农村医疗卫生政策落实的困境、原因与对策——以F县新农合政策和基本公共卫生政策为例

Why some rural health policies are difficult to be implemented in F counties: A case study of New Rural Cooperative Medical System and the Basic Public Health Policy

国家的农村医疗卫生政策在村级存在难落实的现象。从县级卫生行政主管部门和乡镇卫生院的角度来看,是由于村医群体普遍缺乏对接国家各项农村医疗卫生政策的基本条件和基础能力所致。但从村医的角度来看,则是因为乡镇卫生院在人财物匮乏的尴尬处境下,向没有体制身份的村卫生室和村医转嫁危机和风险所致。实际上,医疗卫生政策难以在村级落地,主要原因在于乡村两级医疗卫生机构之间的关系没有被理顺,具体表现为村卫生室相对于乡镇卫生院的弱势地位。理顺乡村两级医疗卫生机构关系的关键在于加强村卫生室的能力建设。要从加强村医人才建设方面破题,同时要破除针对村医的某些思维和政策方面的认识误区,加强对基层主管部门的问责,打通乡村两级医疗卫生机构之间的关联。

Rural health policies are difficult to be implemented at the village level in China.From the perspective of health administrative departments and township health centers, this is due to the lack of the basic conditions of rural health policy and the basic ability of the rural health policy.But from the point of view of village doctors, this is because of the lack of personnel, funding and other embarrassing situations, especially due to crisis and risks are taken to the village clinics and village doctors by the township health centers.In fact, the main reason why the health policy is difficult to land at the village level is that the relationship between the township health centers and village clinics have not been rationalized, as can be specifically seen in weak position of village clinics compared with township health centers.The key to rationalize the relationship between the township health centers and village clinics is to strengthen the development capacity of village doctors, at the same time to get rid of the misunderstanding for village doctors in some of the thinking and policy and strengthen the accountability of primary authorities, and finally open up the relationship between the township health centers and village clinics.