甘肃省临洮县新添中心卫生院基本情况现状调查

A Status Survey on Xintian Central Township Health Center, Lintao County,Gansu Province

目的调查甘肃省临洮县新添中心卫生院基本情况,了解该院服务与经营现状,为乡镇卫生院药物配置、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甘肃省临洮县新添中心卫生院硬件条件不够完善,受制于该县和省财政严重入不敷出。②该院医护比、医药比、医检比分别高于、略低于和等于全国平均水平,医技人员仅1人。全院69名员工中27.5%未达大专水平,81%是初级及以下职称;近2年分配入医护人员26名,流出1人。③2009年卫生院床位使用率高于全国平均水平(109%vs.60.7%);平均住院日高于全国平均水平(6 vs.4.8天)。④2010年门急诊人次比2009年增加17.6%,住院人次减少17%。⑤2010年人均门诊费用增长23.5%,人均住院费用增长14.9%。⑥医院于2010年6月实行国家基本药物目录,现有药品总数767种,超过基本药物目录总数。结论①甘肃省临洮县新添中心卫生院作为西部基本型示范乡镇卫生院,承担了当地民众的大量健康保障服务。②甘肃省"选拔普通高校毕业生到乡镇卫生院工作"的相关政策保障了该院的人员补充,但尚须进一步加强基础建设,调整人员结构,提高员工学历和资质,提升卫生技术水平。③医院药品收入比重较大,门诊费用低于全国平均水平。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,需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遴选、使用培训和指导,确保药物安全合理使用。

Objective To understand the current situation of medical service and management in Xintian Central Township Health Center（XtC） through on-the-spot investigation,and to provide references for development of key techniques and products for township health centers in medicine allocation and delivery.Methods The questionnaire and the focus interview were carried out,which included the general information,human resources,medical service and management,as well as the practice of essential medicine list.Results a） The hardware conditions of XtC were not good enough,and the income of Lintao county and Gansu provincial government fell short of their needs;b） The General Practitioner（GP）/nurse ratio was higher than that of the national level,the GP/pharmacist ratio was a little bit lower,and the GP/laboratorian ratio reached the national level.There was only one medical technician.There was about 27.5% staff members having no college degree,and about 81% having at most primary profession titles.There were 26 medical workers allocated to XtC in recent two years and only one GP left;c） In 2009,the bed utilization ratio was a little bit higher than the national level（109% vs.60.7%）,while the average length of stay was longer than the national level（6 vs.4.8）;d） The outpatient service in 2010 increased by 17.6% compared to 2009 and the inpatient service in 2010 decreased by 17%;e） The average medical expense per outpatient and per inpatient increased by 23.5% and 14.9%,respectively,in 2010 compared to 2009;f） The essential medicine list（EML） was put into practice in June,2010.The current count of medicine in hospital was 767,far beyond the EML demand.Conclusion XtC,as a basic rural Township Health Center in Western China,overtakes the burden of healthcare service for local population.The policy of ＂selecting graduates to work in Township Health Center＂ made by Gansu government ensures sufficient personnel reserve for rural Township Health Center.XtC needs to cope with challenges of insufficient hardware conditions,unreasonable personnel structure,low educational background and profession title of the staff,and low technical level of medical service.XtC has a big ratio of medicine income and the expense of outpatient is lower than that of the national level.The management of XtC may be influenced by zero-profit price of the essential medicine,and appropriate subsidy and policy support are needed to maintain its service quality.And it is necessary to carry out evidence-based selection of the essential medicine account and develop staff training and essential medicine usage guidance,so as to support the medicine used safely and rationally.