【摘要】：研究背景:農(nóng)村與偏遠(yuǎn)地區(qū)衛(wèi)生人力資源不足、分布不均衡已成為亟待解決的全球性衛(wèi)生問(wèn)題,中國(guó)也同樣面臨著衛(wèi)生人力失衡的問(wèn)題。我國(guó)城市與農(nóng)村人口比值不斷縮小,但城市衛(wèi)生人員密度卻遠(yuǎn)高于農(nóng)村衛(wèi)生人員密度,且由于區(qū)域經(jīng)濟(jì)發(fā)展水平、地域環(huán)境差異等原因,我國(guó)西部農(nóng)村地區(qū)衛(wèi)生人力資源短缺問(wèn)題十分嚴(yán)重。因此,根據(jù)中國(guó)西部農(nóng)村衛(wèi)生人員的實(shí)際需求制定、完善中國(guó)西部農(nóng)村衛(wèi)生人力資源政策尤為重要。研究目的:在分析中國(guó)西部農(nóng)村衛(wèi)生人力政策的基礎(chǔ)上,將衛(wèi)生人力政策分為教育、管理、財(cái)政、個(gè)人及專(zhuān)業(yè)支持四個(gè)方面,通過(guò)對(duì)不同省縣鄉(xiāng)各級(jí)醫(yī)療機(jī)構(gòu)的衛(wèi)生人員進(jìn)行滿(mǎn)意度調(diào)查,分析衛(wèi)生人員對(duì)衛(wèi)生人力政策的滿(mǎn)意度情況,探討可能影響衛(wèi)生人力政策滿(mǎn)意度的原因,為中國(guó)西部農(nóng)村衛(wèi)生人力政策的修改與調(diào)整提供參考依據(jù)。研究方法:從中國(guó)西部11個(gè)省按經(jīng)濟(jì)發(fā)展水平抽取33個(gè)縣的人民醫(yī)院、婦幼保健院、疾病預(yù)防控制中心及中醫(yī)院;在已被抽取的縣中按人口規(guī)模大小每個(gè)縣抽取3個(gè)鄉(xiāng)鎮(zhèn)衛(wèi)生院作為樣本。問(wèn)卷調(diào)查法:利用李克特五點(diǎn)計(jì)分法設(shè)計(jì)衛(wèi)生人力政策滿(mǎn)意度調(diào)查問(wèn)卷,對(duì)樣本縣鄉(xiāng)醫(yī)療機(jī)構(gòu)的衛(wèi)生人員進(jìn)行問(wèn)卷調(diào)查;描述性統(tǒng)計(jì)法:對(duì)樣本地區(qū)衛(wèi)生人員對(duì)衛(wèi)生人力政策的認(rèn)知與滿(mǎn)意度情況等進(jìn)行描述性統(tǒng)計(jì);橫向比較法:比較各省不同醫(yī)療機(jī)構(gòu)的衛(wèi)生人員對(duì)衛(wèi)生人力政策的滿(mǎn)意度等;單因素分析。研究結(jié)果:1.樣本地區(qū)衛(wèi)生人力政策總體認(rèn)知與滿(mǎn)意度情況:僅有48.50%的衛(wèi)生人員表示了解國(guó)家及省內(nèi)的衛(wèi)生人力政策,其中24.52%的人持滿(mǎn)意態(tài)度,53.41%的人持一般態(tài)度,22.07%的人持不滿(mǎn)意態(tài)度。2.通過(guò)對(duì)衛(wèi)生人員對(duì)衛(wèi)生人力政策滿(mǎn)意度差異分析得出,在樣本縣人民醫(yī)院衛(wèi)生人員的年齡、學(xué)歷、醫(yī)生內(nèi)部執(zhí)業(yè)類(lèi)別分組間的滿(mǎn)意度分別具有統(tǒng)計(jì)學(xué)意義(P0.05);縣中醫(yī)院與縣疾控中心衛(wèi)生人員僅性別之間滿(mǎn)意度差異具有統(tǒng)計(jì)學(xué)意義(P0.05);縣婦幼保健院各組衛(wèi)生人力政策滿(mǎn)意度差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);鄉(xiāng)鎮(zhèn)衛(wèi)生院衛(wèi)生人員的年齡、學(xué)歷、醫(yī)生護(hù)士分組間滿(mǎn)意度差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.各省在不同機(jī)構(gòu)之間衛(wèi)生人員的總體滿(mǎn)意度較高(78.57%),但也仍有一部分省衛(wèi)生人員的滿(mǎn)意度相對(duì)較低(70.00%)。各省之間各級(jí)醫(yī)療機(jī)構(gòu)衛(wèi)生人員的滿(mǎn)意度差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),同類(lèi)醫(yī)療機(jī)構(gòu)各省之間的滿(mǎn)意度均值有差異,總的來(lái)看廣西壯族自治區(qū)衛(wèi)生人力政策滿(mǎn)意度較低。4.從教育政策來(lái)看,52.40%的衛(wèi)生人員肯定培訓(xùn)的積極作用,且42.98%的衛(wèi)生人員認(rèn)為培訓(xùn)機(jī)會(huì)不足,41.00%的縣疾控中心衛(wèi)生人員參加培訓(xùn)是為解決實(shí)際工作問(wèn)題,而其他機(jī)構(gòu)則多為提高醫(yī)療水平,且主要存在的問(wèn)題是缺乏實(shí)踐與培訓(xùn)時(shí)間短。在管理政策方面,各機(jī)構(gòu)離職意愿較高,且37.50%的衛(wèi)生人員主要離職原因是工資待遇較差,其次是個(gè)人價(jià)值實(shí)現(xiàn)、競(jìng)爭(zhēng)機(jī)會(huì)等。在財(cái)政政策方面,高收入的衛(wèi)生人員較少,43.63%的衛(wèi)生人員工資在2000-2999元之間;54.14%的人對(duì)單位內(nèi)部收入表示滿(mǎn)意,42.85%的人在與同地區(qū)同級(jí)別其他醫(yī)療機(jī)構(gòu)收入相比時(shí)表示滿(mǎn)意;在單位激勵(lì)機(jī)制合理性評(píng)價(jià)中,66.87%的衛(wèi)生人員認(rèn)為比較合理,但也仍有31.12%的衛(wèi)生人員認(rèn)為作用不大。在個(gè)人及專(zhuān)業(yè)支持方面,69.68%的衛(wèi)生人員對(duì)居住條件較滿(mǎn)意,77.86%的衛(wèi)生人員對(duì)執(zhí)業(yè)環(huán)境比較滿(mǎn)意,在工作提升機(jī)會(huì)上縣級(jí)醫(yī)療機(jī)構(gòu)的情況好于鄉(xiāng)鎮(zhèn)衛(wèi)生院。建議:1.精準(zhǔn)規(guī)劃政策惠及范圍,高效優(yōu)化人力政策內(nèi)容2.全國(guó)各省優(yōu)勢(shì)互補(bǔ),相互借鑒成功經(jīng)驗(yàn)3.完善農(nóng)村衛(wèi)生人力培訓(xùn)制度,加強(qiáng)基層人力繼續(xù)教育4.制定區(qū)域衛(wèi)生人力規(guī)劃,構(gòu)建合理衛(wèi)生人力流動(dòng)機(jī)制5.增加財(cái)政投入政策,鼓勵(lì)支援農(nóng)村建設(shè)6.創(chuàng)造良好個(gè)人條件,完善農(nóng)村基礎(chǔ)設(shè)施
[Abstract]:Research background: The shortage of health and human resources in rural and remote areas has become a global health problem to be solved urgently, and China is also facing the problem of the imbalance of health manpower. The ratio of urban and rural population in China is shrinking, but the density of the urban sanitation personnel is much higher than that of the rural health personnel, and the shortage of health and human resources in the western rural areas of China is very serious due to the regional economic development level and the regional environmental difference. Therefore, according to the actual demand of the rural health personnel in the western part of China, it is very important to improve the rural health human resources policy in the western part of China. The purpose of the study is to divide the health manpower policy into four aspects: education, management, finance, personal and professional support based on the analysis of the rural health manpower policy in the western part of China. The paper analyzes the satisfaction of the health personnel to the health manpower policy, and probes into the reasons that may affect the satisfaction of the health manpower policy, and provides a reference for the revision and adjustment of the rural health manpower policy in the western part of China. Methods: The people's hospital, mother and child health care institute, disease prevention control center and middle hospital were taken from 11 provinces in the west of China according to the level of economic development. Methods: The questionnaire of health manpower policy satisfaction survey was designed by using the five-point scoring method of Likert, and the health personnel of the medical institutions of the counties and counties of the samples were investigated by questionnaire. The descriptive statistics method: Descriptive statistics are made on the awareness and satisfaction of the health personnel in the sample area, such as the awareness and satisfaction of the health manpower policy, and the horizontal comparison method: the satisfaction of the health personnel of different medical institutions in the provinces to the health and human policy is compared; and the single-factor analysis. Study Results: 1. The general cognition and satisfaction of the health manpower policy in the sample area: only 48. 50% of the health personnel indicated the national and provincial health manpower policies, of which 24. 52% of the people were satisfied, 53. 41% held the general attitude, and 22. 07% of the people were not satisfied with the attitude. Through the analysis of the difference of the health personnel's satisfaction with the health manpower policy, the degree of satisfaction of the health personnel at the people's hospital in the sample county was statistically significant (P0.05). There was no significant difference in the degree of satisfaction between the health personnel of the county and the county disease control center (P0.05). There was no significant difference in the degree of satisfaction between the health personnel and the health personnel at the county and the county level (P0.05), and the age and the degree of the health personnel in the township health center. The difference of satisfaction among the nurses in the nurses was statistically significant (P0.05). The overall satisfaction of health personnel among the various agencies was high (78. 57%), but there was still a relatively low level of satisfaction in some of the provincial health personnel (70.00%). There was a significant difference in the satisfaction of the health personnel at all levels between the provinces (P0.05). in that light of the education policy, 52. 40% of the health personnel have positive effect on the training, and 42. 98% of the health personnel consider that the training opportunities are insufficient and that 41. 00% of the health personnel of the county disease control centre participate in the training to address the practical problem of work, while the other agencies are increasing the level of medical care, and the main problems are lack of practice and short training time. in that area of management policy, the willingness of the agencies to leave is high, and 37. 50% of the health personnel are mainly due to poor wage treatment, followed by personal value realization, competition opportunity, and the like. In the area of fiscal policy, the high-income health personnel are less, and 43. 63% of the health workers are in the range of 2000-2999 yuan; 54. 14% of the people are satisfied with the internal income of the unit, and 42. 85% of the people are satisfied with the income of other medical institutions at the same level as the same area; In the evaluation of the rationality of the unit's incentive mechanism, 66. 87% of the health personnel think it is reasonable, but there are still 31. 12% of the health personnel think the effect is not big. In the area of personal and professional support, 69. 68% of the health personnel are satisfied with the living conditions, 77. 86% of the health personnel are satisfied with the practice environment, and the situation of the county-level medical institutions at the county level is better than that of the township health center. Recommendation: 1. The policy of precision planning benefits the scope and efficiently optimizes the human policy content 2. The provinces of the whole country have complementary advantages, and learn from each other for reference to the successful experience of 3. Improve the rural health manpower training system, and strengthen the basic level of manpower to continue education. The establishment of the regional health manpower planning and the construction of the rational health manpower flow mechanism 5. To increase the financial investment policy and to encourage the support of rural construction 6. to create good personal conditions and to improve the rural infrastructure
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R197.1

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