新医改形势下乡村医生发展研究

Rural doctors are bottom of the three-tier rural health care network in China and play an indispensable role in meeting basic health demands of rural residents. In the context of new countryside construction and new medical and healthcare reform, health practitioners at grassroots level have been posed higher requirements. However, it is generally accepted that this health staff has been confronted with a series of problems, such as weak service capacity, staff aging and instability. The gap between higher requirements and alarming facts thus contributes a serious impediment to the progress of new health reform in rural. How to stabilize the staff, optimize the composition and enhance service capacity of rural doctors is an urgent issue in health policy research field. This study will introduce competence theory and relative deprivation theory to explore the issue. We will apply mixed methodology combining qualitative and quantitative approaches and follow the logic path of situation review--development of competence model--discrimination of current status--analysis of gap between ideal and practical conditions--introduction of development path. This study aims to develop competence model of rural doctors according to their working functions in new circumstances, to describe the occupational status and the gap between ideal and practical conditions and then explore its cause and mechanism, to identify key events that affect the occupation development of rural doctors, and to put forward the development path and corresponding countermeasures on how to enhance the sustainable development of rural doctors from occupational settings, professional capacity and resources. The study will provide references for policy-making about rural health staff, and has both theoretical and practical implications for implementing the strategic initiatives of safeguarding basic demands, enhancing grassroots construction and creating a sound mechanism.

乡村医生是农村三级卫生服务网的网底，在维护广大农村居民健康方面发挥着难以替代的作用。但目前乡村医生队伍存在整体服务能力不足、队伍老化、心态不稳等问题，这与新农村建设和新医改双重背景下对乡村医生素质能力的更高要求形成了突出矛盾。因此，如何稳定和优化乡村医生队伍、提升其服务能力是亟需解决的问题。本研究以此为出发点，引入胜任力、相对剥夺等理论，以背景分析-胜任力模型构建-现状调查-现实与理想差距分析-提出发展路径为研究思路，采用定性与定量相结合的方法，明晰新形势下乡村医生的职能定位，构建胜任力模型；综合描述其生存发展现状并进行差距分析，探讨差距产生的原因与作用机制；锁定影响乡村医生发展的关键事件，从职业环境、职业能力和资源供给等角度提出乡村医生可持续发展的路径与策略；本研究将为国家完善乡村医生发展政策提供决策参考，对贯彻落实"保基本、强基层、建机制"的新医改战略目标具有重要理论与现实意义。

针对新形势下乡村医生发展的研究主题，本研究遵循背景分析—胜任力模型构建—现状调查—理想与现实差距分析—发展策略研制的研究思路，采用定性与定量相结合的方法，系统解析新医改和新农村建设双重背景下乡村医生的服务功能定位，并结合农村居民的卫生服务需求，构建乡村医生胜任力模型，明确发展目标，从环境、村卫生室建设、岗位胜任力、执业心态与激励约束机制、培训与开发等角度，对乡村医生发展的现状、问题及策略进行系统深入的研究。. 本研究创新性的引入“岗位胜任力”、“相对剥夺”、“脆弱性”、“相对能力”“柯氏模型”等理论以及系统动力学、DEMATEL、集对分析、情景分析等方法，通过理论框架与方法学的系统严密与创新性设计，保障了研究的深度与科学性。. 课题组研究发现：1、当前乡村医生整体相对胜任力水平测量值为0.9757，尚需进一步提升，不同乡村医生胜任力水平存在差距，不同胜任特征对整体胜任力系统作用差异明显；2、乡村医生普遍存在强烈的横向相对剥夺感与明显的纵向相对剥夺感；3、对激励措施总体表示不满意的乡村医生占多数，有7项激励措施的村医偏好得分较高但其满意度较低，需优先进行改善，目前存在4个方面的激励困境需破解；4、乡村医生对培训的普遍反应为“较好”，但在具体的培训过程中尚存在一系列问题需要解决。5、乡村医生的脆弱性是在面临的扰动和具备的应对力共同作用下，四类互动效应综合作用的结果。乡村医生总体脆弱性水平处于可接受范围内，但“危机”型、“风险”型脆弱性比例较大，前景不容乐观。针对上述发现，课题组进行了具备可操作性与可持续性的发展策略的研制。. 课题已发表北大核心期刊论文42篇，ISTP收录的英文论文2篇，会议论文15篇，在日本HTAi2016国际大会等国内外重要学术会议作报告和墙报展示16次，获各类奖项15项，课题培养博士1名，硕士7名。研究产出引起山东省卫计委和多地卫计委的广泛重视并得到一定程度的应用。