“目标偏差”与“工具偏差”:乡村医生长效发展机制探究  

“Goal Deviation”and“Tool Deviation”:A Study on the Long-term Development Mechanism of Rural Doctors

作　　者：杨晓婷 廖睿力 毕怡琳 YANG Xiaoting;LIAO Ruili;BI Yilin

机构地区：[1]中国人民大学农业与农村发展学院 [2]清华大学公共管理学院

出　　处：《中国农村观察》2021年第4期90-106,共17页China Rural Survey

基　　金：国家社会科学基金青年项目“农村老年多维贫困与精准扶贫机制研究”(项目编号:17CGL030)的阶段性研究成果;黄宗智历史与社会研究2019年青年学子资助计划成果;中国人民大学2020年度拔尖创新人才培育资助计划成果。

摘　　要：受2020年新冠肺炎疫情影响,农村医疗卫生安全备受关注。乡村医生作为农村基层医疗卫生服务的重要供给主体,在防控疫情等方面发挥了重要作用。然而,农村基层医疗卫生服务体系面临乡村医生"招不进、留不住"的难题。本文从政策目标、政策工具与社会进程之间形成的"目标偏差-工具偏差"两个维度提出分析框架,剖析乡村医生发展困境的成因,进而提出建立乡村医生长效发展机制。本文发现,"防治同步"的政策目标与"以防为主"的社会进程之间的"目标偏差",是乡村医生发展困境产生的根本原因;而乡村医生执业门槛和其他政策工具(薪酬制度和晋升制度)与社会进程之间的"工具偏差",是乡村医生发展困境产生的表层原因。因此,建立乡村医生长效发展机制应从以下四方面入手:第一,使政策目标适应乡村医生职能转换的社会进程,完善"分级诊疗"制度框架,明确农村基层医疗卫生服务供给主体的职能分工。第二,实施弹性化执业门槛,让乡村医生"招进来"。第三,完善激励机制,适当提高薪酬补助,同时明晰隶属关系,打通乡村医生晋升渠道,让乡村医生"留得住"。第四,构建紧密型县域医疗卫生共同体。Affected by the COVID-19 pandemic in 2020, rural medical and health safety has attracted much attention. As an important supplier of rural primary medical and health services, rural doctors play an important role in the prevention and control of the pandemic. However, the rural primary medical and health service system is facing problems in the construction of rural doctors’ team, such as "no recruitment, no retention". This article proposes a two-dimensional analytical framework of "goal deviation" and "tool deviation", analyzes the causes of the development dilemma of rural doctors and further investigates the mechanism for establishing an effective country doctor system. The study finds that the goal deviation between the policy goal of "prevention and treatment synchronization" and the social process of "prevention in the first place" is the root cause of the development dilemma of rural doctors, whereas the tool deviation resulted from the divergence between policy tools(recruitment requirements of rural doctors, salary system and promotion system) and the social process is the surface cause of their development dilemma. Therefore, the establishment of longterm development mechanism of rural doctors should start from the following four aspects: First, making the policy goals adapt to the social process of rural doctors’ function transformation, improving the "hierarchical diagnosis and treatment" system framework, and clarifying the functional division of rural primary medical and health service providers;Second, providing flexible recruitment requirements, so that rural doctors can be recruited;Third, improving the incentive mechanism, appropriately increasing their salary and subsidies, clarifying the subordinate relationship, and opening up the promotion channels for rural doctors, so that they can stay;Fourth, building a strong county medical and health community.

关 键 词：乡村医生 执业门槛 政策目标 政策工具 社会进程 

分 类 号：C911[经济管理]