公立医院卫生技术人员医改获得感评价研究

Evaluation and analysis of health technical personnel′s sense of gain for the healthcare reform of public hospitals

目的评价公立医院卫生技术人员在医改中的获得感,并提出相关政策建议。方法以中部地区某省份为例,于2018年8—9月对12家公立医院的卫生技术人员开展现场问卷调查,共计发放问卷900份,其中有效问卷886份。根据问卷指标构建医改获得感分析评价框架,运用Mann-Whitney U检验与χ2检验比较不同机构、专业的卫生技术人员医改获得感的差异,运用二分类多因素logistic回归分析卫生技术人员对医改认可度的影响因素。结果县级市较地级市公立医院的卫生技术人员工作负担更重,对工作满意度、所在单位薪酬制度满意度、管理层满意度评价较低(P<0.05);临床医生工作负担相较其他两类人员更重、其收入受政策的影响更大,护理人员在工作满意度、医改认可度方面高于其他两类人员;对管理层的满意度是影响医改认可度的最重要因素。结论公立医院卫生技术人员医改获得感整体有所提升,县级市公立医院医改获得感较地级市低。建议以人事管理制度改革为抓手、以薪酬制度改革为关键、以医疗服务环境改善为保障,进一步推动改革进程。

Objective To evaluate the sense of gain of health technical personnel of public hospitals for the healthcare reform,and to put forward relevant policy recommendations.Methods Taking a province in central China as an example,a questionnaire survey was conducted from August to September 2018,on the health technical personnel in 12 public hospitals.900 questionnaires were distributed,among which 886 were effective.According to the indexes of the questionnaire,this paper constructed the framework of analysis and evaluation of the sense of gain for the healthcare reform by these personnel.The sense of gain of health technical personnel in different institutions and specialties was descriptively analyzed using Mann-Whitney U test and chi square test.Two-class multivariate logistic regression was used to analyze the influencing factors of health technical personnel′s recognition for the healthcare reform.Results Compared with the public hospitals at prefecture level,the health technical personnel in county-level cities shoulder heavier work burden,and their satisfaction evaluation of work,compensation system and management was relatively lower(P<0.05).Medical staff had a heavier workload and their income was affected by the policy to a greater extent.Nursing staff′s job satisfaction and their recognition of the healthcare reform was higher.The satisfaction of the management was the most important factor that affects the recognition of the healthcare reform.Conclusions Health technical personnel in public hospitals had a higher sense of gain for the healthcare reform,while that of county-level public hospitals was lower.It was suggested that the reform should prioritize personnel management system,emphasize the compensation system,and ensure the improvement of medical service environment so as to further promote the reform process.