2010年中国乡村医生现状调查

发布时间：2018-05-12 09:47

本文选题：现状调查 + 乡村医生　；参考：《北京协和医学院》2011年硕士论文

【摘要】：背景改革开放30年来,我国经济飞速发展,人民生活水平得到了很大的提高,农村居民对医疗保健的需求逐年增长。据统计,农村居民家庭平均每人医疗保健支出占生活消费总支出的比例从1990年的3.25%上升至2007年的6.25%。中国农村人口众多,对健康的需求逐年增长,中国广大农村有限的健康资源与健康需求之间的矛盾日益增长。如何解决这个矛盾将是一个长期存在的问题。可以预见中国农村最基层的医疗卫生人员——乡村医生,将在相当长的时间里在国家医疗卫生服务体系中承担重要任务。乡村医生素质的高低关系到农村基层医疗服务网络功能能否发挥作用,关系到国家农村卫生政策的落实,关系到农村健康保障制度的建立,关系到对突发性公共卫生事件的应对效果,影响着亿万农村居民的健康水平。最近几年,国家在农村开始推行新医改和新农合制度,在这个形势下,2004年全国开始实行的《乡村医生从业管理条例》对全国乡村医生提出了更高的要求,对乡村医生准入、培训和考核有了明确、严格的规定,希望能逐步解决多年来乡村医生执业无法可依的问题,是乡村医生走向规范化、科学化和法制化道路的里程碑。在这样的背景下,开展一个全国性、多省份、大样本量、调查内容全面、调查方法多样的乡村医生现状调查,系统了解中国乡村医生的基本情况,分析我国乡村医生教育的现状和培训中存在的问题,可为制定乡村医生政策、加强乡村医生队伍建设提供详实可靠的基线资料。目的一、系统了解我国乡村医生的基本情况(性别、年龄、文化程度等) 二、系统了解我国乡村医生受教育程度、培训情况三、系统了解我国乡村医生收入情况四、系统了解我国乡村医生面临的问题和发展的需求五、为中国农村卫生事业的发展提供基于事实的现状报告和政策建议方法本研究采用流行病学横断面调查的研究方法。在文献综述和专家咨询的基础上开发《中国乡村医生现状调查问卷》,对全国十个省/直辖市/自治区(北京市、浙江省、江苏省、江西省、广西壮族自治区、海南省、山西省、贵州省、云南省和甘肃省)部分乡村医生的工作基本情况、教育培训情况、收入相关情况等进行问卷调查和小组访谈,系统分析调查和访谈资料,在此基础上提出政策建议。结果一、本研究总共调查了18,259名乡村医生。乡村医生的平均年龄为44.3±11.2岁,最大年龄为87岁,最小年龄为19岁。其中,36-45岁年龄段的乡村医生数量,占调查总体的32.8%。男性乡村医生占调查总体的70.2%。66.9%的乡村医生认为家庭条件与同村的其他居民相近；25.1%的乡村医生认为家庭条件与其他村民相比较差。在乡村医生的健康状况方面,87.2%的乡村医生对自己的健康状况评价良好。二、67.1%的乡村医生所学专业为临床医学。乡村医生平均从医年限为21.5±11.9年,最小从医年限为1年,最大从医年限为65年。在乡村医生的日常工作方面,临床常见病治疗占总工作量的60%。54.9%的乡村医生还从事除乡村医生工作以外的其他工作,平均每月从事其他工作的时间比例为20%。乡村医生每日进行卫生服务的平均时间为8.5个小时,高于《中华人民共和国劳动法》规定的每天工作时间。71.4%的乡村医生为村民开展体检服务,平均每年提供体检服务3次。其中,测血压占体检服务工作量的50.5%。59.4%的乡村医生为村民建立了健康档案,服务人口健康档案的平均建档率为65.38%。83.6%的乡村医生在日常工作中帮助慢性病患者改善生活方式。其中,96.4%的乡村医生采用的方法为饮食指导。乡村医生平均每周服务人次数为58.5,与2009年的全国社区卫生服务站的数据(68.5人次/周)相比较低。乡村医生平均每周服务人次数具有东中西部地区的差异性,东部地区平均每周服务140(及以上)人次的乡村医生占调查总数的10.7%,中部和西部地区这一比例分别为3.0%和9.7%。乡村医生每次诊治病人的平均收费为17.4元/人。诊治病人平均收费呈东部到西部递减的趋势。乡村医生平均每周转诊病人在7次/周以下的占总数的80.0%；92.2%乡村医生提供出诊服务,每周出诊少于5次/周的乡村医生占总数的63.0%。61.4%的乡村医生不收取出诊费。收取出诊费用的乡村医生平均每次收取出诊费用为4元/次。73.0%的乡村医生收取出诊费用少于5元/次。92.9%的出诊原因为“病人出门不便”。53.4%的乡村医生采用“口服给药”作为处置发热病人的首选方法。调查地区乡村医生在日常工作中处理最常见的五种疾病/症状为上呼吸道感染、消化道感染、高血压、外伤中毒和皮肤病性病。69.5%的乡村医生对自己的本职工作不满意。不满意的三个主要原因为“收入低”(83.6%)、“工作量大”(38.8%)和“工作条件差”(37.9%)。三、63.0%的乡村医生文化程度为中专学历。大专及以上学历的乡村医生占总数的13.3%。执业资格方面,12.8%的乡村医生具有执业(助理)医师资格证书,比2006年全国的数据高(11.5%)。93.9%的乡村医生在近一年接受过培训,平均每年接受培训次数在2次及以下的人数占调查总体的29.7%。48.8%的乡村医生平均每年培训天数在12天以下,平均每年培训天数在12-24天的乡村医生占总数的27.5%,平均每年培训天数在24天及以上的占总数的23.7%。东部地区有2,024人培训天数在24天及以上,占东部地区调查总数的37.6%；中部和西部地区这一比例分别为12.5%和27.6%。在培训天数需求方面,74.7%的乡村医生认为培训天数在12天及以下比较合适,9.1%的乡村医生认为培训天数在24天及以上比较合适。因此,无论是培训天数的现状还是需求,“12天及以下”的比例是最高的。乡村医生平均培训费用支出为300元/次。其中,培训费用最高为4,000元/次,最低为0元。66.0%的乡村医生平均每年培训费用支出在500元及以下。东部地区乡村医生培训支出在1.000元及以上的人数占总数的20.5%,中部和西部地区这一比例分别为8.8%和8.9%。75.9%的乡村医生培训目的为“知识更新”。在培训方式现状的调查中,较常见的前三种培训方式分别为“会议讲座”(56.6%)、“上级医生现场指导”(45.0%)和“远程/视频教育”(31.4%)。在培训方式需求的调查中,乡村医生需求较大的前三种培训方式分别为“上级医生现场指导”(56.2%)、“临床进修”(53.3%)和“学校培训”(29.3%)。因此,培训方式的现状与需求分布不一致。在培训内容现状的调查中,较常见的前三种培训内容为“临床技能”(80.6%)、“用药知识”(65.8%)和“预防保健知识”(65.5%)。在培训内容需求的调查中,乡村医生需求较大的前三种培训内容分别为“临床技能”(93.2%)、“用药知识”(74.5%)和“预防保健知识”(72.0%)。因此,培训内容的现状与需求分布一致。在培训地点现状的调查中,92.8%的乡村医生在乡镇卫生机构接受培训,“乡镇卫生机构”是乡村医生目前接受培训最多的地点。在培训地点需求的调查中,53.0%的乡村医生希望到“县级卫生机构”接受培训,“县级卫生机构”是乡村医生最希望接受培训的地点。68.4%的乡村医生认为培训后有一定的提高,0.9%的乡村医生认为培训之后业务水平无变化。四、年总收入的平均值为14,591.16元,最高年收入为500,000元,最低年收入为10,000。年总收入为10,000-50,000元的乡村医生占总数的61.6%,东部、中部和西部这一比例分别为77.6%、58.9%和45.9%。药品收入占年总收入的50.0%。乡村医生年总收入的构成为卫生服务收入、农副业收入、预防保健补贴和政府的其他补助,卫生服务收入所占比例为60%；乡村医生期望收入为10,000-50,000元/年的占总数的82.4%,东部、中部和西部这一比例为79.8%、84.0%和82.8%,期望年总收入在100.000元及以上的乡村医生占总数的4.5%。其中,东部、中部和西部这一比例分别为5.9%、4.0%和3.7%。8.8%的乡村医生对现有收入满意,41.8%的乡村医生不满意现有的收入。五、在调查总体中,86.5%的乡村医生所在村卫生室实行了新型农村合作医疗制度。实行和未实行新型农村合作医疗制度地区的乡村医生平均每周服务人次数均为40人次/周,没有统计学差异。实行和未实行新型农村合作医疗制度地区的乡村医生对每个病人平均收费分别为14元/人次和13元/人次,没有统计学差异。实行新型农村合作医疗制度地区的乡村医生每周转诊人次数(4人次/周)高于未实行新型农村合作医疗制度地区的乡村医生(3人次/周)。实行新型农村合作医疗制度地区的乡村医生出诊率(91.5%)高于未实行新型农村合作医疗制度地区的乡村医生(91.1%)。实行和未实行新型农村合作医疗制度地区的乡村医生每周出诊人次数分别为5人次/周和4人次/周,没有统计学差异。实行新型农村合作医疗制度地区的乡村医生“口服给药”的比例(51.5%)低于未实行新型农村合作医疗制度地区的乡村医生(53.8%)；实行新型农村合作医疗制度地区的乡村医生“静脉滴注”(42.2%)高于未实行新型农村合作医疗制度地区的乡村医生(40.4%)。结论一、对乡村医生发展的历史回顾和相关政策研究表明,政府重视、政策支持、社会关注是乡村医生队伍建设和发展的关键。二、乡村医生工作基本状况调查的结果显示,其年龄结构老化,从医年限普遍较长,工作内容以临床常见病为主,公共卫生工作开展的较少,日常工作量大,对工作的满意度较低。三、乡村医生教育培训调查的结果显示,乡村医生的学历以中专水平为主,缺少规范化的学校教育。培训的现状具有以下特点：短期培训为主、主要集中在乡镇卫生院进行培训、培训内容以临床技能为主、培训方式以会议讲座为主。乡村医生希望在县级卫生机构接受短期培训,培训内容以临床技能为主,也要增加预防保健知识的学习,培训方式最好为上级医生现场指导和临床进修。培训的现状与需求存在一定的差距,建议在今后的工作中,政府相关部门应当将乡村医生教育培训的目标真正定位于乡村医生的需求,将社区和全科医学的概念逐步引入到乡村医生教育培训中来。四、乡村医生收入调查的结果显示,其收入较低,工作量大,“以药养医”的现象仍旧存在。乡村医生对收入的满意度普遍较低。五、乡村医生的工作情况、教育培训情况和收入情况大多数呈现地域差异。东部地区的乡村医生逐渐向执业(助理)医师过渡,村卫生室逐渐消亡,逐渐由社区卫生服务中心取代。中部和西部地区的乡村医生的工作模式仍旧以传统的村卫生室为主。因此,政府相关部分应当因地制宜制定乡村医生相关政策。六、新型农村合作医疗制度的实施对乡村医生提供卫生服务情况和使用药物情况产生了影响。实施新型农村合作医疗制度地区的乡村医生转诊人次数、出诊率、使用“静脉滴注”率和药品收入占年总收入的比例均高于未实施新型农村合作医疗制度地区的乡村医生。说明实施新型农村合作医疗制度后,农村地区居民卫生服务利用率有所提高,但是,乡村医生不合理用药的现象有加剧的趋势。七、党和政府高度重视乡村医生队伍建设。乡村医生管理走上规范化、法制化阶段,其能力素质不断提高。长期以来,他们为我国农村卫生和广大农民的健康做出了重要的贡献,他们提供的服务是公益性服务,他们的待遇问题应该得到重视。
[Abstract]:background
In the past 30 years of reform and opening up, China's economy has developed rapidly, the living standard of the people has been greatly improved, and the demand for health care for rural residents is increasing year by year. According to statistics, the proportion of health care expenditure per person per person in rural households has risen from 3.25% in 1990 to 6.25%. in 2007. The demand for health is growing year by year. The contradiction between the limited health resources and the health needs of China's vast rural areas is growing. How to solve this problem will be a long-term problem. It can be foreseen that the rural medical staff, the rural doctors, will be in the national health service for a long time. The quality of rural doctors is related to the role of rural medical service network function, the implementation of the country's rural health policy, the establishment of rural health protection system, the response to the emergency public health events and the healthy water of hundreds of millions of rural residents. Flat.
In recent years, the country began to carry out the new medical reform and new rural cooperative system in rural areas. Under this situation, the regulations of rural doctors' employment management started in the country in 2004 have put forward higher requirements to rural doctors in the country. There are clear and strict regulations on the access, training and assessment of rural doctors. It is hoped that rural doctors can be solved gradually for years. The problem that the student practice cannot be dependent on is a milestone in the road of standardization, science and legalization of rural doctors. Under this background, a national, multi Province, large sample, comprehensive survey and various survey methods of rural doctors are carried out to understand the basic situation of Chinese rural doctors and analyze the rural areas in China. The current situation of doctors' education and the problems in training can provide detailed and reliable baseline information for formulating rural doctors' policies and strengthening the construction of village doctors.
First, systematically understand the basic situation of rural doctors in China (gender, age, education level, etc.).
Two, we should systematically understand the education level and training situation of rural doctors in China.
Three, a systematic understanding of the income of rural doctors in China
Four, we should systematically understand the problems and development needs of rural doctors in China.
Five, provide a factual report and policy recommendations for the development of rural health in China.
On the basis of literature review and expert consultation, this study developed a questionnaire on the status of Chinese rural doctors on the basis of literature review and expert consultation. It was used in ten provinces / municipalities / autonomous regions (Beijing, Zhejiang, Jiangsu, Jiangxi, the Guangxi Zhuang Autonomous Region, Hainan, Shanxi, Guizhou, Yunnan province and Gansu). The basic situation of the work of some rural doctors, the situation of education and training, the related situation of income and so on were conducted by questionnaire survey and group interview, and the survey and interview data were systematically analyzed. On this basis, the policy suggestions were put forward.
A total of 18259 rural doctors. The average age of rural doctors was 44.3 + 11.2 years old, the maximum age was 87, and the minimum age was 19. Among them, the number of rural doctors in the 36-45 year old age group, which accounted for the overall survey of 32.8%. male rural doctors, accounted for the family conditions and the same village. Other residents were similar; 25.1% of rural doctors considered family conditions to be worse than other villagers. 87.2% of rural doctors rated their health well in the health of rural doctors.
Two, 67.1% of the rural doctors studied for clinical medicine. The average age of rural doctors was 21.5 + 11.9 years, the minimum number of medical years was 1 years, and the maximum number of medical years was 65 years. In the daily work of rural doctors, the rural doctors with the 60%.54.9% of the clinical common diseases, which accounted for the total workload, were also engaged in other than the work of the rural doctors. On average, the average time per month for other work is 8.5 hours per day for 20%. rural doctors, which is higher than that of rural doctors of.71.4% per day stipulated in the People's Republic of China labor law. The average medical service for villagers is carried out for villagers. The average medical service is provided 3 times per year. Rural doctors with 50.5%.59.4% for service work set up health records for villagers, and rural doctors with an average archival rate of 65.38%.83.6% to help chronic patients improve their lifestyles in their daily work. Of these, 96.4% of rural doctors use dietary guidance. Rural doctors have an average weekly service. The number of times is 58.5, which is lower than the data of the national community health service station (68.5 person / week) in 2009. The average weekly service number of rural doctors is different in the eastern and western regions. The average number of rural doctors serving 140 (and above) per week in the eastern region accounts for 10.7% of the total, and the proportion in the central and western regions is respectively The average charge of 3% and 9.7%. rural doctors for each patient was 17.4 yuan per person. The average fee for diagnosis and treatment of patients was declining in the east to the West. Rural doctors averaged 80% of the total number of patients per week below 7 times per week; 92.2% rural doctors provided medical services, and fewer than 5 visits per week of rural doctors accounted for 63 of the total. Rural doctors of%.61.4%, who charge 4 yuan per time per visit, charge less than 5 yuan per time per visit for the cost of medical treatment, and the reason for the visit of 5 yuan /.92.9% is the "oral administration" of "oral administration" as the first choice for the treatment of fever patients. Method. Rural doctors in the area of rural areas treated the five most common diseases / symptoms of upper respiratory tract infection, digestive tract infection, hypertension, trauma poisoning and dermatosis.69.5%. Rural doctors were not satisfied with their own work. The three main reasons for dissatisfaction were "low income" (83.6%) and "heavy workload" (38.8%). And "poor working conditions" (37.9%).
Three, 63% of rural doctors have secondary school education. Rural doctors with junior college or above qualifications account for the total number of 13.3%. qualifications, 12.8% of rural doctors have certified (Assistant) physician qualification certificates, which are higher than the national data of 2006 (11.5%).93.9% for rural doctors who have been trained in the last year, and the average number of training times per year is accepted. The average annual training days for the total number of rural doctors with 2 and below the total number of 29.7%.48.8% were less than 12 days, and the average number of training days per year was 27.5% of the total number of rural doctors in 12-24 days. The average number of training days in the eastern region of the east of 23.7%., the average number of training days for 24 days or more, was 24 days and more, accounting for the East. The total number of surveys in the Department is 37.6%; the proportion of the central and western regions is 12.5% and 27.6%. in the training day demand. 74.7% of the rural doctors believe that the number of training days is suitable for 12 days and below, and 9.1% of the rural doctors believe that the number of training days is more suitable for 24 days and above. The ratio of "12 days and below" is the highest. The average training cost of rural doctors is 300 yuan per time. The maximum training cost is 4000 yuan per time, and the average training expenses of rural doctors with the minimum of 0 yuan.66.0% are 500 yuan per year. The number of training expenditure of rural doctors in the eastern region is 20 of the total of 1 yuan and above. .5%, rural doctors in the central and western regions of the central and western regions were 8.8% and 8.9%.75.9% for the purpose of "knowledge renewal". In the survey of the status of the training methods, the most common three kinds of training methods were "conference lecture" (56.6%), "site guidance of superior doctors" (45%) and "distance / video education" (31.4%). In the survey of type demand, the first three training methods for rural doctors were "field guidance of higher level doctors" (56.2%), "clinical learning" (53.3%) and "school training" (29.3%). Therefore, the status of training methods was not consistent with the distribution of demand. In the survey of the status quo of the training capacity, the first three kinds of training contents were common. "Clinical skills" (80.6%), "medication knowledge" (65.8%) and "knowledge of preventive health care" (65.5%). In the survey of the requirements for training content, the first three training contents of rural doctors are "clinical skills" (93.2%), "medicine knowledge" (74.5%) and "preventive health knowledge" (72%). Therefore, the status and needs of the training content In the survey of the status of the training sites, 92.8% of the rural doctors were trained in the township health institutions, and the township health institutions were the most trained places for rural doctors. In the survey of the needs of the training sites, 53% of the rural doctors wanted to be trained at the "county health institutions" and "county health institutions". Rural doctors, the country doctors who are most likely to receive training at.68.4%, think that after training, there are some improvements, and 0.9% of rural doctors believe that the training has no change after the training.
Four, the average annual total income is 14591.16 yuan, the highest annual income is 500000 yuan, and the rural doctors with the total income of 10000. years with the minimum annual income of 10000-50000 yuan are 61.6% of the total, and the proportion of the eastern, central and Western countries is 77.6%, 58.9% and 45.9%., which accounts for the total annual income of the annual income of 50.0%.. The income of health services, agricultural and sideline income, health care subsidies and other government subsidies accounted for 60% of the income of health services; rural doctors expected 82.4% of the total of 10000-50000 yuan per year, and 79.8%, 84% and 82.8% in the eastern, central and Western countries, and rural doctors with a total annual income of 100 yuan and above were expected. Of the total number of 4.5%., the eastern, central and Western countries were 5.9%, 4% and 3.7%.8.8% were satisfied with the current income, and 41.8% of the rural doctors were dissatisfied with the existing income.
Five, in the overall survey, 86.5% of the village doctors in the village clinics carried out a new rural cooperative medical system. The average number of rural doctors who did not implement the new rural cooperative medical system was 40 times per week, with no statistical difference. The average fee of village doctors to each patient was 14 yuan per person per person and 13 yuan per person. There was no statistical difference. The number of referrals per week (4 person / week) for rural doctors in the new rural cooperative medical system was higher than that of rural medical students (3 person person / week) without the new rural cooperative medical system. The new rural cooperative medical system was implemented. The rate of visiting rural doctors in the degree area (91.5%) was higher than that of the rural doctors (91.1%) who did not implement the new rural cooperative medical system. The number of rural doctors who did not implement the new rural cooperative medical system was 5 times per week and 4 times per week, respectively. The new rural cooperative medical system was implemented. The proportion of "oral administration" for rural doctors in the region (51.5%) was lower than that of rural doctors (53.8%) who did not implement the new rural cooperative medical system (53.8%); the rural doctors "intravenous drip" (42.2%) in the new rural cooperative medical system (42.2%) was higher than that of the rural doctors (40.4%) who did not implement the new rural cooperative medical system (40.4%).
First, a historical review of the development of rural doctors and related policy studies show that the government attaches great importance to the policy support and the social concern is the key to the construction and development of the rural doctors.
Two, the results of the survey on the basic situation of the work of rural doctors showed that the age structure was aging, the years of medical treatment were long, the work content was mainly clinical common diseases, the public health work was carried out less, the daily workload was large, and the satisfaction of the work was low.
Three, the results of the rural doctors' education and training survey show that the education of rural doctors is based on the level of secondary school and lack of standardized school education. The present situation of training is characterized by the following characteristics: the short-term training is mainly focused on the township and village guards.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R197.1

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