新医改背景下福建省山区县乡镇卫生院人员流动情况及原因分析

Influencing Factors of Health Personnel Flow in Township Hospitals in Mountain Areas of Fujian Province under New Medical System Reform

目的了解医改实施3年来,福建省山区县乡镇卫生院人员的流动情况及其原因。方法分别对6个山区县的100个乡镇卫生院人员进行问卷调查和访谈。结果 2009—2011年3年来乡镇卫生院流入人员数(698人)大于流出人员数(423人),差异有统计学意义(χ2=23.408,P<0.001);流入人员中女性所占比例是男性的2.86倍,流出人员中女性所占比例是男性的1.78倍,两组人员性别分布间差异有统计学意义(χ2=12.620,P<0.001);流入人员中30岁以下者占77.22%(539/698),流出人员中30岁以下者占43.26%(183/423),两组人员年龄分布间差异亦有统计学意义(χ2=198.021,P<0.001);流入人员中护士316人(占45.27%),流出人员中护士173人(占40.90%);流入人员乡镇卫生院招聘的应届毕业生370人(占53.01%),流出人员辞职的153人(占36.17%)。在访谈的48人中,42人(87.50%)认为工资待遇水平影响人员流动,26人(54.17%)认为自身发展的因素影响人员流动,18人(37.50%)认为子女教育问题影响人员流动,15人(35.71%)认为住房问题影响人员流动。结论流动人员中,女性高于男性,30岁以下的流动人员所占比重大,护士的流动性较强。流入总量大于流出总量缘于医改政策的支持;人员流失受经济因素、自身发展机会、子女受教育机会和住房等因素的影响。

Objective To explore the influencing factors of health personnel flow in township hospitals under medical system reform in the past three years in mountain areas of Fujian Province. Methods The health personnel of 100 township hospi- tals of 6 mountain counties were surveyed using questionnaire and interview. Results The total number of inflow personnel was more than that of the outflow personnel （698 vs. 423 ; X2 =23.408, P 〈0. 001 ） . The number of female was 2. 86 times that of male in the inflow personnel, while the ratio was 1.78 in the outflow personnel （X2 = 12. 620, P 〈0. 001 ） . Significantly differ- ence was observed in proportion of personnel below 30 years old between the inflow personnel （77.22% , 539/698 ） and the out- flow personnel （43.26%, 183/423） （X2 = 198.021, P 〈 O. 001 ） . Nurses accounted for 45.27% （316/698） of the inflow personnel and 40. 90% （ 173/423 ） of the outflow personnel. Totally 370 graduates accounted for 53.01% of the inflow person- nel. Among the outflow personnel, 153 people （36. 17% ） resigned. Payment, career development, children＇s education, and housing were believed to be the major factors influencing personnel flow by 42 （87. 50% ）, 26 （54. 17% ）, 18 （37.50%）, and 15 （35.71%） of the 48 people interviewed, respectively. Conclusion Females, people under 30 years old, and nurses accounted for large proportions of the health personnel flow. Inflow outnumbering outflow is attributed to health system reform poli- cies. Economic factors, career development, children＇s education, and housing are related influencing factors of personnel drainage.