我国乡镇卫生院适宜医疗服务能力研究  

Research on the Appropriate Medical Service Capacity of Township Health Centers in China

作　　者：潘子晶 卢珊[1] 张亮[3] PAN Zijing(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430030,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]中山大学肿瘤防治中心医务处,广东广州510060 [3]武汉大学政治与公共管理学院,湖北武汉430072

出　　处：《医学与社会》2024年第1期36-42,共7页Medicine and Society

基　　金：国家自然科学基金资助重点项目,编号为71734003;中国博士后科学基金资助项目,编号为2021M701296。

摘　　要：目的:基于生态位理论,从系统视角探究我国农村卫生服务体系中乡镇卫生院的适宜医疗服务能力,为厘清乡镇卫生院和县级医院关系、优化农村医疗服务供给提供参考。方法:采用多阶段抽样选取370家乡镇卫生院,分析乡镇卫生院医疗服务能力生态位与重叠度现状,并采用Lowess方法对生态位与重叠度的关系进行拟合以寻找适宜的医疗服务能力生态位范围。医疗服务能力生态位和重叠度分别利用态势理论的生态位计算公式和Pianka公式测量。结果:乡镇卫生院医疗服务能力生态位的平均值(0.129)远低于县级医院医疗服务能力生态位平均值(0.871),且不同乡镇卫生院之间差异显著(最高为0.366、最低为0.021)。乡镇卫生院医疗服务能力生态位重叠度也存在明显差异,最高为0.766,最低为0.099。乡镇卫生院医疗服务能力生态位与重叠度的拟合关系呈“U”形曲线,生态位在0.087至0.228之间取值时重叠度最小。结论:我国乡镇卫生院医疗服务能力生态位处于合适的区间时,县乡两级的重叠摩擦才最小,更有利于农村卫生服务系统的整体优化。Objective:To explore the appropriate medical service capacity of township health centers(THCs)in rural health care system in China based on the niche theory,so as to clarify the relationship between THCs and county hospitals and provide theoretical basis for optimizing healthcare delivery in rural areas.Methods:Based on the multistage sampling,370 THCs were included in this study.The current status of medical service capacity niche and overlap degree of THCs was analyzed,and their relationship was fitted using Lowess method to identify the appropriate range of niche of medical service capacity.The niche and overlap of medical service capacity were calculated based on the niche ecostate-ecorole theory and Pianka formula,repectively.Results:The average value of niche of clinical care capability for THCs(0.129)was much lower than that of county hospitals(0.871),and the difference between THCs was significant(the highest value of niche was 0.366 and the lowest was 0.021).The values of niche overlap showed significant difference.The highest and the lowest value of niche overlap were 0.766 and 0.021,respectively.The niche and overlap of medical service capacity for THCs showed a U-shaped relationship.When the value of niche was between 0.087 and 0.228,the value of niche overlap stayed at the minimum level.Conclusion:Only when the value of niche of medical service capacity for THCs in China is in an appropriate range,the competition between THCs and county hospitals was minimized,which contributes to the optimization of the overall rural health care system.

关 键 词：医疗服务 服务能力 乡镇卫生院 

分 类 号：R-05[医药卫生]