基于目标人群服务份额的乡镇卫生院服务竞争力研究

Analysis on Service Competitive Power of Township Health Centers Based on Service Shares among Target Groups

目的:观察2009年和2015年乡镇卫生院的竞争力变化,探讨其关键影响因素,为乡镇卫生院服务发展定位提供参考。方法:利用2010—2016"中国统计年鉴"、"中国卫生和计划生育统计年鉴"的数据,测算31个省份2009年和2015年乡镇卫生院服务份额水平及变化,用Pearson相关系数反映乡镇卫生院服务份额与相关因素的关系。结果:相较于2009年,2015年相关经济社会变量均大幅增长。2009年门诊份额与农村居民可支配收入正相关(r=0.39),与人均村医数量负相关(r=-0.39),2015年的相关无统计学意义;2009年住院服务份额与人均政府卫生投入和人均医院卫技人员数中度负相关(r=-0.58、-0.56),2015年则不再相关,与每千居民乡镇卫生院卫技人员数2009年不相关,2015年呈中度正相关。结论:新医改以来,乡镇卫生院门诊服务竞争力略有上升但住院竞争力明显下降,其服务竞争力和体系内上下游竞争者的关系以及与经济因素的关系均在减弱,转由人力资源和床位水平决定。要充分发挥乡镇卫生院的效能,关键是在界定服务功能基础上提升资源配置水。

Objective： To observe the evolution of township health centers（THCs） competitiveness during 2009-2015, explore the key factors of the change, and provide references for the development of township hospitals. Methods： Using provincial data from China health statistics yearbook to calculate the service share and changes in target population of THCs from 2009 to 2015, Pearson correlation coefficient was used to measure the relationship between service share and related factors in township hospitals. Results： Compared to 2009, the relevant economic and social variables had increased significantly in 2015. The share of outpatient service was positively correlated with per capita disposable income of rural inhabitants（r=-0.39）, and negatively correlated with the village doctors per 1 000 rural inhabitants（r=-0.39） in 2009. There was no statistical significance in 2015. The share of inpatient service was moderate negative correlated with per capita government health expenditure（r=-0.58） and per capita number of hospital staff（r=-0.56） in 2009. which was not relevant in 2015. THCs personnel per 1 000 rural inhabitants was not related with inpatient shares in 2009, hut was moderate positive correlative in 2015. Conclusion： Since the new medical reform, the competitiveness of outpatient service of township hospitals increased slightly, the competitiveness of hospitals declined significantly. The factors affecting THCs competitiveness showed great change, the competitive relationship with competitors and the economic factors in medical system were weakening. The competitiveness of THCs mainly depended in human resource and hardware. It needed to play the function of THCs, especially promote resource allocation level based on defining service function.