广西乡村医生"乡聘村用"政策实施困境及其对策
Study on the Implementation Dilemma and Countermeasures of the Policy of"Employed by Township and Work in Villages"of the Rural Doctors
徐心怡 1朱平华 1梁朝玉 1黄春源 1王宣伊 1傅琤然1
作者信息
- 1. 广西医科大学人文社会科学学院,广西南宁,530021
- 折叠
摘要
目的:梳理广西乡村医生"乡聘村用"政策实施过程中的困境,为进一步完善"乡聘村用"政策提供参考.方法:于2023 年7-8 月运用目的抽样对广西3 个镇的37 名乡村医生和9 名乡镇卫生院院长进行访谈,基于扎根理论对访谈资料进行开放式编码、主轴编码和选择性编码.结果:经过编码提取了13 个副范畴、7 个主范畴以及职业适应、治理失效、制度缺陷3 个核心范畴,总结出"乡聘村用"政策实施效果影响因素的运行机制,宏观层面的制度缺陷、中观层面的治理失效影响微观层面乡村医生的职业适应,并最终影响政策实施效果.结论:"乡聘村用"政策实施过程中存在制度缺陷、治理失效、职业适应 3 个方面的困境,建议持续提升乡村医生的薪酬水平,建立适度的农村医疗卫生服务竞争机制.增派县域医共体中的县级医疗单位人员协同卫生院对村卫生室进行绩效考核,出台文件明确界定乡村医生发生医疗纠纷和工伤事故后乡镇卫生院的权责.运用信息化管理手段助推乡村医生更好地提供连续性卫生服务.细化乡村医生职称评定倾斜政策,缓解乡村医生角色超载问题.
Abstract
Objective:To identify the challenges encountered in the implementation of the rural doctor"employed by township and work in villages"policy in Guangxi,so as to provide guidance for its further refinement and enhancement.Methods:Using purposive sampling,interviews were conducted with 37 village doctors and 9 township health center directors in three towns in Guangxi in July-August,2023.Employing grounded theory methodology,the interview data were subjected to open coding,axial coding,and selective coding.Results:Thirteen sub-categories,seven main categories,and three core categories of occupational adaptation,governance failure,and institutional defects were identified through coding extraction.The operational mechanism of the policy's implementation effects in villages was revealed.Macro-level institutional deficiencies affected the vocational adaptation of rural doctors.Governance inefficiencies at the meso-level impacted the vocational adaptation of rural doctors,ultimately influencing policy implementation effects.Conclusion:In the implementation of the"employed by township and work in villages"policy,there are problems in three aspects:institutional defects,governance failure,and occupational adaptation.It is suggested to continuously improve the salary level of rural doctors,and establish a moderate competition mechanism for rural medical and health services.As-sign more staff from county-level medical units within the county medical community to collaborate with health centers in conducting performance assessments of village health clinics.Issue documents to clearly define the responsibilities of township health centers in handling medical disputes and work-related accidents involving village doctors.Utilize information management tools to help rural doctors provide better continuous health services.Refine policies for evaluating the professional titles of rural doctors to alleviate the issue of role overload among village doctors.
关键词
乡村卫生/医疗卫生服务/乡聘村用/乡村医生/广西Key words
Rural Health/Medical and Health Service/Employed by Township and Work in Village/Rural Doctor/Guangxi引用本文复制引用
基金项目
国家社会科学基金(22BKS193)
南宁市智库立项重点项目(2022)(2022003)
出版年
2024
NETL
NSTL
万方数据