乡村卫生组织一体化管理政策研究和实践概述

摘要

介绍《乡村卫生组织一体化管理政策研究和实践》项目的研究背景、目的、内容和主要方法，以及该政策思路在样本地区实施后的社会效果与影响。评价结果表明，乡村卫生组织一体化管理，能够缓解乡镇卫生院生存困境，能避免乡村两级卫生机构的恶性竞争并恢复协调，促使乡镇卫生院加强村卫生室的管理和建设，提高了村医素质，统一和规范了村卫生室和村医的进药渠道，村乡两级防保人员的数量和素质改善。一体化的效果与管理观念紧密相连，如管理不当，一体化的经济收益维持不了多久，村卫生室原有的“产权明晰、责任明确”的体制优势，以及有积极性较高、就医较方便、服务价格较低、服务态度较好等特点将会逐步丧失，居民就医经济负担加重，医疗服务的可及性下降。以医养防现象加重，重医轻防依旧存在。并提出了将一体化管理与村乡乃至县卫生机构的劳动人事、分配制度和改革相结合的建议。%The paper gives an account of the background, objective, content and major methods of the research project Policy Study and Practice Concerning the Integrated Management of Rural Health Organizations and discusses the social results and influence brought about by the implementation of the policies contained therein in sample areas. Evaluation of the results indicates that integrated management of rural health organizations can reduce the difficulties of survival as experienced by township hospitals, prevent vicious competitions between township and village health organizations and restore cooperation, and enable township hospitals to strengthen their supervision of village health stations. As a result, the quality of village doctors has been improved, the drug purchasing channels by village health stations and doctors have been standardized, and the number and quality of both village and township health workers have been enhanced. The effect of integrated management is closely related to the concept of management. Improper management will lead to the quick reduction of economic profits of integrated organizations; the gradual loss of such advantages in the system as “definite property rights and clear responsibilities” originally enjoyed by village health stations and such features as great enthusiasm, convenience in seeking medical treatment, low service prices, and good service manners; the increase of financial burdens on the part of citizens seeking medical help; and decrease of accessibility to medical services. The paper points out that the phenomenon of preveutive care relying upon medicaltreatment has worsened and the pheromenon of stressing medical treatment and belittling prevention still exists. It is suggested that integrated management be combined with the reform of personnel, distribution and institutional systems of health organizations at the village, township and even county levels.