农村基层医疗卫生机构运行中存在的问题及对策的实证分析

The empirical analysis of problems and countermeasures on operation of rural community medical institutions

基层医疗卫生工作是整个医疗卫生体制改革的重要突破口和切入点。与城市相比,农村基层医疗卫生机构的运行状况更令人担忧。通过对河南省鲁山县的实地调查发现,基本药物招标采购不规范、部分药品的断供、缺货情况严重、部分乡镇卫生院财务运转困难、"以药养医"现象依然存在、农民用药负担依然沉重、基层医务人员待遇水平低、职业发展空间有限、公共卫生服务补助水平低、预防保健人才极其匮乏、服务方式仍然沿袭传统坐诊制是当前我国农村基层医疗卫生机构运行中面临的突出问题。解决上述问题的关键在于完善基本药物制度、加大财政投入的力度、提高基层医务人员待遇水平、拓展其职业发展空间、加强农村公共卫生服务人才培养和加快服务方式的创新等。

Grassroots medical work is the key to the reform of medical and health system. Comparing with the city, the oper- ation condition of the rural community medical institutions is more worrying. Through the survey in Lushan county in Henan prov- ince, we discovered that the main problems in the operation of rural community medical institutions include the irregularities of basic drugs bids ,serious out-of-stock of some medicines,financial operation difficulties in some of the rural community medical institutions,still existing ＂selling-medicine-for＇treatment＂ phenomenon, heavy burdens for seeing a doctor, low wage level of grassroots medical personnel, limited occupation development space,low compensation level of public health services, serious lack of preventive health care personnel ,traditional service model, and so on. The keys of solving above problems are improving basic drugs system, increasing financial support, improving the wage level of grassroots medical service personnel, expanding their occu- pation development space, strengthening the training of rural medical service personnel, speeding up the innovation of the service model, etc.