乡村卫生人力资源配置中的伦理问题分析及对策探讨

发布时间：2018-02-23 23:45

本文关键词： 农村卫生卫生人力伦理对策　出处：《中国全科医学》2014年31期 　论文类型：期刊论文

【摘要】：目的了解乡村卫生人力资源配置中存在的伦理问题并探讨解决对策。方法于2011年5月,采用分层随机抽样方法,在北京市抽取5个区县的25个乡镇的75个行政村进行现场调研。采用问卷调查5类利益相关者:乡镇卫生院管理者、乡镇卫生院医务人员、村医、村民、村干部共计1 719人;同期在5个区县采取目的抽样法,访谈各类关键知情人:区县政府主管卫生的领导、卫生行政部门管理者、乡村医务人员和村民共计35人,了解乡村卫生人力资源配置中存在的伦理问题并探讨相应对策。结果乡镇卫生院管理者认为,目前乡镇卫生院人才队伍建设面临的主要问题依次为:高素质卫生人才匮乏(35人次);福利待遇对优秀卫生人才的吸引力小(30人次);人员专业结构不合理(22人次);适宜农村的卫生人才培养不足(22人次);中青年卫技人员流失严重,面临人才断层问题(18人次);工作人员以非专业、低素质人员为主(5人次)等。乡镇卫生院管理者认为,乡镇卫生院医务人员将来的合适人选依次为:定向培养"乡来乡去"的大学生(39人次);医学院校毕业的普通大学生(34人次);上级医疗机构对口支援的医务人员(19人次);定向培养"乡来乡去"的中专生(13人次)等。关于将来的村医人选,村民选择结果排序前三位的依次为:卫生院下派的医生(562人次);定向培养的大专生或大学生(546人次);本村懂医术的人(488人次)。村医选择结果排序前三位的依次为:定向培养的大专生或大学生(46人次),定向培养的中专生(38人次),卫生院下派的医生(36人次)。结论基于公平可及的视角,乡村卫生人力资源配置中存在以下伦理问题:乡村卫生人力资源的执业环境影响其服务行为和服务的公平可及;乡村卫生人力资源的准入标准影响后继人才的补充和队伍的可持续发展;乡村卫生人力资源的诊治能力影响农民的健康意识和就医流向。应合理界定乡村两级医疗机构的功能定位,满足农民就诊时的差异化需求;扩大新农合报销的村级医疗机构覆盖范围,提高乡村卫生人力资源的层级配置效率;建立本土化的农村卫生人才培养体系,保障乡村卫生人力资源的有效供给。
[Abstract]:Objective to understand the ethical problems existing in the allocation of rural health human resources and to explore the countermeasures. Methods in May 2011, stratified random sampling was used. A questionnaire survey was conducted in 75 administrative villages in 25 villages and towns in 5 districts and counties in Beijing. Five types of stakeholders were investigated: managers of township health centers, medical staff of township hospitals, village doctors, villagers, village cadres, a total of 1,719 people. During the same period, the purpose sampling method was adopted in 5 districts and counties to interview all kinds of key insiders: leaders of district and county government in charge of health, managers of health administration departments, rural medical personnel and villagers, a total of 35 people, To understand the ethical problems existing in the allocation of rural health human resources and to explore the corresponding countermeasures. At present, the main problems faced by the construction of talents in township health centers are as follows: the shortage of high-quality health personnel is 35 times, the attractiveness of welfare treatment to excellent health personnel is less than 30 times, the unreasonable professional structure of personnel is 22 person-time. The number of health personnel suitable for rural areas is not enough to reach 22 person-times, and the loss of young and middle-aged health professionals is serious. In the face of a talent gap of 18 person-times, the staff members are mainly non-professional and low-quality personnel (5 person-times). The managers of the township health centers believe that. The suitable candidates for medical staff in township health centers in the future are: 39 college students who come to the countryside, 34 ordinary students who graduate from medical colleges and universities, and 34 medical staff supported by medical institutions at higher levels. Number of people; targeted training of 13 secondary school students "coming to the countryside" etc. About the candidates for future village doctors, The first three places in the order of the villagers' selection results were as follows: 562 doctors sent at the bottom of the hospital; 546 students or college students trained in a targeted way; 488 people who knew the techniques of medicine in the village; and the first three doctors in the ranking of the results of the selection of village doctors were as follows:. There were 46 college students or college students, 38 secondary school students and 36 doctors under the hospital. Conclusion based on the perspective of fair access, The following ethical problems exist in the allocation of rural health human resources: the practice environment of rural health human resources affects their service behavior and the fairness of service accessibility; The access standard of rural health human resources affects the supplement of the successors and the sustainable development of the contingent; The diagnosis and treatment ability of rural health human resources affects farmers' health consciousness and the direction of seeking medical treatment. The functional orientation of rural medical institutions at two levels should be reasonably defined to meet the differential needs of farmers when they seek medical treatment. To expand the coverage of village level medical institutions, to improve the level allocation efficiency of rural health human resources, to establish a local rural health personnel training system, and to ensure the effective supply of rural health human resources.
【作者单位】：首都医科大学卫生管理与教育学院;
【基金】：北京市哲学社会科学规划重大项目(11ZDA05) 北京市属高等学校教学创新人才——教学名师项目(PHR201106207) 国家软科学研究项目(2010GXS5D179) 教育部人文社会科学研究项目(10YJAZH055)
【分类号】：R197.1

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