基于健康地理视角的北京市怀柔区村级卫生资源配置研究

Allocation of village-level health resources in Huairou District of Beijing from the perspective of health geography

目的基于健康地理学视角,以卫生政策学为基础,分析北京市怀柔区农村自然地理和社会经济地理现状,研究村级卫生资源配置政策实施效果和存在问题,提出完善村级卫生资源配置政策的相关建议。方法2020年12月至2021年5月,基于文献研究,以信息饱和为原则,在村级卫生机构兜底调查基础上,通过典型案例分析、半结构访谈等方法,对北京市怀柔区的14个涉农乡镇进行卫生资源配置兜底调查;按照自然地理和社会经济地理分布,抽取3个乡镇的15个行政村开展关于村卫生室和乡村医生基本情况、基本医疗卫生服务情况、管理体制与运行机制等内容的实地观察和深入访谈。结果怀柔区的地理环境、人口变动和人口密度特征使村级卫生资源配置现状呈现政策协同性和监督性不足的现状,存在村级卫生机构分布不均衡的现实,乡村医生提供基本医疗服务与村民健康需求存在较大距离。结论实现村级卫生健康配置需要充分考量健康地理要素,通过政策统筹与分策,打破体制界限,以优化村级卫生机构布局为起点逐步优化村级卫生资源配置。

Objective To analyze the physical geography and social and economic geography of Huairou District,Beijing,from the perspective of health geography and based on the science of health policy,and study the implementation effects and existing problems of village-level health resource allocation policy based on household registration system and population number,then put forward relevant countermeasures.Methods From December 2020 to May 2021,14 rural townships in Huairou district of Beijing were investigated on the basis of literature review,on the basis of information saturation,through typical case analysis,semi-structured interview and other methods.According to the distribution of physical geography and social economic geography,15 administrative villages of 3 townships were selected to carry out field observation and in-depth interviews with key insiders on the basic information of village clinics and rural doctors,basic medical and health services,management system and operation mechanism.Results The characteristics of geographical environment,population change and population density of village-level health institutions in Huairou district made the current situation of village-level health resources allocation highlight the current situation of insufficient policy coordination and supervision,and showed the reality of unbalanced distribution of village-level health institutions.There was a big gap between the geographical distribution of villager health institutions and the allocation of health human resources and the health needs of villagers,and the current situation was worrying.The lack of analysis of health geographical factors in the policy formulation and implementation was an important factor.Conclusions To realize village-level health allocation,it is necessary to fully consider health geographic factors,break institutional boundaries through policy coordination and differentiation,and gradually optimize village-level health resource allocation starting from optimizing the layout of village-level health institutions.