新医改以来我国基层卫生人力发展规模及配置现状研究

摘要

目的：了解新医改以来我国基层卫生人力的发展规模及配置现状。方法利用2009—2014年《中国卫生（和计划生育）统计年鉴》数据，研究2009—2014年我国基层卫生人力规模、卫生人力资源配置、学历、职称情况等。结果2009—2014年我国卫生人员、基层卫生人员呈增长趋势，年平均增长速度分别为5.6%、2.3%；基层卫生人员占比从2009年的40.5%下降到34.6%，下降了5.9个百分点。每万人口基层卫生人员数、基层医生数分别从2009年的23.6、7.0人增加到2014年的25.9、7.8人，每万人口全科医生数从2012年的0.81人增加到2014年的1.26人，医护比从2009年的1：0.46改善为2014年的1：0.57。2014年社区卫生服务机构、乡镇卫生院执业（助理）医师中本科及以上学历者占比分别为37.0%、11.9%，较2009年分别增加了6.3、3.1个百分点；执业（助理）医师中高级职称者占比分别为8.4%、2.5%，社区卫生服务机构执业（助理）医师高级职称占比较2009年下降0.2个百分点，乡镇卫生院较2009年增加了0.6个百分点。结论我国基层卫生人力总量不足且增长缓慢、素质不高、配置不合理。建设从全科医生队伍建设和能力提升、基层医务人员薪酬制度完善两方面着手解决这一问题。%Objective To investigate the scale and allocation of the human resources in primary health care system of China after new medical reform. Methods Used data from China Health and Family Planning Statistical Yearbook 2009—2014, the health human resource scale, allocation of health human resources, education level and professional titles were researched. Results From 2009 to 2014,China health care human resources and primary health care human resources were increasing with an annual average increasing rate of 5. 6% and 2. 3% respectively;the proportion of health workers of primary health care decreased from 40. 5% to 34. 6% ,a decrease of 5. 9 percentage points. The numbers of health workers and doctors of primary health care in every ten thousand people increased from 23. 6 and 7. 0 in 2009 to 25. 9 and 7. 8 in 2014;the number of GPs for every ten thousand people increased from 0. 81 people in 2012 to 1. 26 people in 2014;the ratio of doctors to nurses improved from 1: 0. 46 in 2009 to 1: 0. 57 in 2014. The proportion of medical practitioners(assistant doctors)with bachelor degree or above was 37. 0% for community health service settings and 11. 9% for township health centers,a decrease of 6. 3 and 3. 1 percentage points compared with 2009;the proportions of medical practitioners( assistant doctors) with middle and high professional titles were 8. 4% and 2. 5% respectively,and the proportion of medical practitioners(assistant doctors)with high professional title decreased by 0. 2 percentage points in community health service settings and increased by 0. 6 percentage points in township health centers than 2009. Conclusion The human resources of primary health care of China are inadequate and have a slow increase,poor quality and irrational allocation. To solve the problems,the construction and ability of GP team should be enhanced and the remuneration system of medical staff of primary health care should be improved.