体制之弊与现状之困:F县村卫生室建设的教训与启示

The Defects of System and the Realistic Difficulties: the Lessons and Revelation of Clinics in F County

目的:分析案例县在进行村卫生室建设中遇到各方参与积极性不足的问题及建成后卫生室使用率偏低的困境的原因并提出对策。方法:田野调查法、历史文献法和比较分析法。结果:项目投资体制存在严重弊端是导致村卫生室项目进展遇到问题的根本原因;村级医疗卫生事业的普遍性困境是导致村卫生室建成后难以得到高效利用的深层原因,当前我国村级医疗卫生事业面临的危机是一种总体性危机。结论:必须改革现行的项目投资体制;相应的制度设计和政策安排务必要结合农村的实际情况,考虑区域的发展差异,结合城乡二元结构的基本现实,以农民的实际需要为导向,绝不能搞城乡一刀切,更不能拍脑袋决策。

Objective： To analyze the problems of lacking partieipatinn enthusiasm in the construction of village clinics, reasons for low-utilization rate of clinics after the implementation and propose the enuntermeasure in the sample county. Methods： Field in- vestigation method, history literature and comparative analysis method were involved. Results： The existing serous defects of project in- vestment system was the basic reason for the difficulties in village clinic project progress; the universal dilemma of village health care industry, was the underlying reason which resulted village clinics couhl not be efficiently utilized ＇after the implementation. The current crisis faced by village heahh care industry in China was a type of total crisis. Conclusion： It needed to reform the current project in- vestment system, the corresponding system design and strategy arrangement should be combined with the practical rural situation, con- sider the regional development differences combined with the basle practiee of urban-rural dual structure. With the practical demand of rural residents as the lead, it could not separate the urban and rural areas while the impulse decision should not be made.