乡村振兴背景下西部地区乡镇卫生院的发展状况及发展对策_朱晓宇.pdf
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1、论著卫生经济与政策基金项目:广西高等学校人文社会科学研究项目(SK13YB023);广西医科大学人文基地课题(2015WB14);广西高校人文社会科学重点研究基地基金(桂教科研 2019 17 号)作者简介:朱晓宇(1987 ),男,硕士,讲师,研究方向:卫生经济学和医疗保险。通信作者:王前强(1969 ),男,硕士,教授,研究方向:卫生经济与卫生政策。乡村振兴背景下西部地区乡镇卫生院的发展状况及发展对策朱晓宇1,2王前强1,2(广西医科大学 1 健康与经济社会发展研究中心,2 人文社会科学学院,广西南宁市530021)【摘要】目的分析西部地区乡镇卫生院的发展状况,探讨在乡村振兴背景下乡镇卫生
2、院的发展对策。方法收集 2011 2020 年西部地区的乡镇级行政区划数量,乡村人口数,乡镇卫生院数量,以及乡镇卫生院的执业(助理)医生数、注册护士数、医护比、诊疗人次、入院人数、医师日均负担诊疗人次、床护比、病床使用率、平均住院日等数据。运用 Microsoft Excel 2010 软件对数据进行描述性分析,计算上述指标的年均增速。采用Spearman 秩相关检验分析乡镇卫生院数与乡镇级行政区划数量,以及乡镇卫生院的诊疗人次、入院人数与乡村人口数的相关性。结果(1)2011 2020 年,西部地区仅有西藏、青海和新疆 3 个省(自治区)的乡镇卫生院数量年均增速呈正增长,西部地区乡镇卫生院数
3、量年均增速低于中部地区和全国水平;西部地区各省(自治区、直辖市)乡镇卫生院数量与乡镇级行政区划数量呈正相关(P 0 05)。(2)相较于 2011 年,2020 年西部地区各省(自治区、直辖市)乡镇卫生院的执业(助理)医生数和注册护士数均增多,且总体年均增速高于东部地区、中部地区和全国水平;除青海和新疆外,其余西部地区各省(自治区、直辖市)乡镇卫生院的注册护士数年均增速均高于执业(助理)医生数年均增速。(3)2011 年,西部地区乡镇卫生院的医护比与东部地区、中部地区和全国水平相近;2020 年,西部地区乡镇卫生院的医护比达到 0 91,高于东部地区、中部地区和全国水平,但仅有广西、云南和陕西
4、 3 个省(自治区)的乡镇卫生院医护比超过 1。(4)2011 2019 年,除内蒙古、重庆、甘肃、青海外,西部地区其余省(自治区)乡镇卫生院的诊疗人次均呈正增长,除内蒙古、贵州、西藏、青海、宁夏外,西部地区其余省(自治区、直辖市)乡镇卫生院的入院人数均呈正增长。诊疗人次年均增速和入院人数年均增速均与乡村人口数年均增速无相关性(均 P 0 05)。(5)2019 年,西部地区乡镇卫生院医师日均负担诊疗人次高于东部地区、中部地区和全国水平;床护比低于东部地区和全国水平,但年均增速高于东部地区、中部地区和全国水平;病床使用率高于东部地区、中部地区和全国水平;平均住院日少于东部地区、中部地区和全国水
5、平,但年均增速高于东部地区、中部地区和全国水平。结论2011 2020 年,西部地区乡镇卫生院数量呈下降趋势,虽然乡镇卫生院医生和护士人才队伍发展趋势向好,但仍存在医护比偏低、人才流失等问题。在乡村振兴背景下,应该凸显乡镇卫生院在农村医疗建设中的枢纽地位,发挥医共体职能,促进优质医疗资源下移,推进分级诊疗制度,提高乡镇卫生院的医疗服务能力,让更多的农村居民愿意留在基层医院就医。【关键词】乡镇卫生院;西部地区;发展状况;发展对策;乡村振兴【中图分类号】197【文献标识码】A【文章编号】0253-4304(2022)23-2786-07DOI:10 11675/j issn 0253-4304 2
6、022 23 15Development state and countermeasure of township health centersin Western China in the context of strategy for rural revitalizationZHU Xiao-yu1,2,WANG Qian-qiang1,2(1 esearch Center for Health and Economic and Social Development,2 Faculty of Humanitiesand Social Sciences,Guangxi Medical Uni
7、versity,Nanning 530021,Guangxi,China)【Abstract】ObjectiveTo analyze the development state of township health centers in Western China,and toexplore the countermeasure for development of township health centers in the context of strategy for rural revitalizationMethodsThe data of number of administrat
8、ive divisions at township level,rural population,number of township healthcenters,as well as number of certified(assistant)doctors,number of registered nurses,ratio of doctors to nurses,diagnostic and therapeutic person-time,number of inpatients,person-time of doctors daily average burden of diagnos
9、is6872Guangxi Medical Journal,Dec 2022,Vol 44,No 23and treatment,ratio of bed to nurses,rate of bed utilization,and average length of hospital stay,etc in the Westernfrom 2011 to 2020 were collected The Microsoft Excel 2010 software was used for descriptive analysis of the data,andthe average annual
10、 growth speed of the above indicators was calculated The Spearman rank correlation was used toanalyze the correlation of number of township health centers with number of administrative divisions at township level,and of diagnostic and therapeutic person-time and number of inpatients of township heal
11、th centers with rural populationesults(1)From 2011 to 2020,only three provinces(autonomous region)in the Western with respect to Tibet,Qinghai and Xinjiang presented a positive increase of the township health centers number The average annual growthspeed of the township health centers number in the
12、Western was lower than that in the central region and nation-widelevels;in addition,there was a positive correlation between the number of township health centers and the numberof administrative divisions at township level in various provinces(autonomous regions,municipalities)in theWestern(all P 0
13、05)(2)Compared with 2011,the number of certified(assistant)doctors and registered nursesin township health centers of various provinces(autonomous regions,municipalities)in the Western increased in2020,and the overall average annual growth speed was higher than that in the Eastern,central region and
14、 nation-widelevels Except for Qinghai and Xinjiang,the average annual growth speed of registered nurses number of townshiphealth centers in the remaining provinces(autonomous regions,municipalities)in the Western was higher than that ofthe average annual growth speed of certified(assistant)doctors(3
15、)In 2011,the ratio of doctors to nurses of townshiphealth centers in the Western was similar to the Eastern,central region and nation-wide levels In 2020,the ratio ofdoctors to nurses of township health centers in the Western reached 0 91,which was higher than that in the Eastern,central region and
16、nation-wide levels;however,only three provinces(autonomous regions),namely Guangxi,Yunnanand Shaanxi,exhibited a ratio of doctors to nurses of more than 1(4)From 2011 to 2019,except for Inner Mongolia,Chongqing,Gansu and Qinghai,the diagnostic and therapeutic person-time of township health centers o
17、f the remainingprovinces(autonomous regions)in Western depicted a positive growth Except for Inner Mongolia,Guizhou,Tibet,Qinghai and Ningxia,the number of inpatients of township health centers in the remaining provinces(autonomousregions,municipalities)exhibited a positive growth There was no corre
18、lation of the average annual growth speed ofdiagnostic and therapeutic person-time and inpatients number with the average annual growth speed of rural population(all P 0 05)(5)In 2019,the person-time of doctors daily average burden of diagnosis and treatment at townshiphealth centers in the Western
19、was higher than that in the Eastern,central region and nation-wide levels The ratio ofbeds to nurses was lower in the Western than that in the Eastern and nation-wide levels;however,the average annualgrowth speed was higher than that in the Eastern,central region and nation-wide levels The rate of b
20、ed utilization washigher in the Western than in the Eastern,central region and nation-wide levels The average length of hospital staywas less than that in the Eastern,central region and nation-wide levels;however,the average annual growth speed washigher than that in the Eastern,central region and n
21、ation-wide levels ConclusionFrom 2011 to 2020,the numberof township health centers in the Western interprets a downward trend Although the development trend of doctors andnurses in township health centers was improving,there are still problems concerning low ratio of doctors to nurses andbrain drain
22、,etc In the context of strategy for rural revitalization,it is necessary to highlight the pivotal position oftownship health centers in rural medical construction,give full play to the functions of medical alliances,promote thedownward shift of high-quality medical resources,promote the hierarchical
23、 medical system,and improve the medicalservice capacity of township health centers,so that more rural residents are willing to stay at primary hospitals formedical treatment【Key words】Township health centers,The Western,Development state,Development countermeasure,ural revitalization乡镇卫生院属于农村基层医疗机构,
24、在“县-乡-村”三级医疗体系中起到枢纽作用,发展乡镇卫生院有利于实现乡村居民“小病在基层”的目标。西部农村地区由于地理位置等因素,经济发展相对滞后,在乡村振兴战略背景下,如何巩固西部地区的健康扶贫工作成果,避免“因病致贫、因病返贫”发生,乡镇卫生院的发展尤为重要。2021 年 2 月,中共中央办公厅、国务院办公厅印发的关于加快推进乡村人才振兴的意见1 明确指出,加强乡村卫生健康人才队伍建设,从宏观层面提出推动乡镇卫生院发展、服务乡村7872广西医学2022 年 12 月第 44 卷第 23 期振兴的路径。本研究通过分析西部地区乡镇卫生院发展状况,提出发展的新思路。1资料与方法1 1资料来源数据
25、来源于 2012 年和 2021 年的中国统计年鉴2 3、中国 2010 年人口普查资料4、2012 中国卫生统计年鉴5、2013 中国卫生和计划生育统计年鉴6、2014 中国卫生和计划生育统计年鉴7、2015 中国卫生和计划生育统计年鉴8、2016 中国卫生和计划生育统计年鉴9、2017 中国卫生和计划生育统计年鉴10、2018 中国卫生健康统计年鉴11、2019 中国卫生健康统计年鉴12、2020 中国卫生健康统计年鉴13、2021中国卫生健康统计年鉴14。依据2012 中国卫生统计年鉴,西部地区包括内蒙古、广西、重庆、四川、贵州、云南、西藏、陕西、甘肃、青海、宁夏、新疆 12 个省(自治
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