本文選題：鄉(xiāng)鎮(zhèn)衛(wèi)生院 + 運(yùn)行機(jī)制��； 參考：《華中科技大學(xué)》2016年博士論文

【摘要】：[目的]鄉(xiāng)鎮(zhèn)衛(wèi)生院是農(nóng)村醫(yī)療衛(wèi)生服務(wù)網(wǎng)的重要組成部分,是維護(hù)全民健康的主要載體。本研究基于我國社會(huì)經(jīng)濟(jì)形勢的劇烈變化,結(jié)合衛(wèi)生系統(tǒng)內(nèi)部改革影響,從農(nóng)村居民需求出發(fā),打破行政區(qū)劃的界限,在分析近年來鄉(xiāng)鎮(zhèn)衛(wèi)生院功能發(fā)揮和運(yùn)行現(xiàn)狀的基礎(chǔ)上,提出進(jìn)一步完善轉(zhuǎn)型期鄉(xiāng)鎮(zhèn)衛(wèi)生院的功能定位和保障機(jī)制,同時(shí)提出鄉(xiāng)鎮(zhèn)衛(wèi)生院的不同發(fā)展模式,為新時(shí)期鄉(xiāng)鎮(zhèn)衛(wèi)生院發(fā)展提供政策制定的參考依據(jù)。l方法]在現(xiàn)狀分析和回顧性研究的基礎(chǔ)上,利用Excel、SPSS等軟件,綜合運(yùn)用衛(wèi)生政策學(xué),衛(wèi)生經(jīng)濟(jì)學(xué),統(tǒng)計(jì)學(xué)等方法,定性與定量相結(jié)合,從社會(huì)經(jīng)濟(jì)變化和衛(wèi)生系統(tǒng)改革對(duì)農(nóng)村居民需求和鄉(xiāng)鎮(zhèn)衛(wèi)生院服務(wù)提供做了前瞻性研究。資料收集方法：(1)定量研究。對(duì)江蘇等6省發(fā)放問卷。(2)現(xiàn)有的統(tǒng)計(jì)資料收集。收集鄉(xiāng)鎮(zhèn)衛(wèi)生院運(yùn)行和服務(wù)提供狀況等相關(guān)統(tǒng)計(jì)資料。(3)定性調(diào)查。通過問卷調(diào)查、關(guān)鍵知情人訪談、專題小組討論,了解典型地區(qū)鄉(xiāng)鎮(zhèn)衛(wèi)生院服務(wù)提供情況。分析方法：(1)文獻(xiàn)研究法。對(duì)鄉(xiāng)鎮(zhèn)衛(wèi)生院發(fā)展歷程和典型國家基層醫(yī)療衛(wèi)生服務(wù)方面的文獻(xiàn)進(jìn)行分析。(2)回歸分析預(yù)測法：根據(jù)老齡化、農(nóng)村居民人均純收入變化、流動(dòng)人口情況等,分析農(nóng)村居民對(duì)醫(yī)療服務(wù)的需求。(3)比較分析法。比較分析不同地區(qū)、不同經(jīng)濟(jì)水平鄉(xiāng)鎮(zhèn)衛(wèi)生院資源配置、籌資、運(yùn)行、業(yè)務(wù)開展和服務(wù)利用的變化情況。(4)聚類分析。對(duì)調(diào)研的鄉(xiāng)鎮(zhèn)衛(wèi)生院按照地理、社會(huì)經(jīng)濟(jì)、服務(wù)功能等特征進(jìn)行聚類分析,分析發(fā)展趨勢。(5)DEA分析。分析了76所鄉(xiāng)鎮(zhèn)衛(wèi)生院的運(yùn)行效率,比較了不同時(shí)期不同地區(qū)鄉(xiāng)鎮(zhèn)衛(wèi)生院資源配置效率和變化趨勢,為研究資源配置提供依據(jù)。統(tǒng)計(jì)模型預(yù)測[結(jié)果]1.理論分析結(jié)果表明,我國鄉(xiāng)鎮(zhèn)衛(wèi)生院的功能受社會(huì)經(jīng)濟(jì)變化影響,每個(gè)時(shí)期都有所側(cè)重,特別是隨著分級(jí)診療制度的建立、醫(yī)養(yǎng)結(jié)合的推進(jìn)和基本公共衛(wèi)生服務(wù)任務(wù)的增加,加上老齡化進(jìn)程的加快,鄉(xiāng)鎮(zhèn)衛(wèi)生院的康復(fù)護(hù)理和衛(wèi)生管理功能需要加強(qiáng)。2.鄉(xiāng)鎮(zhèn)衛(wèi)生院的各項(xiàng)功能發(fā)揮情況(1)醫(yī)療功能。鄉(xiāng)鎮(zhèn)衛(wèi)生院的門急診呈增長態(tài)勢,住院總體穩(wěn)定,90%左右的鄉(xiāng)鎮(zhèn)衛(wèi)生院具備提供基本醫(yī)療服務(wù)和常見理化檢查的能力,但鄉(xiāng)鎮(zhèn)衛(wèi)生院手術(shù)量偏低且呈下滑態(tài)勢,較大風(fēng)險(xiǎn)和較高技術(shù)含量的醫(yī)療服務(wù)根據(jù)鄉(xiāng)鎮(zhèn)衛(wèi)生院發(fā)展類型的不同出現(xiàn)多樣化的情況。(2)公共衛(wèi)生服務(wù)功能。雖然防保人員數(shù)量不足且年齡偏大,但公共衛(wèi)生服務(wù)開展率整體較高,服務(wù)質(zhì)量明顯提升改善,鄉(xiāng)鎮(zhèn)衛(wèi)生院已逐步將基本公共衛(wèi)生服務(wù)作為重要的服務(wù)內(nèi)容。(3)公共衛(wèi)生管理職能。隨著鄉(xiāng)村一體化的推進(jìn)、基本藥物制度實(shí)施后財(cái)政給予的專項(xiàng)補(bǔ)助、村衛(wèi)生室信息化逐步建立、基本公共衛(wèi)生服務(wù)項(xiàng)目經(jīng)費(fèi)的不斷提高和按考核結(jié)果發(fā)放,鄉(xiāng)鎮(zhèn)衛(wèi)生院的衛(wèi)生管理職能得到加強(qiáng)。3.轉(zhuǎn)型期社會(huì)經(jīng)濟(jì)變化如農(nóng)村常住人口減少、老齡化、農(nóng)村居民人均收入增加、醫(yī)保制度健全等因素對(duì)鄉(xiāng)鎮(zhèn)衛(wèi)生院功能影響較大,未來對(duì)鄉(xiāng)鎮(zhèn)衛(wèi)生院的醫(yī)療服務(wù)出現(xiàn)多樣化需求,對(duì)康復(fù)和護(hù)理服務(wù)需求較大。[結(jié)論](1)轉(zhuǎn)型期鄉(xiāng)鎮(zhèn)衛(wèi)生院承擔(dān)醫(yī)療、公共衛(wèi)生服務(wù)、衛(wèi)生管理和康復(fù)護(hù)理4項(xiàng)主要功能。其中醫(yī)療功能作為公共衛(wèi)生功能和康復(fù)護(hù)理功能發(fā)揮的支撐,需要進(jìn)一步加強(qiáng)各項(xiàng)功能和服務(wù)間的聯(lián)動(dòng)：公共衛(wèi)生功能,鄉(xiāng)鎮(zhèn)衛(wèi)生院要進(jìn)一步發(fā)揮好基本公共衛(wèi)生服務(wù)提供和對(duì)村衛(wèi)生室的管理考核的雙重責(zé)任；衛(wèi)生管理和康復(fù)護(hù)理功能需要重點(diǎn)強(qiáng)化。(2)要保障鄉(xiāng)鎮(zhèn)衛(wèi)生院功能的正常發(fā)揮,要繼續(xù)加大投入力度,并按照鄉(xiāng)鎮(zhèn)衛(wèi)生院的功能定位進(jìn)行分類管理,加強(qiáng)人才隊(duì)伍建設(shè),深化綜合改革并完善收支管理方式,并主動(dòng)轉(zhuǎn)變成為預(yù)防-治療-康復(fù)-護(hù)理的服務(wù)模式。(3)鄉(xiāng)鎮(zhèn)衛(wèi)生院的發(fā)展模式要因地制宜,結(jié)合當(dāng)?shù)貙?shí)際,不能簡單按照經(jīng)濟(jì)發(fā)展水平劃分功能。對(duì)于老齡化程度較高的地區(qū),要強(qiáng)化慢病管理、老年護(hù)理保健和康復(fù)等服務(wù)；對(duì)于服務(wù)人口較少、距離縣級(jí)醫(yī)療機(jī)構(gòu)較近、缺少有資質(zhì)醫(yī)師和護(hù)士的衛(wèi)生院將弱化高風(fēng)險(xiǎn)醫(yī)療服務(wù)；對(duì)于服務(wù)人口多的地區(qū)如超過10萬人,要加強(qiáng)醫(yī)療服務(wù)能力建設(shè)。[創(chuàng)新1(1)本研究對(duì)鄉(xiāng)鎮(zhèn)衛(wèi)生院功能定位的思路有變化,主要基于我國社會(huì)經(jīng)濟(jì)發(fā)展的劇烈變革,結(jié)合衛(wèi)生系統(tǒng)內(nèi)部改革如分級(jí)診療制度建立、農(nóng)村居民未來需求變化和6年間鄉(xiāng)鎮(zhèn)衛(wèi)生院功能與運(yùn)行情況的縱向變化,重點(diǎn)考慮當(dāng)?shù)亟?jīng)濟(jì)社會(huì)發(fā)展、人口結(jié)構(gòu)、人員資質(zhì)、與縣醫(yī)院距離等因素,按照經(jīng)濟(jì)發(fā)展水平,從東、中、西部選取典型地區(qū),結(jié)合當(dāng)?shù)貙?shí)際發(fā)展情況,對(duì)醫(yī)療、公共衛(wèi)生、衛(wèi)生管理和康復(fù)護(hù)理四項(xiàng)功能進(jìn)行深入研究,提出了鄉(xiāng)鎮(zhèn)衛(wèi)生院在未來發(fā)展模式上的功能定位方向。(2)本研究通過實(shí)證研究和理論研究歸納總結(jié)：新時(shí)期鄉(xiāng)鎮(zhèn)衛(wèi)生院要主動(dòng)應(yīng)對(duì)分級(jí)診療制度建立和醫(yī)養(yǎng)結(jié)合推進(jìn),結(jié)合鄉(xiāng)村一體化管理的快速推進(jìn)、村衛(wèi)生室實(shí)施基本藥物制度和國家基本公共生服務(wù)的鄉(xiāng)村聯(lián)動(dòng)等情況,在承擔(dān)基本醫(yī)療和公共衛(wèi)生服務(wù)功能的同時(shí),重視和加強(qiáng)另外兩項(xiàng)功能,包括大力加強(qiáng)康復(fù)護(hù)理功能,進(jìn)一步強(qiáng)化衛(wèi)生管理功能,并提出強(qiáng)化衛(wèi)生管理職能可依托的手段和工具。(3)本研究綜合考慮服務(wù)人口、老齡化程度、農(nóng)村居民人均純收入、與縣醫(yī)院距離,以及縣醫(yī)院和村衛(wèi)生室的服務(wù)能力和布局等因素,通過聚類分析和DEA分析、定性資料的主題框架分析等分析方法對(duì)鄉(xiāng)鎮(zhèn)衛(wèi)生院的發(fā)展趨勢進(jìn)行研究及預(yù)測。[局限1由于鄉(xiāng)鎮(zhèn)衛(wèi)生院的功能定位要結(jié)合各地區(qū)實(shí)際情況,而我國社會(huì)經(jīng)濟(jì)發(fā)展水平差別較大,存在多樣化和快速變化情況,導(dǎo)致實(shí)證研究和聚類分析中樣本的代表性、技術(shù)效率與規(guī)模效率分析中對(duì)公共衛(wèi)生服務(wù)量的分析有待商榷。本研究所得出的結(jié)果受研究條件、調(diào)研經(jīng)費(fèi)及人員素質(zhì)和數(shù)量等的影響,在全國范圍內(nèi)的可推廣性也存在一定局限。
[Abstract]:[Objective] township hospital is an important part of the rural medical and health service network, and it is the main carrier to maintain the health of the whole people. This study is based on the dramatic changes in the social and economic situation in China, combined with the influence of the internal reform of the health system, starting from the needs of the rural residents, breaking the boundaries of the administrative district, and analyzing the functions of the township hospitals in recent years. On the basis of the present situation, the function orientation and guarantee mechanism of township hospitals in the transition period are further improved. At the same time, the different development modes of township health centers are put forward, and the reference basis of policy formulation for the development of township health centers in the new period is provided by the.L method] on the basis of the status analysis and retrospective study, and the use of Excel, SPSS and so on. Software, comprehensive use of health policy science, health economics, statistics and other methods, qualitative and quantitative combination, from social and economic changes and health system reform of rural residents' needs and township health service provide a prospective study. Data collection methods: (1) quantitative research. 6 provinces and other provinces of Jiangsu issued questionnaires. (2) existing statistical funds. Materials collection. Collect the status of the operation and service supply of township health centers. (3) qualitative investigation. Through questionnaire survey, key lovers interview, special group discussion, to understand the service provision of township hospitals in typical areas. Analysis methods: (1) literature research method. The development process of township health centers and typical national medical treatment. The literature of health service is analyzed. (2) regression analysis and prediction method: according to the aging, the change of the per capita net income of rural residents, the situation of the floating population, and so on, the demand of rural residents to medical service is analyzed. (3) comparative analysis method. Compare and analyze the resources allocation, financing, operation and business development of different economic level township hospitals in different regions. And the change of service utilization. (4) cluster analysis. Cluster analysis on the characteristics of township hospitals in accordance with geography, social economy and service function. (5) DEA analysis. Analysis of the operation efficiency of 76 township hospitals, and compared the efficiency and change trend of the resources allocation of township hospitals in different areas in different periods, The results of statistical model prediction show that the function of township hospitals in China is affected by social and economic changes, and the results of]1. theoretical analysis show that there is a particular emphasis in each period, especially with the establishment of the classification system, the promotion of the combination of medical care and the increase of basic public health services, and the aging. The acceleration of the course, the rehabilitation nursing and the health management function of the township hospitals need to strengthen the functions of the.2. Township Hospital (1) the medical function. The township health hospital has a growing trend in the emergency department, the overall hospital is stable, and 90% of the township health centers have the ability to provide basic medical services and common physical and chemical inspection, but the village and township health service. The number of medical services in the hospital was low and declined, and the medical services with greater risk and high technical content varied according to the development types of township hospitals. (2) the public health service function. Although the number of the personnel was insufficient and the age was large, the public health service rate was higher and the quality of service was obviously improved. The basic public health service has been gradually taken as an important service content. (3) the function of public health management. With the promotion of the rural integration and the special subsidies given by the financial system after the implementation of the basic drug system, the informatization of village health rooms is gradually established, and the funds for basic public health services are constantly improved and evaluated. The health management functions of the township health centers have been strengthened, such as the social and economic changes in the.3. transformation period, such as the reduction of the rural resident population, the aging, the increase of the per capita income of the rural residents, the sound medical insurance system and so on, which have a great influence on the function of the township health centers. The demand for the service is large. [Conclusion] (1) the township hospitals in the transition period undertake 4 main functions of medical treatment, public health service, health management and rehabilitation nursing. Among them, the medical function as the support of the function of public health and the function of rehabilitation nursing needs to further strengthen the linkage of various functions and services: public health function, township and village health. The hospital should give full play to the dual responsibility of providing basic public health services and assessing the management of village health rooms; health management and rehabilitation nursing functions need to be strengthened. (2) to ensure the normal function of the functions of township hospitals, to continue to increase investment, and to carry out classification management in accordance with the functional orientation of township hospitals. The construction of strong talent team, deepening the comprehensive reform and improving the mode of revenue and expenditure management, and actively transforming into the service mode of prevention treatment rehabilitation nursing. (3) the development mode of township hospitals should be adapted to local conditions, combined with the local practice, and can not simply divide the function according to the level of economic development. Diseases management, elderly care and rehabilitation services, less service population, closer to county-level medical institutions and lack of qualified doctors and nurses will weaken the high risk medical service; for more than 100 thousand people in the area with more population, we should strengthen the construction of medical service capacity. [innovation 1 (1) study on Township Health The thinking of the function orientation of the hospital has changed, mainly based on the dramatic changes in the social and economic development of our country, combined with the reform of the internal health system, such as the establishment of the grading diagnosis and treatment system, the change of the rural residents' future demand and the longitudinal changes of the function and operation of the township hospitals in the past 6 years, focusing on the local economic and social development, the population structure and the personnel qualification, With the county hospital distance and other factors, according to the economic development level, from the eastern, middle and Western selected typical areas, combined with the local actual development situation, the four functions of medical, public health, health management and rehabilitation nursing were studied in depth, and the orientation of the functional orientation of township hospitals in the future development mode was put forward. (2) this study through empirical research In the new period, the township health centers should take the initiative to deal with the establishment of the classification diagnosis and treatment system and the combination of medical and maintenance, combined with the rapid promotion of rural integrated management, the village health room implementation of the basic drug system and the country's basic public health services, such as the rural linkage, to undertake the basic medical and public health services. At the same time, we should pay more attention to and strengthen the other two functions, including strengthening the function of rehabilitation nursing, further strengthening the function of health management, and putting forward the means and tools to strengthen the function of health management. (3) this study comprehensively considers the service population, the degree of aging, the per capita net income of the rural residents, the distance from the county hospitals, and the county hospitals and the hospitals. The service ability and layout of the village health room, such as the cluster analysis and DEA analysis, the analysis method of the qualitative data and the theme frame analysis method to study and forecast the development trend of township hospitals. [Limited 1 because the function orientation of the township health centers should be combined with the actual situation in various regions, and the difference of the social and economic development level of our country is more different. There is a variety and rapid change, which leads to the representativeness of samples in empirical research and cluster analysis. The analysis of public health services in the analysis of technical efficiency and scale efficiency is open to discussion. The results obtained by this study are influenced by the research conditions, the research funds and the quality and quantity of the personnel and so on. There are also limitations in the nature of the nature.

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R197.62

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5 袁t，

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