不同类型社区卫生服务中心人力资源配置研究
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摘要
目的:探讨在社会办医多元化的背景下,2015年山东省8类社区卫生服务中心人力资源现状及存在问题,为基层卫生人力合理配置提供科学依据。方法:采用PPS抽样方法,抽取东中西部17个地市333家8类样本社区卫生服务中心,运用描述性研究指标对人力资源配备现况进行分析评价。结果:8类333家社区卫生服务中心共在岗员工19794人,在编12209人,无编制率38. 32%,空编制率15. 26%,全员聘用率15. 62%,中高级职称占比33. 57%,企业高校举办机构占比最高;医师6421人,占32. 86%,护士5172人,占27. 70%,医药技3870人,占15. 26%。卫生专业技术14862人,其中,医疗、中医药、预防保健人员占比63. 14%、10. 03%和16. 26%;医护比为1. 17∶1,政府举办、一级医院和乡镇卫生院转型机构占比高于均值;执业医师4896人,占医师79. 29%,执业助理医师1280人,占17. 86%,妇产科、中医科和全科医师占比为11. 43%、6. 43%和32. 14%,企业高校举办机构全科医师占比为50. 00%,政府举办机构占比仅为25. 26%;全科医师中,全科毕业322人,占15. 56%,规范化培训1236人,占68. 89%,转岗培训1068人,占53. 33%,个人举办机构人员规范化培训占比88. 73%。结论:大多数社区卫生服务中心沿袭医院服务模式,预防保健功能定位不明确,各类人员结构不合理,全科医师和公共卫生人员缺乏严重,"两少四低"问题突出;一级医院和乡镇卫生院转型社区卫生服务中心人员配置比其他类型更适应基层医疗服务发展需要;政府需建立"社区医学"终身培训教育制度,利用存量盘活、增量调节、适度引进、留住培养等手段增加人员数量,优化人员结构,努力构建小密度、广覆盖、多类型的社区卫生人力服务体系。
Objective Under pluralistic social medicines,to explore manpower current situations and problems of 8 kinds of community health service centers in Shandong province in 2015 for offering scientific advices to basic health manpower allocation.Methods PPS sampling method was used to extract data about 8 kinds of 333 community health service centers in 17 east-central-west cities. Then,human resource status was analyzed and evaluated by descriptive research indexes. Results Data showed that8 kinds of 333 community health centers had 19794 employees and 12209 permanent staffs. Among employees,some were uncompiled staffs,accounted for 38. 32%,and others were not on duty,accounted for 15. 26%. Only 15. 62% institutions put into full employment system. Medium and senior titles of position were accounted for 33. 57%. Community health centers established by corporates and universities had the highest proportion. In on-post staffs,there were 6421 physicians,accounted for 32. 86%,5172 nurses,accounted for 27. 70%,3870 medicinal technicians,accounted for 15. 26%. Ratios of medical treatment,Chinese medicine and prevention were 63. 14%,10. 03% and 16. 26% in 14862 professional medical workers. Doctor and nurse ratios were above 1. 17∶ 1 in institutions held and transformed by government,primary and township hospitals. In physicians,4896 doctors had qualification certificates,accounted for 79. 29%,and 1280 doctors had assistant qualification certifications,accounted for17. 86%. Ratios of obstetricians and gynecologists,herbalist doctors,and general practitioners were 11. 43%,6. 43% and32. 14%. In proportions of general practitioners,stations held by enterprises and colleges were accounted for 50. 00%,however,government institutions only were accounted for 25. 26%. Data showed that,322 general practitioners were general graduates,accounted for 15. 56%,1236 physicians participated in standardized trains,accounted for 68. 89%,and 1068 physicians attended position transition trains,accounted for 53. 33%. Meanwhile,88. 73% general practitioners went through standardized trains in organizations established by individuals. Conclusions Following hospital service mode,most of community health service centers had some problems such as unclear preventive function,unreasonable structure,less public health workers and general practitioners,serious 'two less and four low'. In personnel allocations,stations transformed by primary and township hospitals were more suitable for primary care health services than other types. The government should establish life-long‘community medicine'edu-cation system. Meanwhile coordinating inventory resurrection with increment adjustment,and combining appropriate introduction with remain training were necessary measures to improve employee members and structures. Finally,use our best efforts to construct a community health manpower service system with small density,wide coverage and multiple types.
Objective Under pluralistic social medicines,to explore manpower current situations and problems of 8 kinds of community health service centers in Shandong province in 2015 for offering scientific advices to basic health manpower allocation.Methods PPS sampling method was used to extract data about 8 kinds of 333 community health service centers in 17 east-central-west cities. Then,human resource status was analyzed and evaluated by descriptive research indexes. Results Data showed that8 kinds of 333 community health centers had 19794 employees and 12209 permanent staffs. Among employees,some were uncompiled staffs,accounted for 38. 32%,and others were not on duty,accounted for 15. 26%. Only 15. 62% institutions put into full employment system. Medium and senior titles of position were accounted for 33. 57%. Community health centers established by corporates and universities had the highest proportion. In on-post staffs,there were 6421 physicians,accounted for 32. 86%,5172 nurses,accounted for 27. 70%,3870 medicinal technicians,accounted for 15. 26%. Ratios of medical treatment,Chinese medicine and prevention were 63. 14%,10. 03% and 16. 26% in 14862 professional medical workers. Doctor and nurse ratios were above 1. 17∶ 1 in institutions held and transformed by government,primary and township hospitals. In physicians,4896 doctors had qualification certificates,accounted for 79. 29%,and 1280 doctors had assistant qualification certifications,accounted for17. 86%. Ratios of obstetricians and gynecologists,herbalist doctors,and general practitioners were 11. 43%,6. 43% and32. 14%. In proportions of general practitioners,stations held by enterprises and colleges were accounted for 50. 00%,however,government institutions only were accounted for 25. 26%. Data showed that,322 general practitioners were general graduates,accounted for 15. 56%,1236 physicians participated in standardized trains,accounted for 68. 89%,and 1068 physicians attended position transition trains,accounted for 53. 33%. Meanwhile,88. 73% general practitioners went through standardized trains in organizations established by individuals. Conclusions Following hospital service mode,most of community health service centers had some problems such as unclear preventive function,unreasonable structure,less public health workers and general practitioners,serious 'two less and four low'. In personnel allocations,stations transformed by primary and township hospitals were more suitable for primary care health services than other types. The government should establish life-long‘community medicine'edu-cation system. Meanwhile coordinating inventory resurrection with increment adjustment,and combining appropriate introduction with remain training were necessary measures to improve employee members and structures. Finally,use our best efforts to construct a community health manpower service system with small density,wide coverage and multiple types.
引文
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[15]苏宁,彭迎春.基于工作分析的社区卫生服务团队公共卫生人力资源配置研究[J].中国全科医学,2013,16(10):1093-1095.
[16]毛瑛,朱斌,刘锦林,等.依托地理分级标准的卫生人力资源配置—澳大利亚经验对我国的启示[J].中国卫生事业管理,2015,32(10):758-760.
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[18]吴悦,杨坚,唐文熙,等.医护人员工作投入与任务绩效的影响因素及相互关系研究[J].中国卫生事业管理,2017,34(3):184-188.
[2]方允静,王海涛,陈大伟,等.灌南县社区卫生服务中心人力资源现状分析[J].中国初级卫生保健,2014,28(1):17-18.
[3]李永斌.全国重点联系城市社区卫生服务机构人力资源研究[D].武汉:华中科技大学,2008,72-73.
[4]朱剑融,方伟,唐惠兰. 2014年度无锡市惠山区基层防保人员人力资源现况调查和分析[J].社区医学杂志,2015,13(16):15-17.
[5]李伦.社区卫生服务中心人力资源非正常流失状况分析[J].中国初级卫生保健,2016,30(1):18-20.
[6]蔡维汉,董晓建. 2012年陕西省基层医疗卫生机构人力资源初步调研[J].中国医药导报,2014,11(2):117-121.
[7]张勘,东伟.上海市社区卫生服务中心卫生技术人员现状分析及建议[J].中国卫生资源,2009,11(12):289-291.
[8]代宝珍,王慧.江苏省乡村医生发展现状研究—基于5个县/市(区)的实地调查[J].中国卫生事业管理,2017,34(4):277-279.
[9]陈超,邵爽,金光辉,等.我国内地社区卫生服务管理研究现状[J].中国全科医学,2016,19(13):1489-1492.
[10]朱坤,张小娟,田淼淼.我国乡镇卫生院卫生人力资源配置现状分析———基于6省18县的调查[J].中国卫生政策研究,2015,8(9):58-63.
[11]罗志红,朱青.公平正义视阈下城乡公共卫生资源配置研究:基于江西省的实证分析[J].中国卫生事业管理,2015,32(3):201-203.
[12]陈莹,许传志,李晓梅,等.卫生人力资源配置标准研究评析[J].卫生软科学,2010,24(2):120-123.
[13]王晓曼,朱海珊.广东省卫生人力资源现状及配置公平性分析[J].中国卫生事业管理,2015,32(1):38-40.
[14]刘鸿宇,孙玉凤,王健.卫生人力资源需求预测研究进展、问题探讨及展望[J].中国卫生事业管理,2016,33(11):828-830.
[15]苏宁,彭迎春.基于工作分析的社区卫生服务团队公共卫生人力资源配置研究[J].中国全科医学,2013,16(10):1093-1095.
[16]毛瑛,朱斌,刘锦林,等.依托地理分级标准的卫生人力资源配置—澳大利亚经验对我国的启示[J].中国卫生事业管理,2015,32(10):758-760.
[17]姚云,侯万里,卢祖洵,等.湖北省城市社区卫生人力资源配置公平性分析[J].中国卫生经济,2010,29(4):37-39.
[18]吴悦,杨坚,唐文熙,等.医护人员工作投入与任务绩效的影响因素及相互关系研究[J].中国卫生事业管理,2017,34(3):184-188.