基层卫生人力资源困境的职业地位解释  

Explanation of Human Resources Shortage of Grassroots Healthcare by Professional Status

作　　者：张明吉[1] 严非[2] ZHANG Ming-ji(School of Public Health,Shanghai Jiao Tong University,Shanghai,200025,China)

机构地区：[1]上海交通大学公共卫生学院,上海200025 [2]复旦大学公共卫生学院,卫生部卫生技术评估重点实验室,上海200032

出　　处：《医学与社会》2020年第11期1-8,51,共9页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为71704109;2019年上海交通大学新进青年教师启动计划,编号为19X100040039。

摘　　要：本研究根据结构功能主义理论,利用多来源的一二手资料论证了基层卫生人力资源不足不应只看作需求未满足的资源困境,根本上是由于职业地位较低,而职业地位的制度性根源在于卫生行业的行政等级制和医疗技术分级结构。行政等级制造成医疗技术、资源均按级别排序,基层卫生处于低层;医疗技术分级和医疗技术级别认知使基层全科医生被认为级别最低、知识权威最弱,因此也缺乏地位和声誉。应用职业地位解释机制,本研究发现当前政策主要针对人员资源需求进行改善,但对基层医疗技术等级的放开还不够。进一步比较他国经验发现,若缺乏对职业地位,尤其是医疗技术分级结构的调整,则不能从根本上阻断基层卫生低地位自我强化过程,也无法解决基层人力不足问题。最后建议政策更重视职业地位问题,减少对基层医疗技术能级的限制;提倡功能区分的职业认知;并通过健全基本医疗卫生学科和学术体系,赋予家庭医生健康管理权,让家庭医生成为健康管家,来提升职业地位。From structural functionalism,applying multiple sources of material,this article demonstrated that shortage of grassroots healthcare practitioners is not merely about dissatisfied resource demands,rather driven by professional status structure in medical sector.This status structure in turn has been shaped by two institutional causes,the first is bureacratic hierarchy in health sector which stratified every category of resources;the second is medical technology hierarchy which dooms general practice and grassroots healthcare in the lowest of levels set by specialist skills.Consequently,grassroots healthcare practitioners obtain scarce knowledge power,low prestige.Applying this explanation,this article evaluated current policies and noticed effective measures for satisfying resource demands but inadequate emphasis on releasing technology restriction on primary health facilities.Comparison with international experiences and indicated by our professional status explanation,it is not possible to radically resolve grassroots healthcare shortage without adjust professional status structure and corresponding perception.Finally,it is suggested to emphasize professional status,lift restriction on medical technology,advocate for perception of role difference not status gap;and to strengthen academic organization of grassroots healthcare,empower family doctors and portray family doctors not as gatekeeper but health manager to elevate their professional status.

关 键 词：基层卫生 社区卫生服务 人力资源 职业地位 

分 类 号：R195[医药卫生—卫生统计学]