新医改以来四川省乡镇卫生院卫生技术人员的发展趋势研究

目的 在新医改政策背景下，探讨乡镇卫生院卫生技术人员的发展趋势。方法 梳理新医改以来与乡镇卫生院卫生人力建设相关的政策，利用2008和2013年四川省卫生服务调查数据以及2017年的现场调查数据，3次调查均采用多阶段分层整群抽样的方式，样本量分别为295、424和220，结合国家和四川省卫生统计年鉴，采用单因素方差分析及广义线性模型来分析2008 - 2017年四川省乡镇卫生院卫生技术人员的基本情况和职业认知变化。结果 从2009年到2017年，四川省每千农村人口乡镇卫生院卫生技术人员数1.04增加到1.49，工作年限少于9年的比例从32.94%上升到54.96%，本科及以上学历的比例从2.76%上升到6.97%，初级职称占比从84.47%下降到80.73%，月收入在3 000元以上的比例从0.7%升高到73.6%；卫生技术人员感知到的工作压力变小，总满意度从2013年的33.22升高到35.90分，感知的医患关系较差且呈恶化趋势。结论 新医改以来发布的与乡镇卫生院人力建设相关的政策取得了一定成效，但目前四川省乡镇卫生院卫生技术人员整体水平依然较低，且影响了乡镇卫生院医疗服务质量的提升。

Development trends of heath technicians of township health centers in Sichuan province since the new health care reform

The aim of this study was to investigate the development trends of health technicians in township hospitals under the background of the new medical reform policy. Methods Study methods included reviewing the policies related to the health workforce development of township health centers since the new medical reform, using the data of the national health services surveys of Sichuan province in 2008 and 2013, and the field survey data of 2017. The three surveys all adopted the method of multi-stage stratified cluster sampling, with the sample size of 295, 424 and 220, respectively.Combined with the data of national and Sichuan provincial health statistics yearbook, this study analyzed the changes of the demographic characteristics and professional cognition of health workers in township health centers in Sichuan province from2008 to 2017 using single factor ANOVA and generalized linear model analysis. Results From 2009 to 2017, the number of health technical personnel in township hospitals per 1000 rural population in Sichuan province increased from 1.04 to 1.49,the proportion of working years less than 9 years increased from 32.94% to 54.96%, the proportion of bachelor degree and above increased from 2.76% to 6.97%, the proportion of junior professional title decreased from 84.47% to 80.73%, and the proportion of monthly income above 3000 yuan increased from 0.7% to 73.6%. Health technical personnel perceived an increased total satisfaction from 33.22 in 2013 to 35.90 in 2017. The perceived doctor-patient relationship was worsened.Conclusion The policy on rural health workforce development since the new health care reform achieved certain results, but the overall quality of health workforce was still low, which affected the improvement of the quality of medical services in township health centers.