems existing in the allocation of rural health human resources and to explore the corresponding countermeasures. At present, the main problems faced by the construction of talents in township health centers are as follows: the shortage of high-quality health personnel is 35 times, the attractiveness of welfare treatment to excellent health personnel is less than 30 times, the unreasonable professional structure of personnel is 22 person-time. The number of health personnel suitable for rural areas is not enough to reach 22 person-times, and the loss of young and middle-aged health professionals is serious. In the face of a talent gap of 18 person-times, the staff members are mainly non-professional and low-quality personnel (5 person-times). The managers of the township health centers believe that. The suitable candidates for medical staff in township health centers in the future are: 39 college students who come to the countryside, 34 ordinary students who graduate from medical colleges and universities, and 34 medical staff supported by medical institutions at higher levels. Number of people; targeted training of 13 secondary school students "coming to the countryside" etc. About the candidates for future village doctors, The first three places in the order of the villagers' selection results were as follows: 562 doctors sent at the bottom of the hospital; 546 students or college students trained in a targeted way; 488 people who knew the techniques of medicine in the village; and the first three doctors in the ranking of the results of the selection of village doctors were as follows:. There were 46 college students or college students, 38 secondary school students and 36 doctors under the hospital. Conclusion based on the perspective of fair access, The following ethical problems exist in the allocation of rural health human resources: the practice environment of rural health human resources affects their service behavior and the fairness of service accessibility; The access standard of rural health human resources affects the supplement of the successors and the sustainable development of the contingent; The diagnosis and treatment ability of rural health human resources affects farmers' health consciousness and the direction of seeking medical treatment. The functional orientation of rural medical institutions at two levels should be reasonably defined to meet the differential needs of farmers when they seek medical treatment. To expand the coverage of village level medical institutions, to improve the level allocation efficiency of rural health human resources, to establish a local rural health personnel training system, and to ensure the effective supply of rural health human resources.
【作者單位】： 首都醫(yī)科大學(xué)衛(wèi)生管理與教育學(xué)院;
【基金】：北京市哲學(xué)社會科學(xué)規(guī)劃重大項目(11ZDA05) 北京市屬高等學(xué)校教學(xué)創(chuàng)新人才——教學(xué)名師項目(PHR201106207) 國家軟科學(xué)研究項目(2010GXS5D179) 教育部人文社會科學(xué)研究項目(10YJAZH055)
【分類號】：R197.1

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