中国六省国家基本公共卫生服务项目中乡村医生工作量评估模型

Model to assess workload of village doctors in the National Essential Public Health Services Program in six provinces of China.

作者信息

Yin Delu, Yin Tao, Yang Huiming, Wang Lihong, Chen Bowen

机构信息

Capital Institute of Pediatrics, 2 YaBao Road, #330, ChaoYang District, Beijing, 100020, China.

Community Health Association of China, 2 YaBao Road, #330, ChaoYang District, Beijing, 100020, China.

出版信息

BMC Health Serv Res. 2020 Dec 9;20(1):1134. doi: 10.1186/s12913-020-05992-y.

DOI:10.1186/s12913-020-05992-y

PMID:33298047

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7727222/

Abstract

BACKGROUND

No studies, particularly quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. In this study, we developed a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. We aimed to identify areas and services of the NEPHS needing improvement, so as to implement targeted measures to ensure adequate delivery of NEPHSs in rural remote underserved areas.

METHODS

Based on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors' share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service.

RESULTS

Village doctors' share of the workload under the NEPHS program was 43.71% across the 300 sampled THCs in six provinces. The village doctors' workload shares for different NEPHS ranged from 17.14 to 57.00%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%.

CONCLUSIONS

The total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government's requirement of 40%, but the workload proportion in some provinces was less than 40%. In addition, the percentage workload for some NEPHS undertaken by village doctors was lower than others. We suggest conducting district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify areas and services needing improvement, to implement targeted measures to expand and promote health service provision in China's rural underserved areas.

摘要

背景

尚未有研究，尤其是定量分析，针对国家基本公共卫生服务（NEPHS）项目中村医的工作量以及村医在服务提供方面因地区和服务内容不同而存在的差异展开。在本研究中，我们开发了一种定量分析方法，以衡量2016年中国六个省份村医提供的国家基本公共卫生服务工作量。我们旨在确定国家基本公共卫生服务中需要改进的领域和服务，以便实施针对性措施，确保在农村偏远服务不足地区充分提供国家基本公共卫生服务。

方法

基于来自六个选定省份60个县的300个乡镇卫生院中心（THC）的调查数据，我们使用等效值（EV）模型计算村医在国家基本公共卫生服务中的工作量占比。为确定每项国家基本公共卫生服务的工作量及相应的等效值，与乡镇卫生院中心管理人员、公共卫生工作者、家庭医生、护士和村医举行了一系列五次会议。进行实地观察以核实每项服务的工作量和等效值。

结果

在六个省份的300个抽样乡镇卫生院中心中，村医在国家基本公共卫生服务项目中的工作量占比为43.71%。村医在不同国家基本公共卫生服务中的工作量占比在17.14%至57.00%之间。村医在国家基本公共卫生服务项目下承担的工作量百分比在不同省份有所不同，最高比例为63.4%，最低为28.5%。

结论

六个抽样省份的乡镇卫生院中心分配给村医的国家基本公共卫生服务总工作量超过了中国政府规定的40%，但部分省份的工作量占比低于40%。此外，村医承担的部分国家基本公共卫生服务的工作量百分比低于其他服务。我们建议使用等效值方法对国家基本公共卫生服务项目中村医的工作量进行县级分析，以确定需要改进的领域和服务，实施针对性措施，扩大并促进中国农村服务不足地区的卫生服务提供。