浙江省'百千万'卫生人才政策干预效果研究——基于系统动力学模型

摘要

In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of "effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction"(hereinafter referred to as "double allocation, double improvement"), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.%新医改中,各试点地区对建立分级诊疗制度新模式进行探索实践,其中浙江省实行了以推动城市优质医疗资源下沉和医务人员下基层、提升县域医疗卫生机构服务能力和群众就医满意度(简称"双下沉、两提升")为特色的政策,重点落实"百千万"人才下基层政策,以期填补基层人力资源缺口,提升基层医疗卫生机构服务能力.由于政策具有探索性,政策干预的效果尚不清楚,因此有必要对政策可能产生的影响进行估计.本研究采用系统动力学方法和世界卫生组织的工作负荷法估算分级诊疗模式下医生资源需求量,计算基层医生缺口.采用系统动力学模型仿真"百千万"人才下基层政策效果,并进行敏感性分析.结果显示,基层医生人力资源缺口约为1.4万人."百千万"人才下基层政策能够逐渐增加基层医生数量,可能在2021年左右填补医生人力缺口.如果医生工作效能提高10%,定向培养就业和基层招聘100%达成政策计划目标,2020年可能填补基层医生缺口.结果显示,该人才政策可能使卫生人力资源结构快速、有效调整,对分级诊疗改革具有一定的促进作用.