CAJ | 학술논문

目的：探讨基本药物制度背景下乡村医生胜任力不足的原因。方法于2012年8—12月采用多阶段分层随机抽样法抽取山东省134个村卫生室的621名乡村医生及于2013年12月—2014年3月采用完全随机抽样法抽取山东省225个村卫生室的642名乡村医生为研究对象。采用问卷调查、定性访谈及文献资料分析方法收集乡村医生基本情况、基本药物制度实施对乡村医生的影响、乡村医生目前的工作生活现状、乡村医生对职业的认知等资料。运用故障树分析模型，将乡村医生胜任力不足设置为顶上事件，分析乡村医生胜任力不足产生的原因。结果两次实证调研，分别发放问卷621、642份，均全部收回，有效回收率为100.0％。81.1％（499/615）的乡村医生仅为中专及以下学历，57.3％（335/585）目前仍未参加任何养老保险；94.2％（572/607）的乡村医生表示对其收入不满意，55.9％（356/637）对其工作不满意，76.3％（488/640）认为其对社会的贡献有所提高，而58.1％（371/639）认为其生活水平并没有较大的改观；47.6％（303/637）的乡村医生表示自己最常与乡村教师相比较，并且有40.0％（255/638）的乡村医生认为在农村最好的职业是乡村教师。通过访谈及文献分析可知，随着基本药物制度在基层的不断推进，乡村医生工作量与工作压力也随之增加，而经济收入却不增反减，药品收益的降低使乡村医生的收入情况更不乐观，且村民对乡村医生的信任度降低，另外乡村医生与乡村小学民办教师在中国特定的历史条件下有着相似的发展轨迹，却在身份和待遇上有着截然不同的命运，乡村教师早在20世纪80年代就已转为公办，普遍享有事业单位的工资标准和保险待遇，而乡村医生却长期处于被边缘化的状态，相关的福利待遇无法得到切实的保障。结论乡村医生胜任力不足包括乡村医生自身、村民以及政策3方面的原因，乡村医生从医素质不足以及工作状态不良导致了其自身存在问题；村民存在医疗服务需求增加及部分要求不合理的现象；政策方面存在福利保障不完善、财政补助不及时和相关法律不健全的问题。目的：探討基本藥物製度揹景下鄉村醫生勝任力不足的原因。方法于2012年8—12月採用多階段分層隨機抽樣法抽取山東省134箇村衛生室的621名鄉村醫生及于2013年12月—2014年3月採用完全隨機抽樣法抽取山東省225箇村衛生室的642名鄉村醫生為研究對象。採用問捲調查、定性訪談及文獻資料分析方法收集鄉村醫生基本情況、基本藥物製度實施對鄉村醫生的影響、鄉村醫生目前的工作生活現狀、鄉村醫生對職業的認知等資料。運用故障樹分析模型，將鄉村醫生勝任力不足設置為頂上事件，分析鄉村醫生勝任力不足產生的原因。結果兩次實證調研，分彆髮放問捲621、642份，均全部收迴，有效迴收率為100.0％。81.1％（499/615）的鄉村醫生僅為中專及以下學歷，57.3％（335/585）目前仍未參加任何養老保險；94.2％（572/607）的鄉村醫生錶示對其收入不滿意，55.9％（356/637）對其工作不滿意，76.3％（488/640）認為其對社會的貢獻有所提高，而58.1％（371/639）認為其生活水平併沒有較大的改觀；47.6％（303/637）的鄉村醫生錶示自己最常與鄉村教師相比較，併且有40.0％（255/638）的鄉村醫生認為在農村最好的職業是鄉村教師。通過訪談及文獻分析可知，隨著基本藥物製度在基層的不斷推進，鄉村醫生工作量與工作壓力也隨之增加，而經濟收入卻不增反減，藥品收益的降低使鄉村醫生的收入情況更不樂觀，且村民對鄉村醫生的信任度降低，另外鄉村醫生與鄉村小學民辦教師在中國特定的歷史條件下有著相似的髮展軌跡，卻在身份和待遇上有著截然不同的命運，鄉村教師早在20世紀80年代就已轉為公辦，普遍享有事業單位的工資標準和保險待遇，而鄉村醫生卻長期處于被邊緣化的狀態，相關的福利待遇無法得到切實的保障。結論鄉村醫生勝任力不足包括鄉村醫生自身、村民以及政策3方麵的原因，鄉村醫生從醫素質不足以及工作狀態不良導緻瞭其自身存在問題；村民存在醫療服務需求增加及部分要求不閤理的現象；政策方麵存在福利保障不完善、財政補助不及時和相關法律不健全的問題。
목적：탐토기본약물제도배경하향촌의생성임력불족적원인。방법우2012년8—12월채용다계단분층수궤추양법추취산동성134개촌위생실적621명향촌의생급우2013년12월—2014년3월채용완전수궤추양법추취산동성225개촌위생실적642명향촌의생위연구대상。채용문권조사、정성방담급문헌자료분석방법수집향촌의생기본정황、기본약물제도실시대향촌의생적영향、향촌의생목전적공작생활현상、향촌의생대직업적인지등자료。운용고장수분석모형，장향촌의생성임력불족설치위정상사건，분석향촌의생성임력불족산생적원인。결과량차실증조연，분별발방문권621、642빈，균전부수회，유효회수솔위100.0％。81.1％（499/615）적향촌의생부위중전급이하학력，57.3％（335/585）목전잉미삼가임하양로보험；94.2％（572/607）적향촌의생표시대기수입불만의，55.9％（356/637）대기공작불만의，76.3％（488/640）인위기대사회적공헌유소제고，이58.1％（371/639）인위기생활수평병몰유교대적개관；47.6％（303/637）적향촌의생표시자기최상여향촌교사상비교，병차유40.0％（255/638）적향촌의생인위재농촌최호적직업시향촌교사。통과방담급문헌분석가지，수착기본약물제도재기층적불단추진，향촌의생공작량여공작압력야수지증가，이경제수입각불증반감，약품수익적강저사향촌의생적수입정황경불악관，차촌민대향촌의생적신임도강저，령외향촌의생여향촌소학민판교사재중국특정적역사조건하유착상사적발전궤적，각재신빈화대우상유착절연불동적명운，향촌교사조재20세기80년대취이전위공판，보편향유사업단위적공자표준화보험대우，이향촌의생각장기처우피변연화적상태，상관적복리대우무법득도절실적보장。결론향촌의생성임력불족포괄향촌의생자신、촌민이급정책3방면적원인，향촌의생종의소질불족이급공작상태불량도치료기자신존재문제；촌민존재의료복무수구증가급부분요구불합리적현상；정책방면존재복리보장불완선、재정보조불급시화상관법률불건전적문제。
Objective To explore reasons for the lack of competency of rural doctors under essential medicine system. Methods We enrolled 621 rural doctors from 134 village health centers in Shandong Province from August to December, 2012 using multi - stage stratified random sampling method. We also enrolled 642 rural doctors form 225 village centers in Shandong province from December 2013 to March 2014 using complete random sampling method. Questionnaire survey, qualitative interview and literature analysis were conducted to collect relevant data,including general information,the influence of essential medicine system on rural doctors,the current status of life and work of rural doctors and the cognition of rural doctors on the occupation. We built fault tree analysis model,in which the lack of competency of rural doctors was set as the top event,to investigate reasons for the lack of competency of rural doctors. Results In two surveys, we distributed 621 and 642 questionnaires respectively,and all questionnaires were returned with an effective returning rate of 100. 0% . Among subjects, 81. 1% (499 / 615) graduated from technical secondary school or below that education level,57. 3% (335 / 585)hadn' t registered with any pension insurance,94. 2% (572 / 607)were unsatisfied with their income,55. 9% (356 / 637) were unsatisfied with their job,76. 3% (488 / 640)believed their contribution to the society was increasing,and 58. 1% (371 / 639) thought their living condition hadn't been improved;47. 6% (303 / 637)said that they always compared themselves with rural teachers,and 40. 0% (255 / 638) thought the best occupation in rural areas is teacher. The interviews and literature analysis showed the following results. With further implementation of essential medicine system in grass root level,the working volume and working pressure of rural doctors increased,while their income decreased,and the drop of medicine revenue further lowered their income. The trust of villagers in rural doctors lessened. Rural doctors and teachers of rural primary schools have similar development tracks in the certain period of China's history,while their present identity and income are remarkably different;in 1980s,the rural schools where rural teachers served in became state - run schools,thus their income and insurance followed public institutions,while rural doctors was marginalized and their benefit cannot be guaranteed. Conclusion The lack of competency of rural doctors is concerned with three aspects,including rural doctors themselves,rural residents and policy. The inadequate capability and bad working status cause the problems of rural doctors themselves;the rural residents' increasing demand of medical service and some unreasonable demand exist;problems in welfare,untimely financial subsidy and unsound laws make it worse.