宁夏回族自治区吴忠市高闸中心卫生院基本情况现状调查

A Survey on Current Situation of Gaozha Central Township Health Center in Wuzhong City of Ningxia Hui Autonomous Region

目的调查宁夏自治区吴忠市高闸镇中心卫生院的基本情况,了解该院服务与经营现状,为乡镇卫生院药物配置与物流关键技术研究与产品开发提供基线数据。方法问卷调查结合专题访谈,内容包括一般情况、人员、经营及业务状况、基本药物目录实施情况等。结果①宁夏自治区吴忠市高闸镇中心卫生院硬件条件不够完善,服务人群人均收入低于吴忠市和全国平均水平。②医护比、医检比均低于全国平均水平,医技比略高于全国平均水平。各专业岗位人员数量不足,缺乏专业药剂人员,工勤人员与护理人员比重相等。卫生院3.4%的卫技人员无专业学历,38%未达大专水平;86.2%的员工是初级及以下职称;员工流动性差。③2009年卫生院床位使用率低于全国平均水平(46.4%vs.60.7%);平均住院日、医师日均诊疗负担和日均住院负担均高于全国平均水平(8 vs.4.8,9 vs.8.3,4 vs.1.3)。④2010年门急诊人次比2009年减少26.9%,住院人次减少42.4%。⑤2010年人均门诊费用增长127.3%,人均住院费用增长56.2%。⑥医院于2010年4月1日起使用国家基本药物目录(EML),药品总数195种,仅占EML总数的63.5%。结论宁夏自治区吴忠市高闸中心卫生院要达到西部全科型示范乡镇卫生院要求和服务标准,尚须进一步加强基础建设,增加卫生技术人员数量,调整人员结构,提高员工学历和资质,促进人员流动,提升卫生技术水平。医院药品收入控制较好,医药费用低于全国平均水平,2010年医药费用增长迅速。完全实行基本药物零差价销售可能对医院经营造成较大影响,须及时足额补贴及配套政策才能维持现有卫生服务水平;同时应开展基本药物循证增选补充、使用培训和指导,确保药物安全合理使用。

Objective To investigate current situation of medical service and management in Gaozha Central Township Health Center（GzC）,so as to provide baseline data for township health centers in both key techniques research and product development of drugs allocation and delivery.Methods A questionnaire combined with a special interview was carried out,which included the general information,human resources,medical service and management,and the practice of essential medicine list.Results a） The hardware condition of GzC was not good enough,and the economic status of the service recipients was lower than the average level of both Wuzhong City and China mainland;b） The constituent ratio of general practitioner（GP） and nurse,and GP and laboratorian were all lower than those of national level,while,the constituent ratio of GP and technician was a little bit higher.GzC was in short of medical technical personnel and,especially,the professional pharmacists.The logistics technical workers were as the same proportion as the nurses.The medical technical personnel without professional education background accounted for 3.4%,and about 38% of the staff members had no college degree,about 86.2% had at most primary profession titles.There was no personnel turnover of GzC in recently years;c） The bed utilization ratio was lower than national level（46.4% vs.60.7%）,while the average duration of stay and the in-patient and out-patient service workload of GP were longer or heavier than national level（8 vs.4.8,9 vs.8.3,4 vs.1.3）;d） The out-patient service in 2010 decreased 26.9% compared to 2009;and the in-patient service in 2010 decreased 42.4%;e） The average medical expense per outpatient and per inpatient increased 127.3% and 56.2%,respectively in 2010 compared to 2009;and f） Essential medicine list was put into practice in April 1st of 2010 and there was only 195 species available in GzC,which has not met the requirements of the national essential medicine list.Conclusion In order to meet the standards of general rural township health center in western China,GzC needs to cope with challenges of insufficient hardware conditions,short of staff,unreasonable personnel structure,low educational background and professional title of the staff,none human resources flow and low technical level of medical service.GzC dose well in drug expenses control,and the hospitalization costs are lower than those of the national level.However,it increases rapidly in 2010.The management of GzC may be influenced by zero-profit sale of the essential drugs,and appropriate subsidy and policy support are necessary to maintain its service quality.And it is required to complement the medicine based on the evidences,to carry out staff training and usage guidance of essential medicine,and to finally guarantee the safe and reasonable use of medicines.