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首页> 中文期刊> 《中国全科医学》 >基本药物制度背景下乡村医生胜任力不足的故障树分析

基本药物制度背景下乡村医生胜任力不足的故障树分析

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摘要

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.%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。

著录项

  • 来源
    《中国全科医学》 |2015年第25期|3024-3029|共6页
  • 作者

    贾海艺; 尹文强; 陈钟鸣; 朱丽丽; 郑骥飞; 秦晓强; 黄冬梅;

  • 作者单位

    261053 山东省潍坊市;

    潍坊医学院管理学院;

    健康领域社会风险预测治理协同创新中心;

    “健康山东”重大社会风险预测与治理协同创新中心;

    261053 山东省潍坊市;

    潍坊医学院管理学院;

    健康领域社会风险预测治理协同创新中心;

    “健康山东”重大社会风险预测与治理协同创新中心;

    261053 山东省潍坊市;

    潍坊医学院管理学院;

    健康领域社会风险预测治理协同创新中心;

    “健康山东”重大社会风险预测与治理协同创新中心;

    261053 山东省潍坊市;

    潍坊医学院管理学院;

    健康领域社会风险预测治理协同创新中心;

    “健康山东”重大社会风险预测与治理协同创新中心;

    261053 山东省潍坊市;

    潍坊医学院管理学院;

    健康领域社会风险预测治理协同创新中心;

    “健康山东”重大社会风险预测与治理协同创新中心;

    261053 山东省潍坊市;

    潍坊医学院管理学院;

    健康领域社会风险预测治理协同创新中心;

    “健康山东”重大社会风险预测与治理协同创新中心;

    261053 山东省潍坊市;

    潍坊医学院管理学院;

    健康领域社会风险预测治理协同创新中心;

    “健康山东”重大社会风险预测与治理协同创新中心;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类 医疗卫生制度与机构;
  • 关键词

    基本药物制度; 故障树分析模型; 乡村医生; 胜任力;

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