对当前医改进展及相关问题的认知分析——部分地市卫生主管领导调查

Attitudes to the progress and related issues of health care reform——survey for chief executives in some prefecture level cities

目的:了解地市级卫生主管领导对医疗卫生事业和医改工作的态度和观点,从而判断形势、发现问题,更好地推进医改工作。方法:对来自29个省市的34名地市级卫生主管领导进行了结构式和半结构式的问卷调查和小组访谈。结果:(1)地市级卫生主管领导对卫生事业的基本规律和医改的主要目标理解正确、掌握清楚,但对"管办分开"的内涵和公立医院功能定位等仍存在模糊认识;(2)目前推进医改工作中的主要障碍为管理体制分散,资金投入数量不足、结构不合理,以及地方政府财政压力较大等;(3)地方领导认为理顺管理体制,建立长效、制度化的补偿机制和不同层级间的分担机制是未来医改亟需解决的问题,同时要加强对现有基层卫生人员的培训,从而完善人才队伍建设。

Objective： This article is to understand health chief executives＇ attitudes to the health care reform in prefecture level cities, in order to evaluate the situation, identify problems, and to promote the implementation of health care reforms. Methods： The paper investigates 34 health chief executives in prefecture level cities cross 29 provinces using structured and semi-structured questionnaires and group interviews. Results ： （ 1 ） Health chief executives in prefecture level cities have a good understanding of fundamental rules of health care undertakings and objectives of health care system reform, but have a vague awareness of the ＂separation between government administration and business operations＂ and functional orientations of public hospitals; （2） The main obstacles to health care reform are the decentralization of management system, lack of capital investment, unreasonable structure, and the financial burden to local governments; （3） The local health administrators in the survey cities thought that the condition to make the reform successful is to clearly sole the managerial mechanism, establish the institutionalized and sustainable compensation mechanisms, and to solve the cost sharing mechanisms among different level of administrations. Meanwhile, the government should strengthen training of grass-roots professional talents to improve the capacity of talents.