乡村振兴背景下西部地区乡镇卫生院的发展状况及发展对策

Development state and countermeasure of township health centers in Western China in the context of strategy for rural revitalization

目的分析西部地区乡镇卫生院的发展状况,探讨在乡村振兴背景下乡镇卫生院的发展对策。方法收集2011~2020年西部地区的乡镇级行政区划数量,乡村人口数,乡镇卫生院数量,以及乡镇卫生院的执业(助理)医生数、注册护士数、医护比、诊疗人次、入院人数、医师日均负担诊疗人次、床护比、病床使用率、平均住院日等数据。运用Microsoft Excel 2010软件对数据进行描述性分析,计算上述指标的年均增速。采用Spearman秩相关检验分析乡镇卫生院数与乡镇级行政区划数量,以及乡镇卫生院的诊疗人次、入院人数与乡村人口数的相关性。结果(1)2011~2020年,西部地区仅有西藏、青海和新疆3个省(自治区)的乡镇卫生院数量年均增速呈正增长,西部地区乡镇卫生院数量年均增速低于中部地区和全国水平;西部地区各省(自治区、直辖市)乡镇卫生院数量与乡镇级行政区划数量呈正相关(P<0.05)。(2)相较于2011年,2020年西部地区各省(自治区、直辖市)乡镇卫生院的执业(助理)医生数和注册护士数均增多,且总体年均增速高于东部地区、中部地区和全国水平;除青海和新疆外,其余西部地区各省(自治区、直辖市)乡镇卫生院的注册护士数年均增速均高于执业(助理)医生数年均增速。(3)2011年,西部地区乡镇卫生院的医护比与东部地区、中部地区和全国水平相近;2020年,西部地区乡镇卫生院的医护比达到0.91,高于东部地区、中部地区和全国水平,但仅有广西、云南和陕西3个省(自治区)的乡镇卫生院医护比超过1。(4)2011~2019年,除内蒙古、重庆、甘肃、青海外,西部地区其余省(自治区)乡镇卫生院的诊疗人次均呈正增长,除内蒙古、贵州、西藏、青海、宁夏外,西部地区其余省(自治区、直辖市)乡镇卫生院的入院人数均呈正增长。诊疗人次年均增速和入院人数年均增速均与乡村人口数年均增速无相关性(均P>0.05)。(5)2019年,西部地区乡镇卫生院医师日均负担诊疗人次高于东部地区、中部地区和全国水平;床护比低于东部地区和全国水平,但年均增速高于东部地区、中部地区和全国水平;病床使用率高于东部地区、中部地区和全国水平;平均住院日少于东部地区、中部地区和全国水平,但年均增速高于东部地区、中部地区和全国水平。结论2011~2020年,西部地区乡镇卫生院数量呈下降趋势,虽然乡镇卫生院医生和护士人才队伍发展趋势向好,但仍存在医护比偏低、人才流失等问题。在乡村振兴背景下,应该凸显乡镇卫生院在农村医疗建设中的枢纽地位,发挥医共体职能,促进优质医疗资源下移,推进分级诊疗制度,提高乡镇卫生院的医疗服务能力,让更多的农村居民愿意留在基层医院就医。

Objective To analyze the development state of township health centers in Western China,and to explore the countermeasure for development of township health centers in the context of strategy for rural revitalization.Methods The data of number of administrative divisions at township level,rural population,number of township health centers,as well as number of certified(assistant)doctors,number of registered nurses,ratio of doctors to nurses,diagnostic and therapeutic person-time,number of inpatients,person-time of doctors daily average burden of diagnosis and treatment,ratio of bed to nurses,rate of bed utilization,and average length of hospital stay,etc.in the Western from 2011 to 2020 were collected.The Microsoft Excel 2010 software was used for descriptive analysis of the data,and the average annual growth speed of the above indicators was calculated.The Spearman rank correlation was used to analyze the correlation of number of township health centers with number of administrative divisions at township level,and of diagnostic and therapeutic person-time and number of inpatients of township health centers with rural population.Results(1)From 2011 to 2020,only three provinces(autonomous region)in the Western with respect to Tibet,Qinghai and Xinjiang presented a positive increase of the township health centers number.The average annual growth speed of the township health centers number in the Western was lower than that in the central region and nation-wide levels;in addition,there was a positive correlation between the number of township health centers and the number of administrative divisions at township level in various provinces(autonomous regions,municipalities)in the Western(all P<0.05).(2)Compared with 2011,the number of certified(assistant)doctors and registered nurses in township health centers of various provinces(autonomous regions,municipalities)in the Western increased in 2020,and the overall average annual growth speed was higher than that in the Eastern,central region and nation-wide levels.Except for Qinghai and Xinjiang,the average annual growth speed of registered nurses number of township health centers in the remaining provinces(autonomous regions,municipalities)in the Western was higher than that of the average annual growth speed of certified(assistant)doctors.(3)In 2011,the ratio of doctors to nurses of township health centers in the Western was similar to the Eastern,central region and nation-wide levels.In 2020,the ratio of doctors to nurses of township health centers in the Western reached 0.91,which was higher than that in the Eastern,central region and nation-wide levels;however,only three provinces(autonomous regions),namely Guangxi,Yunnan and Shaanxi,exhibited a ratio of doctors to nurses of more than 1.(4)From 2011 to 2019,except for Inner Mongolia,Chongqing,Gansu and Qinghai,the diagnostic and therapeutic person-time of township health centers of the remaining provinces(autonomous regions)in Western depicted a positive growth.Except for Inner Mongolia,Guizhou,Tibet,Qinghai and Ningxia,the number of inpatients of township health centers in the remaining provinces(autonomous regions,municipalities)exhibited a positive growth.There was no correlation of the average annual growth speed of diagnostic and therapeutic person-time and inpatients number with the average annual growth speed of rural population(all P>0.05).(5)In 2019,the person-time of doctors daily average burden of diagnosis and treatment at township health centers in the Western was higher than that in the Eastern,central region and nation-wide levels.The ratio of beds to nurses was lower in the Western than that in the Eastern and nation-wide levels;however,the average annual growth speed was higher than that in the Eastern,central region and nation-wide levels.The rate of bed utilization was higher in the Western than in the Eastern,central region and nation-wide levels.The average length of hospital stay was less than that in the Eastern,central region and nation-wide levels;however,the average annual growth speed was higher than that in the Eastern,central region and nation-wide levels.Conclusion From 2011 to 2020,the number of township health centers in the Western interprets a downward trend.Although the development trend of doctors and nurses in township health centers was improving,there are still problems concerning low ratio of doctors to nurses and brain drain,etc.In the context of strategy for rural revitalization,it is necessary to highlight the pivotal position of township health centers in rural medical construction,give full play to the functions of medical alliances,promote the downward shift of high-quality medical resources,promote the hierarchical medical system,and improve the medical service capacity of township health centers,so that more rural residents are willing to stay at primary hospitals for medical treatment.