县域医共体对乡村医生的影响——基于相邻两县实地调研的经验证据  

Influence of county medical community on village doctors:An empirical evidence based on field research in two neighboring counties

作　　者：赵瑞娜 ZHAO Ruina(University of Chinese Academy of Social Sciences,Fangshan,Beijing 102488,China)

机构地区：[1]中国社会科学院大学,北京房山102488

出　　处：《中国农村卫生事业管理》2021年第2期113-117,共5页Chinese Rural Health Service Administration

摘　　要：我国乡村医生数量不断下降,素质不高,成为影响农村医疗卫生事业和居民健康的重要制约因素。县域医共体是应对我国农村卫生人力短缺和医疗服务体系改革的重要组织模式创新。文章基于两县实地调研的案例,对比县域医共体对乡村医生的影响,分析影响路径和制约因素。结果表明:县域医共体通过绩效管理提高乡村医生工作积极性和业务能力,增强乡村医生从事基本公共卫生服务和医疗服务的规范性,让乡村医生按时得到各项补助,并优化乡村医生工作环境。但短期内并未显著提高乡村医生的收入水平。其原因在于城镇化背景下乡村人口不断缩减,难以养活乡村医生;乡村医生从能力提升到业务量提升是一个长期的过程;县域整体医疗服务能力有限。同时,县域医共体面临人事、财务等体制约束,难以解决乡村医生的身份认同和养老保障困境。未来需要优化县域医共体的制度环境,提高县域医共体的信息管理水平,着重解决边远地区人才缺乏问题。Village doctors that are in insufficient quantity and poor quality have become an important constraining factor of rural health care and residents’health.County medical community is an important organizational model innovation to deal with the shortage of rural health manpower and the reform of health care system.Based on a case study of field investigation in two counties,the paper compared the influence of county medical community on rural doctors and analyzed the influencing paths and restricting factors.The results showed that county medical community improved the work enthusiasm and professional ability of rural doctors through performance management,enhanced the standardization of rural doctors’participation in basic public health services and medical services,enabled rural doctors to get all kinds of subsidies on time,and optimized the working environment for rural doctors.However,the income level of rural doctors had not significantly increased in the short term.The reason was that under the background of urbanization,rural population was shrinking,thus difficult to support rural doctors.It needs a long process for rural doctors to improve their ability and patient visits.The overall medical service capacity of the county is limited.Meanwhile,county medical community is faced with institutional constraints such as personnel and finance,which makes it difficult to solve the dilemma of rural doctors’identity and pension security.In the future,it is necessary to optimize the institutional environment of the county medical community,improve the information management level,and focus on solving the problems of talents shortage in remote areas.

关 键 词：县域医共体 乡村医生 农村卫生人力 农村医疗服务体系整合 

分 类 号：R19[医药卫生—卫生事业管理]