卫生人力需求量预测研究综述

卫生人力是指受过不同卫生职业培训,能够根据居民的健康需求提供卫生服务,为卫生事业发展贡献自己的才能和智慧的人员的总称。卫生人力资源是反映一个国家卫生服务水平的重要标志,也是改善人民身体素质的卫生资源中的基本因索。卫生人力的培养具有周期长、专业性强的特点,要适应社会经济对卫生的需求,必须制定科学、合理的卫生人力规划和政策。卫生人力规划是指为实现预定卫生目标,改善健康水平,估计需要卫生人员的数量和种类的过程。而卫生人力需要地预测是卫生人力规划中最重要最复杂的方面之一。做好卫生人力预测工作,将为我国各级卫生部门制订中长期卫生人力发展规划提供重要的参考意见。现将近年来卫生人力需求址预测研究方法、研究成果以及需要考虑问题作一简单回顾。     

扩大医院自主权对卫生人力培训与发展的影响

目的；探讨扩大医院自主权对卫生人力培训发展的影响，从中吸取经验和教训。方法：采取定量与定性调查相结合，定量资料来源于县，乡两级医疗保健机构1987－2000年工作记录与报表；定性调查采取了召开专题小组讨论会，知情者访谈两种方式。结果：放权后领导观念变化，医务人员进修培训的积极性提高，培训数量增加；卫生人力结构优化，且知识和技术水平相应提高。结论：卫生服务管理权下放有利于卫生 的培训与发展，但在贫困地区的乡镇卫生院由于资金紧缺，在扩大自主权的同时，政府还应辅以必要的前期人员培训经费。对培训造成的人才流失等负面影响，应通过制定政策，对预期亏损建立补偿机制，由受益单位与个人共同分担。     

江苏盐城基层卫生人员卫生人力政策认知及满意度分析

目的了解江苏省盐城市大丰、东台和滨海3县基层卫生人员对卫生人力政策的认知情况及满意度,探究其影响因素,以期为当地基层卫生队伍建设和国家及省内卫生人力政策的推行提供参考意见。方法以盐城市经济发展水平(人均GDP)为标准,抽取经济较好的、一般和较差的县各1个作为样本县(依次分别为大丰县、东台市和滨海县),调查12家乡镇卫生院和17家村卫生室,共计443名卫生人员为调查对象进行问卷调查。所得数据采用SPSSS 16.0进行χ~2检验。结果对国家及省内的卫生人力资源的了解程度方面,54.3%的卫生人员不了解,仅有5.8%的卫生人员表示了解相关政策。调查人群中,仅4.7%的卫生人员对当前农村的卫生人力资源政策表示满意,而45.6%认为一般,49.7%的卫生人员表示不满意。结论基层卫生人员对国家及省内卫生人力资源政策了解率过低,政府卫生人力政策实施亟待提高;基层卫生人员对当前农村卫生人力资源满意度很低。     

对我市乡村两级卫生人力配置及培训的思考

在对该市卫生人力进行调查的基础上,对乡、村两级卫生人力配置和培训进行探讨。提出要建立健全乡、村卫生人员管理机制,合理配置和有效利用卫生人力资源;完善卫生人员岗位培训和考评制度,提高在职人员素质;卫生人力资源管理和人员培训必须同卫生工作有机结合,统筹规划,综合运作,增强协同性。     

美国卫生人力研究现状

卫生人力研究约起始于本世纪30年代,70年代以来受到全球普遍关注。美国是世界较早进行卫生人力研究的国家之一,近十余年来,进行了相当规模的而且较系统和细微的研究,美国卫生与人类服务部每年都向总统和国会提交有关卫生人力现状和预测的报告。本文据1988年出版的美国卫生人力研究报告,着重介绍他们的卫生人力现状、特点、存在问题、研究方法及模式、影响卫生人力的因素,以及预测结果和在卫生人力方面的不同观点。     

卫生人力开发与卫生系统协调

卫生人力开发与卫生系统协调冯玲芳，龚幼龙（上海医科大学２０００３２）卫生人力是指为了改善人群健康目的，参与提供医疗、预防、卫生保健的人员，卫生人力不论是否接受过正规训练，在卫生系统内工作，是否通过服务接受报酬，只要从事和改善健康状况有关的工作，均应列...     

基本卫生人力政策研究

医疗卫生是知识密集型行业,当前在世界各地都出现了卫生人力危机。目前,我国基本卫生人力资源存在着数量不足、素质不高、结构不合理及配置不平衡等问题,这些问题是普及基本卫生服务的主要障碍。要实现中国卫生改革与发展蓝图,就要建设一支道德高尚、素质优良、规模适当并且结构合理的卫生人才队伍,为全体人民提供安全有效、技术适宜和方便快捷的基本卫生服务。基本卫生人力发展政策应该与国民经济发展、卫生事业发展相协调,以满足全体人民基本卫生服务需要为目标,按照基本卫生服务均等化原则,增加基本卫生人力数量、提高基本卫生人力素质以及调整卫生人力结构和布局。     

我国基层卫生人力配置公平性研究： 基于基尼系数和泰尔指数分析*

目的对2012—2017年我国基层卫生人力的配置公平性进行分析,为加强基层卫生人力资源尤其是全科医生配置提供一定参考。方法综合运用统计性描述、基尼系数和泰尔指数等方法对我国基层卫生技术人员和全科医生的资源配置进行分析。结果基层卫生人员、全科医生数量和质量均有所改善,但依然有待提升;基层卫生人员配置公平性较好,全科医生地区间配置公平性相对较差,但差距逐步减小,经济发展水平与其公平性配置具有较大关系。建议政府应持续加大全科医生培养力度,进一步拓展和落实基层卫生人员尤其是全科医生的职业发展路径,提升职业吸引力;注重对基层骨干人员和经济发展水平相对较低地区全科医生的激励机制。     

The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence

The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting-out, which could be either positive or negative. Although the study results leave open the question of how contracting-out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success.     

如何制订农村初级卫生保健技术岗位培训的计划

农村初级卫生保健技术人员的素质不高严重影响到初级卫生保健工作的水平.要提高农村初级卫生保健工作的水平必须从源头抓起,即:开展初级卫生保健技术岗位培训.制订切实有效的培训计划是做好培训工作的关键环节.该文就制订培训计划应该遵循的基本原则和制订培训计划的步骤、方法作一探讨,旨在规范初级卫生保健技术岗位培训和提高培训效果,使有限的培训资源发挥更大的培训效用,进而提高农民卫生服务的质量和水平.     

New Zealand rural primary health care workforce in 2005: more than just a doctor shortage

OBJECTIVE: To obtain a 2005 snapshot of New Zealand (NZ) rural primary health care workforce, specifically GPs, general practice nurses and community pharmacists. DESIGN: Postal questionnaires, November 2005. SETTING: NZ-wide rural general practices and community pharmacies. PARTICIPANTS: Rural general practice managers, GPs, nurses, community pharmacy managers and pharmacists. MAIN OUTCOME MEASURES: Self-reported data: demographics, country of training, years in practice, business ownership, hours worked including on-call, intention to leave rural practice. RESULTS: General practices: response rate 95% (206/217); 70% GP-owned, practice size ranged from one GP/one nurse to 12 GPs/nine nurses. PHARMACIES: Response rate 90% (147/163). Majority had one (33%) or two (32%) pharmacists; <10% had more than three pharmacists. GPs: response rate 64% (358/559), 71% male, 73% aged >40, 61% full-time, 79% provide on-call, 57% overseas-trained, 78% male and 57% female GPs aged >40; more full-time male GPs (76%) than female (37%) . Nurses: response rate 65% (445/685), 97% female, 72% aged >40, 31% full-time, 28% provide on-call, 84% NZ-trained, 45% consulted independently in 'nurse-clinics' within practice setting. Pharmacists: response rate 96% (248/258), 52% male, 66% aged >40, 71% full-time, 33% provide on-call, 92% NZ-trained, 55% sole/partner pharmacy owners. Many intend to leave NZ rural practice within 5 years: GPs (34%), nurses (25%) and pharmacists (47%). CONCLUSION: This is the first NZ-wide rural workforce survey to include a range of rural primary health care providers (GPs, nurses and pharmacists). Ageing rural primary health care workforce and intentions to leave herald worsening workforce shortages.     

The role of the schools of public health in the development of primary health care

Starting with the assumption that the schools of public health can and should be major promoters of primary health care but that they have not fully utilized their potential, the paper reviews the different interpretations of primary health care and their implications for the recruitment policies, educational objectives, teaching methods and research orientation of the schools. Four interpretations (primary health care as a set of activities; as a level of care; as a strategy of organizing health services; and as a philosophy permeating the entire health care system) are identified. It is suggested that most industrialized countries already have a primary medical care system which has to be transformed into primary health care. A blueprint for this transformation is outlined. Many of the changes included in the blueprint are related to the concept of primary health care as a strategy. Schools of public health can play a major role in implementing the necessary strategic changes and in training their implementers. The training of actual primary care providers for leadership; increased emphasis on management in the curricula; and reorientation of research towards primary health care are underlined as particularly important elements in the new role of the schools of public health.     

Community pharmacy in Ghana: enhancing the contribution to primary health care

It is widely believed that pharmacists could make a greater contribution to the provision of primary health care, especially in developing countries. Particular strengths of pharmacy services commonly cited include their accessibility within many communities and the opportunities for advising on the management of health problems. The potential for pharmacy to respond to health care needs and contribute to specific health policy objectives is receiving greater prominence both internationally and in individual countries. However, despite this widely acknowledged potential, developments have been limited. Pharmacy is concerned with promoting the safe and appropriate use of drugs. Drug use in developing countries has frequently been described as irrational. It is influenced by a wide range of factors, including health and drugs policy, the organization and provision of health care, the availability of objective information, and health beliefs and cultural perspectives regarding health and drug therapy. The practices of pharmacy retailers, which are conducted in the context of wider structures and processes of health care provision, have also been questioned. The aim of this paper is to consider possible directions for community pharmacy service development in Ghana. The paper draws on the literature relating to health care, drug use and pharmacy in Ghana to describe the background against which pharmacy services operate. In the context of current directions in pharmacy practice and policy, potential opportunities and barriers regarding the development of services are then addressed.     

Preparing the workforce for integrated healthcare: A systematic review

Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.     

The next phase of Title VII funding for training primary care physicians for America's health care needs

Health care reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training. Title VII, Section 747 of the Public Health Service Act previously supported the growth of the health care workforce but has been severely cut over the past 2 decades. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. To accomplish these goals, Congress should act on the Council on Graduate Medical Education's recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk.