Key Laboratory of Public Health Safety, Ministry of Education (Fudan University), Shanghai, China.
BMC Health Serv Res. 2013 Apr 12;13:136. doi: 10.1186/1472-6963-13-136.
Township-village health centers in rural areas play an important role in health service system in China. In East China's Jiangsu Province, the City of Haimen privatized all 25 township-village health centers in 2002. This study assesses the effect of privatization on staff retention among these health centers.
This is a retrospective study based on 10-year administrative data from Haimen City. Three waves of administrative data were collected in 2000 (2 years before privatization), 2005 (3 years after privatization) and 2009 (7 years after privatization) for all health care providers in Haimen City, including 3 county hospitals, 6 central township health centers (CTHC) and 25 township-village health centers (TVHC). The effect of privatization on TVHCs' staff retention was evaluated in comparison with the other two types of health care providers. We conducted focus groups with people from Haimen Bureau of Health and various health care providers to help understand the context of these administrative statistics.
Each township-village health centers had an average of 40 staff members before the privatization, and the majority of those staff members were their permanent staff. In 2005, three years after the privatization, a substantial amount of staff decrease (from 39.7 staff members per TVHC to 27.5 per TVHC) occurred in these township-village health centers. From 2000 to 2009, the total payroll in TVHCs decreased by almost 29%, while the number of their permanent staff members and nurses decreased by more than 40%. Among the two types of health care providers that did not go through a privatization, those central township health centers had no significant change on their payroll size during this period whereas the county hospitals' average payroll size actually increased by 20%, especially for the number of doctors. In addition, the average salary and caseload in TVHC showed similar decreasing trends from 2000 to 2009, while no such trends can be observed among the other two types of providers that did not undergo privatization.
The privatization of township-village health center could have adverse effects on their staff retention, a phenomenon that occurs with a decrease in salary and caseload in these centers. To ensure that these health institutions keep providing health care for rural communities, a stronger social safety net and stronger financing of rural health insurance might be helpful in their staff retention.
乡镇卫生院在中国农村卫生服务体系中发挥着重要作用。在中国东部的江苏省，海门市于 2002 年将所有 25 家乡镇卫生院私有化。本研究评估了私有化对这些卫生中心员工保留率的影响。
这是一项基于海门市 10 年行政数据的回顾性研究。在私有化前 2 年（2000 年）、私有化后 3 年（2005 年）和私有化后 7 年（2009 年），从海门市所有医疗机构（包括 3 家县级医院、6 家中等乡镇卫生院和 25 家乡镇卫生院）中收集了三波行政数据。与其他两种类型的医疗机构相比，评估了私有化对乡镇卫生院员工保留率的影响。我们与海门市卫生局和各种医疗机构的人员进行了焦点小组讨论，以帮助了解这些行政统计数据的背景。
私有化前，每个乡镇卫生院平均有 40 名员工，其中大多数为正式员工。2005 年，即私有化三年后，这些乡镇卫生院的员工数量大幅减少（从每个乡镇卫生院 39.7 名员工减少到 27.5 名）。从 2000 年到 2009 年，乡镇卫生院的总薪酬减少了近 29%，而正式员工和护士的数量减少了 40%以上。在没有经历私有化的两种类型的医疗机构中，这些中等乡镇卫生院在此期间的薪酬规模没有明显变化，而县级医院的平均薪酬规模实际上增加了 20%，尤其是医生人数。此外，从 2000 年到 2009 年，乡镇卫生院的平均工资和工作量呈类似的下降趋势，而在没有经历私有化的另外两种类型的医疗机构中，没有观察到这种趋势。
乡镇卫生院私有化可能对其员工保留率产生不利影响，这种现象伴随着这些中心工资和工作量的减少。为了确保这些卫生机构继续为农村社区提供医疗服务，加强社会保障网和农村医疗保险的筹资可能有助于留住员工。
