CAJ | 학술논문

目的：了解北京市郊区乡村两级医疗卫生服务供给现状及其对医患信任的影响。方法课题组于2013年7-9月，根据地理位置、经济水平和社会文化选取北京市 H 区的 B 镇、Q 镇和 C 乡所下辖的12个村落为调查现场，采用实地观察和深入访谈法先后两次对乡镇卫生院管理者、医务人员、村干部、乡村医生和乡村两级患者共计112人进行个人深入访谈，访谈内容包括乡村两级卫生机构人员基本情况、设备设施、管理体制、运行机制和医患信任情况等。课题组于2013年11月对 H 区下辖的全部共16所乡镇卫生机构（13所乡镇卫生院和3所社区卫生服务中心）以及260所村卫生室进行定量问卷调查，调查内容包括机构基本情况、设备设施与医疗卫生服务情况等。结果 H 区医疗卫生服务供给能力在乡村两级地区有着不同体现。在村一级，乡村医生年龄偏大且达不到国家要求的学历水平和执业资质，村卫生室医疗设备的配备不完备，6类访谈对象对乡村医生基本医疗服务评分为3.19分（满分为5分），对公共卫生服务评分为3.49分（满分为5分）。在乡镇一级，乡镇卫生机构医务人员流动较频繁，公共卫生人才匮乏，相关手术无法进行，同样影响了基本医疗和公共卫生服务的开展，使医患信任的建立根基不稳。结论乡村两级医疗卫生服务供给现状尚不尽如人意，是影响医患信任的重要因素。乡村医生年老体衰和卫生院医务人员缺乏的现状对医疗设备的使用效率和医疗卫生服务的质量会产生重要影响，进而影响医患之间的信任。卫生行政部门应根据卫生服务供给现状，探寻更深层次的问题，出台相关卫生政策以重构医患信任。
목적：료해북경시교구향촌량급의료위생복무공급현상급기대의환신임적영향。방법과제조우2013년7-9월，근거지리위치、경제수평화사회문화선취북경시 H 구적 B 진、Q 진화 C 향소하할적12개촌락위조사현장，채용실지관찰화심입방담법선후량차대향진위생원관리자、의무인원、촌간부、향촌의생화향촌량급환자공계112인진행개인심입방담，방담내용포괄향촌량급위생궤구인원기본정황、설비설시、관리체제、운행궤제화의환신임정황등。과제조우2013년11월대 H 구하할적전부공16소향진위생궤구（13소향진위생원화3소사구위생복무중심）이급260소촌위생실진행정량문권조사，조사내용포괄궤구기본정황、설비설시여의료위생복무정황등。결과 H 구의료위생복무공급능력재향촌량급지구유착불동체현。재촌일급，향촌의생년령편대차체불도국가요구적학력수평화집업자질，촌위생실의료설비적배비불완비，6류방담대상대향촌의생기본의료복무평분위3.19분（만분위5분），대공공위생복무평분위3.49분（만분위5분）。재향진일급，향진위생궤구의무인원류동교빈번，공공위생인재궤핍，상관수술무법진행，동양영향료기본의료화공공위생복무적개전，사의환신임적건립근기불은。결론향촌량급의료위생복무공급현상상불진여인의，시영향의환신임적중요인소。향촌의생년로체쇠화위생원의무인원결핍적현상대의료설비적사용효솔화의료위생복무적질량회산생중요영향，진이영향의환지간적신임。위생행정부문응근거위생복무공급현상，탐심경심층차적문제，출태상관위생정책이중구의환신임。
Objective To understand the current supply condition of medical and health services as well as its influ-ences upon doctor - patient trust relationship in Beijing rural areas. Methods During July to September in 2014,the research team selected 12 villages from towns B,Q and C in H county of Beijing according to geographical position,economic level and social culture. Field observation and in - depth interview were used to interview village cadres,rural doctors,township hospital administrators,doctors and patients of both villages and townships and they were 112 people in all. The interview contents includ-ed basic information,medical equipments,management,operating mechanism and doctor - patient trust etc. In November 2014, 16 township health institutions(13 township hospitals and 3 community health centers)and 260 village clinics were involved in a qualitative investigation about basic information of the institution,medical equipments and medical health services condi-tion. Results Medical and health services institutions in towns and villages showed different supply capabilities. In village level, rural doctors were too elder and had no necessary educational background and required professional qualifications set by our coun-try;medical equipments in village clinics were not enough. Medical service evaluation provided by all the 6 kinds of interviewees was just 3. 19 marks(5 full marks),and public health service was 3. 49 marks(5 full marks). In township level,frequent re-moval among doctors and lack of public health intellectuals made relevant operations unable to be performed,which had negative influences upon medical and health services. All these gave rise to unstable foundation of doctor - patient trust relation-ship. Conclusion The disappointing supply status of the medical and health services is the influencing factor for doctor - patient trust relationship. Doctors being old and weak and township hospitals being lack of qualified doctors produces detrimental effects on quality of medical and health services,which is further on trust between doctors and patients. It is imperative that government and health administration should make an effort to discover the root cause and enact appropriate policy to rebuild doctor - patient trust relationship according to the current condition.