山西省乡村医生现状分析

本研究源于世界银行贷款《中国农村卫生人力开发》项目。对山西省翼城和汾阳两县的基线调查数据分析表明：乡村医生年龄偏大,结构不合理;男女乡医比例失调,女乡医严重不足;乡村医生素质低,文化程度以初中为主,专业程度以短期培训为主,乡村医生报酬主要依靠业务投入,而业务收入的90％是药品收入。由于报酬结构不合理,乡村医生的行医行为发生扭曲,农民看病经济负担加重,造成有限卫生资源的浪费。因此,合理的报酬结构是提高乡村医生医疗保健服务质量的重要保证。建议对乡村医生实行“工资加奖金”的报酬模式,按乡村医生的技术职务、医龄、岗位工作效率等实行有层次的结构工资制,以医疗预防保健工作质量作为分发奖金的依据。最终建立以调整乡村医生报酬结构、保证基本报酬和调控激励报酬的干预措施,使乡村医生的行医行为由单纯医疗型逐步向医疗预防保健型转变。

ANALYSIS OF VILLAGE DOCTOR IN SHANXI PROVINCE

The analysis of data shows that the distribution of village doctors' age is unreasonable, the sex ratio is unbalance that the women doctors are much less than men doctors. The diathesis of village doctors is low,most of them graduated from junior middle school. They are payed most by medical service, 90 per come from drug sale. The structure of remuneration is unreasonable, it distort doctors' medical behavior, burden the countrymen with medical costs, and result in much waste of health resource. So a remuneration mode of"laborage and bonus" is suggested. Pay the village doctors based on their technic office, their years of medical work, and their work efficiency. A prevent measure could be established to gradual transform simple medical type of practicing medicine to preventive care type in the way of village doctors.