转型期乡镇卫生院功能定位与发展策略

发布时间：2018-04-27 10:14

本文选题：乡镇卫生院 + 运行机制　；参考：《华中科技大学》2016年博士论文

【摘要】：[目的]乡镇卫生院是农村医疗卫生服务网的重要组成部分,是维护全民健康的主要载体。本研究基于我国社会经济形势的剧烈变化,结合卫生系统内部改革影响,从农村居民需求出发,打破行政区划的界限,在分析近年来乡镇卫生院功能发挥和运行现状的基础上,提出进一步完善转型期乡镇卫生院的功能定位和保障机制,同时提出乡镇卫生院的不同发展模式,为新时期乡镇卫生院发展提供政策制定的参考依据。l方法]在现状分析和回顾性研究的基础上,利用Excel、SPSS等软件,综合运用卫生政策学,卫生经济学,统计学等方法,定性与定量相结合,从社会经济变化和卫生系统改革对农村居民需求和乡镇卫生院服务提供做了前瞻性研究。资料收集方法：(1)定量研究。对江苏等6省发放问卷。(2)现有的统计资料收集。收集乡镇卫生院运行和服务提供状况等相关统计资料。(3)定性调查。通过问卷调查、关键知情人访谈、专题小组讨论,了解典型地区乡镇卫生院服务提供情况。分析方法：(1)文献研究法。对乡镇卫生院发展历程和典型国家基层医疗卫生服务方面的文献进行分析。(2)回归分析预测法：根据老龄化、农村居民人均纯收入变化、流动人口情况等,分析农村居民对医疗服务的需求。(3)比较分析法。比较分析不同地区、不同经济水平乡镇卫生院资源配置、筹资、运行、业务开展和服务利用的变化情况。(4)聚类分析。对调研的乡镇卫生院按照地理、社会经济、服务功能等特征进行聚类分析,分析发展趋势。(5)DEA分析。分析了76所乡镇卫生院的运行效率,比较了不同时期不同地区乡镇卫生院资源配置效率和变化趋势,为研究资源配置提供依据。统计模型预测[结果]1.理论分析结果表明,我国乡镇卫生院的功能受社会经济变化影响,每个时期都有所侧重,特别是随着分级诊疗制度的建立、医养结合的推进和基本公共卫生服务任务的增加,加上老龄化进程的加快,乡镇卫生院的康复护理和卫生管理功能需要加强。2.乡镇卫生院的各项功能发挥情况(1)医疗功能。乡镇卫生院的门急诊呈增长态势,住院总体稳定,90%左右的乡镇卫生院具备提供基本医疗服务和常见理化检查的能力,但乡镇卫生院手术量偏低且呈下滑态势,较大风险和较高技术含量的医疗服务根据乡镇卫生院发展类型的不同出现多样化的情况。(2)公共卫生服务功能。虽然防保人员数量不足且年龄偏大,但公共卫生服务开展率整体较高,服务质量明显提升改善,乡镇卫生院已逐步将基本公共卫生服务作为重要的服务内容。(3)公共卫生管理职能。随着乡村一体化的推进、基本药物制度实施后财政给予的专项补助、村卫生室信息化逐步建立、基本公共卫生服务项目经费的不断提高和按考核结果发放,乡镇卫生院的卫生管理职能得到加强。3.转型期社会经济变化如农村常住人口减少、老龄化、农村居民人均收入增加、医保制度健全等因素对乡镇卫生院功能影响较大,未来对乡镇卫生院的医疗服务出现多样化需求,对康复和护理服务需求较大。[结论](1)转型期乡镇卫生院承担医疗、公共卫生服务、卫生管理和康复护理4项主要功能。其中医疗功能作为公共卫生功能和康复护理功能发挥的支撑,需要进一步加强各项功能和服务间的联动：公共卫生功能,乡镇卫生院要进一步发挥好基本公共卫生服务提供和对村卫生室的管理考核的双重责任；卫生管理和康复护理功能需要重点强化。(2)要保障乡镇卫生院功能的正常发挥,要继续加大投入力度,并按照乡镇卫生院的功能定位进行分类管理,加强人才队伍建设,深化综合改革并完善收支管理方式,并主动转变成为预防-治疗-康复-护理的服务模式。(3)乡镇卫生院的发展模式要因地制宜,结合当地实际,不能简单按照经济发展水平划分功能。对于老龄化程度较高的地区,要强化慢病管理、老年护理保健和康复等服务；对于服务人口较少、距离县级医疗机构较近、缺少有资质医师和护士的卫生院将弱化高风险医疗服务；对于服务人口多的地区如超过10万人,要加强医疗服务能力建设。[创新1(1)本研究对乡镇卫生院功能定位的思路有变化,主要基于我国社会经济发展的剧烈变革,结合卫生系统内部改革如分级诊疗制度建立、农村居民未来需求变化和6年间乡镇卫生院功能与运行情况的纵向变化,重点考虑当地经济社会发展、人口结构、人员资质、与县医院距离等因素,按照经济发展水平,从东、中、西部选取典型地区,结合当地实际发展情况,对医疗、公共卫生、卫生管理和康复护理四项功能进行深入研究,提出了乡镇卫生院在未来发展模式上的功能定位方向。(2)本研究通过实证研究和理论研究归纳总结：新时期乡镇卫生院要主动应对分级诊疗制度建立和医养结合推进,结合乡村一体化管理的快速推进、村卫生室实施基本药物制度和国家基本公共生服务的乡村联动等情况,在承担基本医疗和公共卫生服务功能的同时,重视和加强另外两项功能,包括大力加强康复护理功能,进一步强化卫生管理功能,并提出强化卫生管理职能可依托的手段和工具。(3)本研究综合考虑服务人口、老龄化程度、农村居民人均纯收入、与县医院距离,以及县医院和村卫生室的服务能力和布局等因素,通过聚类分析和DEA分析、定性资料的主题框架分析等分析方法对乡镇卫生院的发展趋势进行研究及预测。[局限1由于乡镇卫生院的功能定位要结合各地区实际情况,而我国社会经济发展水平差别较大,存在多样化和快速变化情况,导致实证研究和聚类分析中样本的代表性、技术效率与规模效率分析中对公共卫生服务量的分析有待商榷。本研究所得出的结果受研究条件、调研经费及人员素质和数量等的影响,在全国范围内的可推广性也存在一定局限。
[Abstract]:[Objective] township hospital is an important part of the rural medical and health service network, and it is the main carrier to maintain the health of the whole people. This study is based on the dramatic changes in the social and economic situation in China, combined with the influence of the internal reform of the health system, starting from the needs of the rural residents, breaking the boundaries of the administrative district, and analyzing the functions of the township hospitals in recent years. On the basis of the present situation, the function orientation and guarantee mechanism of township hospitals in the transition period are further improved. At the same time, the different development modes of township health centers are put forward, and the reference basis of policy formulation for the development of township health centers in the new period is provided by the.L method] on the basis of the status analysis and retrospective study, and the use of Excel, SPSS and so on. Software, comprehensive use of health policy science, health economics, statistics and other methods, qualitative and quantitative combination, from social and economic changes and health system reform of rural residents' needs and township health service provide a prospective study. Data collection methods: (1) quantitative research. 6 provinces and other provinces of Jiangsu issued questionnaires. (2) existing statistical funds. Materials collection. Collect the status of the operation and service supply of township health centers. (3) qualitative investigation. Through questionnaire survey, key lovers interview, special group discussion, to understand the service provision of township hospitals in typical areas. Analysis methods: (1) literature research method. The development process of township health centers and typical national medical treatment. The literature of health service is analyzed. (2) regression analysis and prediction method: according to the aging, the change of the per capita net income of rural residents, the situation of the floating population, and so on, the demand of rural residents to medical service is analyzed. (3) comparative analysis method. Compare and analyze the resources allocation, financing, operation and business development of different economic level township hospitals in different regions. And the change of service utilization. (4) cluster analysis. Cluster analysis on the characteristics of township hospitals in accordance with geography, social economy and service function. (5) DEA analysis. Analysis of the operation efficiency of 76 township hospitals, and compared the efficiency and change trend of the resources allocation of township hospitals in different areas in different periods, The results of statistical model prediction show that the function of township hospitals in China is affected by social and economic changes, and the results of]1. theoretical analysis show that there is a particular emphasis in each period, especially with the establishment of the classification system, the promotion of the combination of medical care and the increase of basic public health services, and the aging. The acceleration of the course, the rehabilitation nursing and the health management function of the township hospitals need to strengthen the functions of the.2. Township Hospital (1) the medical function. The township health hospital has a growing trend in the emergency department, the overall hospital is stable, and 90% of the township health centers have the ability to provide basic medical services and common physical and chemical inspection, but the village and township health service. The number of medical services in the hospital was low and declined, and the medical services with greater risk and high technical content varied according to the development types of township hospitals. (2) the public health service function. Although the number of the personnel was insufficient and the age was large, the public health service rate was higher and the quality of service was obviously improved. The basic public health service has been gradually taken as an important service content. (3) the function of public health management. With the promotion of the rural integration and the special subsidies given by the financial system after the implementation of the basic drug system, the informatization of village health rooms is gradually established, and the funds for basic public health services are constantly improved and evaluated. The health management functions of the township health centers have been strengthened, such as the social and economic changes in the.3. transformation period, such as the reduction of the rural resident population, the aging, the increase of the per capita income of the rural residents, the sound medical insurance system and so on, which have a great influence on the function of the township health centers. The demand for the service is large. [Conclusion] (1) the township hospitals in the transition period undertake 4 main functions of medical treatment, public health service, health management and rehabilitation nursing. Among them, the medical function as the support of the function of public health and the function of rehabilitation nursing needs to further strengthen the linkage of various functions and services: public health function, township and village health. The hospital should give full play to the dual responsibility of providing basic public health services and assessing the management of village health rooms; health management and rehabilitation nursing functions need to be strengthened. (2) to ensure the normal function of the functions of township hospitals, to continue to increase investment, and to carry out classification management in accordance with the functional orientation of township hospitals. The construction of strong talent team, deepening the comprehensive reform and improving the mode of revenue and expenditure management, and actively transforming into the service mode of prevention treatment rehabilitation nursing. (3) the development mode of township hospitals should be adapted to local conditions, combined with the local practice, and can not simply divide the function according to the level of economic development. Diseases management, elderly care and rehabilitation services, less service population, closer to county-level medical institutions and lack of qualified doctors and nurses will weaken the high risk medical service; for more than 100 thousand people in the area with more population, we should strengthen the construction of medical service capacity. [innovation 1 (1) study on Township Health The thinking of the function orientation of the hospital has changed, mainly based on the dramatic changes in the social and economic development of our country, combined with the reform of the internal health system, such as the establishment of the grading diagnosis and treatment system, the change of the rural residents' future demand and the longitudinal changes of the function and operation of the township hospitals in the past 6 years, focusing on the local economic and social development, the population structure and the personnel qualification, With the county hospital distance and other factors, according to the economic development level, from the eastern, middle and Western selected typical areas, combined with the local actual development situation, the four functions of medical, public health, health management and rehabilitation nursing were studied in depth, and the orientation of the functional orientation of township hospitals in the future development mode was put forward. (2) this study through empirical research In the new period, the township health centers should take the initiative to deal with the establishment of the classification diagnosis and treatment system and the combination of medical and maintenance, combined with the rapid promotion of rural integrated management, the village health room implementation of the basic drug system and the country's basic public health services, such as the rural linkage, to undertake the basic medical and public health services. At the same time, we should pay more attention to and strengthen the other two functions, including strengthening the function of rehabilitation nursing, further strengthening the function of health management, and putting forward the means and tools to strengthen the function of health management. (3) this study comprehensively considers the service population, the degree of aging, the per capita net income of the rural residents, the distance from the county hospitals, and the county hospitals and the hospitals. The service ability and layout of the village health room, such as the cluster analysis and DEA analysis, the analysis method of the qualitative data and the theme frame analysis method to study and forecast the development trend of township hospitals. [Limited 1 because the function orientation of the township health centers should be combined with the actual situation in various regions, and the difference of the social and economic development level of our country is more different. There is a variety and rapid change, which leads to the representativeness of samples in empirical research and cluster analysis. The analysis of public health services in the analysis of technical efficiency and scale efficiency is open to discussion. The results obtained by this study are influenced by the research conditions, the research funds and the quality and quantity of the personnel and so on. There are also limitations in the nature of the nature.

【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R197.62

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