新医改前后宁夏乡村医生薪酬福利的比较研究

发布时间：2018-11-25 17:23

【摘要】：研究背景乡村医生作为我国农村卫生医疗队伍的重要组成部分,在农村卫生医疗预防方面、基本医疗方面、宣传教育方面等都起着至关重要的作用,然而在乡村医生发展的整个历程中,薪酬福利问题却成为影响该队伍稳定与发展的重要因素,成为深化农村卫生改革的难点问题。自2009年出台的《中国中央、国务院关于深化医药卫生体制改革的意见》,虽然在村医的管理规范上有了一定的说明,但是在如何提高乡村医生薪酬福利方面仍旧没有得到良好解决,引起了村医的流失量逐年增长。另一方面由于宁夏地处偏远,上级财政部门受经济能力的限制,加上一些人为因素导致部分国家政策无法落到实处,使得村医工作缺乏积极性,人才储备量得不到较好的补充。研究目的以西北偏远地区宁夏作为研究地点,通过实地考察,调查问卷等方式对比了解新医改前后乡村医生薪酬福利的变化;以薪酬管理学、社会保障学、公共政策学等相关的管理理论作为理论基础;运用统计学的方法分析宁夏乡村医生薪酬福利医改前后的变化,及新医改对薪酬福利产生的影响程度,找出其中存在的主要问题,分析原因,提出具有针对性的参考建议。研究方法运用构成比、频数、均数等描述性的统计学方法对乡村医生的基本现状进行阐述;运用两样本均数t检验的方法对新医改前后乡村医生收入水平、收入结构方面的变化及影响进行分析;运用多元线性回归的方法对影响乡村医生收入水平的因子进行分析;运用卡方检验的方法对乡村医生收入满意度、养老保险方面的改变进行对比分析;运用单因素方差分析方法将乡村医生的收入水平同乡镇卫生员、乡村教师进行比较分析。研究结果新医改后乡村医生在收入水平方面由新医改前的年总收入12346.53元/人/年,增加到22758.81元/人/年,增长幅度为10412.28元/人/年,且研究表明P0.05,说明较新医改前相比收入有所增加,新医改政策对其产生影响;通过运用多元线性回归的方法,了解到执业资格证及村卫生室的辐射人口是影响村医收入水平的主要因素;在收入结构方面乡村医生的从医收入与农业收入较新医改前相比没有发生太大变化,而发生最大变化的是补助收入,从医改前的0%增长到目前的26.70%,结果显示两样本之间的差异具有统计学意义(P0.05),表明较医改之前相比确有变化,且影响较大;在收入满意度方面由新医改前的13.00%增长到医改后的44.40%,且差异性具有统计学意义(P0.05),表明较新医改前相比乡村医生在收入满意度方面有了显著提升;在养老保险方面由新医改前的0.30%上升到医改后的11.30%,结果表明其差异性具有统计学意义(P0.05),虽有了一定程度的提高,但从实际情况来看其影响程度还是不大。建议:1、加大政策扶持力度,完善乡村医生薪酬福利管理制度;2、规范乡村医生绩效考核制度,扩宽村医的职业发展道路;3、提高乡村医生基本待遇,保障村医的可持续发展;4、落实乡村医生养老保险政策,减少村医的大量流失;5、重视乡村医生晋升机会,促进轮转模式的建立。
[Abstract]:As an important part of China's rural health medical team, the study of rural doctors is of vital importance in the area of rural health and medical prevention, basic medical care and publicity and education, but in the whole course of the development of rural doctors, The issue of compensation benefits has become an important factor that affects the stability and development of the team, and becomes a difficult problem to deepen the reform of rural health. Since 2009, the State Council's Opinions on Deepening the Reform of the Health and Health System of the State Council and the State Council's Opinions on Deepening the Reform of the Medical and Health System have not been well solved in terms of how to improve the remuneration and welfare of the rural doctors, even though there has been some explanation in the management regulations of the village doctors, The loss of the village medicine has increased year by year. On the other hand, because of the remoteness of Ningxia, the financial department of the higher level is limited by the economic capacity, and some of the human factors have caused some of the national policy to be unable to fall to the real position, so that the village doctor's work is lacking of enthusiasm and the reserve of talents can not be supplemented. The purpose of this study is to compare the change of the salary and welfare of the rural doctors before and after the new medical reform in Ningxia as the research site in the remote and remote areas of the northwest, and to provide the theoretical basis for the management theory, such as salary management, social security, public policy and so on. Based on the statistical method, the changes of the salary and welfare reform of the rural doctor in Ningxia and the impact of the new medical reform on the salary and welfare are analyzed, the main problems in the reform and the reasons of the analysis are found out, and the relevant reference suggestions are put forward. The basic status of rural doctors was described by means of descriptive statistics methods, such as the proportion, frequency and mean number of the rural doctors, and the changes of the income and the income structure of the rural doctors before and after the new medical reform were analyzed by using the method of the two-difference method. The factors that affect the income level of the rural doctors are analyzed by the method of the multiple linear regression, the income satisfaction of the rural doctors and the change of the old-age insurance are compared and analyzed by using the method of the card-side test. The income level of the rural doctors was compared with the township health workers and the rural teachers by means of single factor analysis of variance. The results showed that the annual total income of the rural doctors in the income level by the new medical reform was 12343.53 yuan/ person/ year, and the increase to 227.58. 81 yuan/ person/ year, the growth rate was 104.28 yuan/ person/ year, and the study showed that the income increased before the new medical reform. The influence of the new medical reform policy on the village medical income level is realized by applying the method of the multiple linear regression, and the radiation population of the village health room is the main factor that affects the income level of the village doctor; In the income structure, the rural doctor has not changed much from the medical income and the agricultural income before the new medical reform, but the biggest change is the subsidy income, from 0% before the medical reform to the current 26. 70%, and the result shows that the difference between the two differences is of statistical significance (P0.05). The results showed that there was a change before and after the reform of the medical reform, and the effect was large; the rate of income satisfaction was increased from 13.00% in the first of the new medical reform to 44.4% after the medical reform, and the difference was of statistical significance (P <0.05), indicating that the rural doctor had a significant improvement in the income satisfaction before the new medical reform; The results showed that the difference was statistically significant (P0.05). Recommendation: 1. Increase policy support and improve rural doctor's salary and welfare management system; 2. standardize the performance appraisal system of rural doctors and widen the professional development path of village doctors; 3. Improve the basic treatment of rural doctors and ensure the sustainable development of village doctors; 4. Implement the rural doctor's endowment insurance policy, reduce the large amount of loss of the village doctor; 5, pay attention to the promotion opportunity of the rural doctor, and promote the establishment of the round-robin mode.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1

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