【摘要】：研究背景鄉(xiāng)村醫(yī)生作為我國農(nóng)村衛(wèi)生醫(yī)療隊伍的重要組成部分,在農(nóng)村衛(wèi)生醫(yī)療預(yù)防方面、基本醫(yī)療方面、宣傳教育方面等都起著至關(guān)重要的作用,然而在鄉(xiāng)村醫(yī)生發(fā)展的整個歷程中,薪酬福利問題卻成為影響該隊伍穩(wěn)定與發(fā)展的重要因素,成為深化農(nóng)村衛(wèi)生改革的難點問題。自2009年出臺的《中國中央、國務(wù)院關(guān)于深化醫(yī)藥衛(wèi)生體制改革的意見》,雖然在村醫(yī)的管理規(guī)范上有了一定的說明,但是在如何提高鄉(xiāng)村醫(yī)生薪酬福利方面仍舊沒有得到良好解決,引起了村醫(yī)的流失量逐年增長。另一方面由于寧夏地處偏遠,上級財政部門受經(jīng)濟能力的限制,加上一些人為因素導致部分國家政策無法落到實處,使得村醫(yī)工作缺乏積極性,人才儲備量得不到較好的補充。研究目的以西北偏遠地區(qū)寧夏作為研究地點,通過實地考察,調(diào)查問卷等方式對比了解新醫(yī)改前后鄉(xiāng)村醫(yī)生薪酬福利的變化;以薪酬管理學、社會保障學、公共政策學等相關(guān)的管理理論作為理論基礎(chǔ);運用統(tǒng)計學的方法分析寧夏鄉(xiāng)村醫(yī)生薪酬福利醫(yī)改前后的變化,及新醫(yī)改對薪酬福利產(chǎn)生的影響程度,找出其中存在的主要問題,分析原因,提出具有針對性的參考建議。研究方法運用構(gòu)成比、頻數(shù)、均數(shù)等描述性的統(tǒng)計學方法對鄉(xiāng)村醫(yī)生的基本現(xiàn)狀進行闡述;運用兩樣本均數(shù)t檢驗的方法對新醫(yī)改前后鄉(xiāng)村醫(yī)生收入水平、收入結(jié)構(gòu)方面的變化及影響進行分析;運用多元線性回歸的方法對影響鄉(xiāng)村醫(yī)生收入水平的因子進行分析;運用卡方檢驗的方法對鄉(xiāng)村醫(yī)生收入滿意度、養(yǎng)老保險方面的改變進行對比分析;運用單因素方差分析方法將鄉(xiāng)村醫(yī)生的收入水平同鄉(xiāng)鎮(zhèn)衛(wèi)生員、鄉(xiāng)村教師進行比較分析。研究結(jié)果新醫(yī)改后鄉(xiāng)村醫(yī)生在收入水平方面由新醫(yī)改前的年總收入12346.53元/人/年,增加到22758.81元/人/年,增長幅度為10412.28元/人/年,且研究表明P0.05,說明較新醫(yī)改前相比收入有所增加,新醫(yī)改政策對其產(chǎn)生影響;通過運用多元線性回歸的方法,了解到執(zhí)業(yè)資格證及村衛(wèi)生室的輻射人口是影響村醫(yī)收入水平的主要因素;在收入結(jié)構(gòu)方面鄉(xiāng)村醫(yī)生的從醫(yī)收入與農(nóng)業(yè)收入較新醫(yī)改前相比沒有發(fā)生太大變化,而發(fā)生最大變化的是補助收入,從醫(yī)改前的0%增長到目前的26.70%,結(jié)果顯示兩樣本之間的差異具有統(tǒng)計學意義(P0.05),表明較醫(yī)改之前相比確有變化,且影響較大;在收入滿意度方面由新醫(yī)改前的13.00%增長到醫(yī)改后的44.40%,且差異性具有統(tǒng)計學意義(P0.05),表明較新醫(yī)改前相比鄉(xiāng)村醫(yī)生在收入滿意度方面有了顯著提升;在養(yǎng)老保險方面由新醫(yī)改前的0.30%上升到醫(yī)改后的11.30%,結(jié)果表明其差異性具有統(tǒng)計學意義(P0.05),雖有了一定程度的提高,但從實際情況來看其影響程度還是不大。建議:1、加大政策扶持力度,完善鄉(xiāng)村醫(yī)生薪酬福利管理制度;2、規(guī)范鄉(xiāng)村醫(yī)生績效考核制度,擴寬村醫(yī)的職業(yè)發(fā)展道路;3、提高鄉(xiāng)村醫(yī)生基本待遇,保障村醫(yī)的可持續(xù)發(fā)展;4、落實鄉(xiāng)村醫(yī)生養(yǎng)老保險政策,減少村醫(yī)的大量流失;5、重視鄉(xiāng)村醫(yī)生晉升機會,促進輪轉(zhuǎn)模式的建立。
[Abstract]:As an important part of China's rural health medical team, the study of rural doctors is of vital importance in the area of rural health and medical prevention, basic medical care and publicity and education, but in the whole course of the development of rural doctors, The issue of compensation benefits has become an important factor that affects the stability and development of the team, and becomes a difficult problem to deepen the reform of rural health. Since 2009, the State Council's Opinions on Deepening the Reform of the Health and Health System of the State Council and the State Council's Opinions on Deepening the Reform of the Medical and Health System have not been well solved in terms of how to improve the remuneration and welfare of the rural doctors, even though there has been some explanation in the management regulations of the village doctors, The loss of the village medicine has increased year by year. On the other hand, because of the remoteness of Ningxia, the financial department of the higher level is limited by the economic capacity, and some of the human factors have caused some of the national policy to be unable to fall to the real position, so that the village doctor's work is lacking of enthusiasm and the reserve of talents can not be supplemented. The purpose of this study is to compare the change of the salary and welfare of the rural doctors before and after the new medical reform in Ningxia as the research site in the remote and remote areas of the northwest, and to provide the theoretical basis for the management theory, such as salary management, social security, public policy and so on. Based on the statistical method, the changes of the salary and welfare reform of the rural doctor in Ningxia and the impact of the new medical reform on the salary and welfare are analyzed, the main problems in the reform and the reasons of the analysis are found out, and the relevant reference suggestions are put forward. The basic status of rural doctors was described by means of descriptive statistics methods, such as the proportion, frequency and mean number of the rural doctors, and the changes of the income and the income structure of the rural doctors before and after the new medical reform were analyzed by using the method of the two-difference method. The factors that affect the income level of the rural doctors are analyzed by the method of the multiple linear regression, the income satisfaction of the rural doctors and the change of the old-age insurance are compared and analyzed by using the method of the card-side test. The income level of the rural doctors was compared with the township health workers and the rural teachers by means of single factor analysis of variance. The results showed that the annual total income of the rural doctors in the income level by the new medical reform was 12343.53 yuan/ person/ year, and the increase to 227.58. 81 yuan/ person/ year, the growth rate was 104.28 yuan/ person/ year, and the study showed that the income increased before the new medical reform. The influence of the new medical reform policy on the village medical income level is realized by applying the method of the multiple linear regression, and the radiation population of the village health room is the main factor that affects the income level of the village doctor; In the income structure, the rural doctor has not changed much from the medical income and the agricultural income before the new medical reform, but the biggest change is the subsidy income, from 0% before the medical reform to the current 26. 70%, and the result shows that the difference between the two differences is of statistical significance (P0.05). The results showed that there was a change before and after the reform of the medical reform, and the effect was large; the rate of income satisfaction was increased from 13.00% in the first of the new medical reform to 44.4% after the medical reform, and the difference was of statistical significance (P <0.05), indicating that the rural doctor had a significant improvement in the income satisfaction before the new medical reform; The results showed that the difference was statistically significant (P0.05). Recommendation: 1. Increase policy support and improve rural doctor's salary and welfare management system; 2. standardize the performance appraisal system of rural doctors and widen the professional development path of village doctors; 3. Improve the basic treatment of rural doctors and ensure the sustainable development of village doctors; 4. Implement the rural doctor's endowment insurance policy, reduce the large amount of loss of the village doctor; 5, pay attention to the promotion opportunity of the rural doctor, and promote the establishment of the round-robin mode.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R197.1

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