乡村卫生人力资源配置中的伦理问题分析及对策探讨  

Ethical Issues Analysis and Countermeasures Exploration of the Allocation of Rural Health Human Resource

作　　者：彭迎春[1] 王晓燕[1] 黄昊[1] 李珑[1] 

机构地区：[1]首都医科大学卫生管理与教育学院,北京市100069

出　　处：《中国全科医学》2014年第31期3689-3695,共7页Chinese General Practice

基　　金：北京市哲学社会科学规划重大项目(11ZDA05);北京市属高等学校教学创新人才--教学名师项目(PHR201106207);国家软科学研究项目(2010GXS5D179);教育部人文社会科学研究项目(10YJAZH055)

摘　　要：目的了解乡村卫生人力资源配置中存在的伦理问题并探讨解决对策。方法于2011年5月,采用分层随机抽样方法,在北京市抽取5个区县的25个乡镇的75个行政村进行现场调研。采用问卷调查5类利益相关者:乡镇卫生院管理者、乡镇卫生院医务人员、村医、村民、村干部共计1 719人;同期在5个区县采取目的抽样法,访谈各类关键知情人:区县政府主管卫生的领导、卫生行政部门管理者、乡村医务人员和村民共计35人,了解乡村卫生人力资源配置中存在的伦理问题并探讨相应对策。结果乡镇卫生院管理者认为,目前乡镇卫生院人才队伍建设面临的主要问题依次为:高素质卫生人才匮乏(35人次);福利待遇对优秀卫生人才的吸引力小(30人次);人员专业结构不合理(22人次);适宜农村的卫生人才培养不足(22人次);中青年卫技人员流失严重,面临人才断层问题(18人次);工作人员以非专业、低素质人员为主(5人次)等。乡镇卫生院管理者认为,乡镇卫生院医务人员将来的合适人选依次为:定向培养"乡来乡去"的大学生(39人次);医学院校毕业的普通大学生(34人次);上级医疗机构对口支援的医务人员(19人次);定向培养"乡来乡去"的中专生(13人次)等。关于将来的村医人选,村民选择结果排序前三位的依次为:卫生院下派的医生(562人次);定向培养的大专生或大学生(546人次);本村懂医术的人(488人次)。村医选择结果排序前三位的依次为:定向培养的大专生或大学生(46人次),定向培养的中专生(38人次),卫生院下派的医生(36人次)。结论基于公平可及的视角,乡村卫生人力资源配置中存在以下伦理问题:乡村卫生人力资源的执业环境影响其服务行为和服务的公平可及;乡村卫生人力资源的准入标准影响后继人才的补充和队伍的可持续发展;乡村卫生人力资源的诊治能力影响农民的健康意识和就医流向�Objective To investigate the ethical issues existed in the allocation of rural health human Resource in Bei-jing and then attempt to work out the countermeasures. Methods 75 administrative villages were selected from 25 villages and towns of 5 districts in Beijing by stratified sampling in May 2011. 5 kinds of stakeholders were investigated on site by question-naire：township hospital managers,medical staff,village doctors,villagers and village cadres and they were 1 719 totally. At the same time,purpose sampling method was used to investigate 35 people including the insiders,district leaders in charge of health,health administrative department managers,village medical workers and villages. Results Township hospitals managers believed that the main problems facing the construction of township hospitals personnel were：lack of qualified health personnel （35 people）;low welfare benefit attraction to excellent health personnel（30 people）;unreasonableness of professional staff structure（22 people）;deficiency in cultivating more talents suitable to rural areas（22 people）;serious loss of health techni-cians in middle age and youth and appearing the problem of break in talents（18 people）;mainly non - professional staff with low quality（5 people）and so on. Township hospitals managers believed that the most suitable medical staff for the future town-ship hospitals were：“ from township and to township” college students through orientation training（39 people）;ordinary medi-cal graduates（34 people）;counterpart support medical staff from higher medical institutions（19 people）;“from township to township ”; secondary school students through orientation training（13 people）and so on. About the future village doctor candi-dates,according to the villagers,the top three were：doctors sent by upper health institutions（562 people）,secondary school students or collect graduates trained for rural areas（546 people）,the village people who understand medicine（488 people）;Acco

关 键 词：农村卫生 卫生人力 伦理 对策 

分 类 号：R197[医药卫生—卫生事业管理]