【作者】 高原；

【导师】 徐爱军；

【作者基本信息】 南京中医药大学 ， 社会医学与卫生事业管理， 2020， 硕士

【摘要】 目的:在资源同质性假设下,探讨江苏省妇幼人才队伍现状,掌握省内各市妇幼保健机构、卫生人才基本情况,深入分析妇幼卫生机构数量、机构性质、隶属关系和妇幼人才基于人口-地理维度公平性,以及各市妇幼人才紧缺性,并就分析结果提出建议,以提高妇幼卫生机构和人才动态科学化管理水平,满足妇幼人群卫生服务需求,实现妇幼卫生服务可及性,从而助力“健康中国”建设。方法:通过问卷调查,利用江苏省卫生健康委员会妇幼健康处信息系统收集数据,对各市妇幼卫生机构、儿科和妇产科执业(助理)医师进行研究。首先是利用描述性统计分析,了解江苏省各市妇幼卫生机构数量、机构性质、隶属关系、编制等情况和儿科、妇产科执业(助理)医师社会人口学特征、卫生服务能力;其次是利用HRDI模型、基尼系数-洛伦兹曲线和泰尔指数对各市公平性进行分析;最后利用需求预测模型测算标准工作量、实际工作量下需要的儿科、妇产科执业(助理)医师数需求数,与存量对比,统计出缺口数即为紧缺人数。结果:截至2018年年底,江苏省共有妇幼保健机构110家,全都隶属于同级卫生健康行政部门,67%(50家)机构是全员全额拨款事业单位;在队伍情况上,江苏省儿科执业(助理)医师有5728人,妇产科11794人,女性医师为主,年龄主要在34～54岁之间,多为本科学历,工作年限主要在20年以上,大多数是中级职称和执业医师;卫生服务能力方面,江苏省每千名14岁以下儿童儿科、每千名15～64岁妇女妇产科执业(助理)医师数为0.52人、0.40人,儿科、妇产科年门诊人次为3505.33万人次、3631.84万人次,年出院人数为103.19万人、141.86 万人。公平性分析显示,在人才资源密度上,江苏省儿科(0.0641)、妇产科(0.1326)人才整体发展水平良好;从基尼系数和洛伦兹曲线发现,江苏省妇幼人才配置较为公平,且按人口配置比按地理面积配置公平性更高,苏中地区比苏南、苏北公平性高;结合泰尔指数,在儿科方面,人才配置差异主要来自组内差异,且该差异主要是苏北地区;在妇产科方面,卫生人才按人口配置差异主要来自组间差异,该差异主要是苏南地区。紧缺性研究显示,江苏省儿科紧缺执业(助理)医师数为1.83万人左右,妇产科在2.59万人左右,各市儿科、妇产科紧缺医师数平均值约为1404人、1991人。紧缺数量较多的地区为苏州市、徐州市、南京市,较少的为泰州市、扬州市、镇江市。结论:在“全面二孩”政策背景下,江苏省妇幼人才按人口配置公平性较高但是区域间存在差异,妇幼人才紧缺,编制总量不足,薪酬待遇和卫生服务价格较低,医师职业满意度较低。为此在“江苏高质量发展”的新时代,建议江苏省应充分解放思想,实现区域人才规划的优化和新的妇幼机构编制标准及时更新;统筹改革薪酬制度和颁布人才引进等相关福利性政策,加强人才培养和引进;另外创新“互联网+医联体”协同管理模式,高效科学化妇幼人才管理方法,探索组建妇幼专科联盟,多举措,全方位探索有利于江苏省妇幼人才队伍发展的道路,继续夯实人才队伍建设,为健康江苏高质量发展保驾护航。更多还原

【Abstract】 Objective:The study explored the current situation of pediatricians and obstetricians based on the assumption of resource homogeneity,and grasped the situation of maternal and child health institutions and personnel in each city.Analyzed the number,nature and affiliation of maternal and child health institutions,in addition,demographic-geographic dimension fairness and shortage would be included.Finally,made suggestions on the analysis results to improve the dynamic and scientific management of maternal and child health institutions and talents,met the needs of health services for women and children,then achieved access to maternal and child health services to accelerate the construction of Healthy China.Methods:A questionnaire survey was used to collect data from the information system of the Maternal and Child Health Division of the Jiangsu Provincial Health Committee to conduct a study of practicing(assistant)physicians in maternal and child health institutions,pediatricians and obstetricians in various cities.The first was using descriptive statistics to know the number,nature,affiliation,establishment of maternal and child health institutions,besides,demographic characteristics and health service capability were also included.The second was to use HRDI model,Gini coefficient and Theil index to analyze the fairness of each city.Finally,the demand forecasting model was used to measure the number of pediatricians and obstetricians under the standard workload and the actual workload,and compared with the stock,the number of gaps was the shortage.Results:By the end of 2018,there were totally 110 maternal and child health institutions in Jiangsu Province,all of which belong to the same level of health and health administrative departments,67%(50)institutions are full-funded institutions;in terms of team status,Jiangsu Province Pediatric Practitioner(Assistant)Physician There are 5728 people,11794 in obstetrics and gynecology,mainly female physicians,mainly aged between 34 and 54 years old,mostly with a bachelor’s degree,working years are more than 20 years,most of them are intermediate titles and licensed physicians;health service capabilities In terms of pediatrics per thousand children under the age of 14,and obstetrics and gynecology practitioners(assistant)physicians per thousand women aged 15 to 64 in Jiangsu Province,there were 0.52 and 0.40,and there were 3,535,333 and 36,184,400 outpatient and pediatric,the number of discharged patients was 1.031,1.418 million.The fairness analysis showed that in terms of talent resource density,the overall development level of pediatricans(0.0641)and obstetricans(0.1326)in Jiangsu Province was good.According to the Gini coefficient and Lorentz curve,it found that the allocation of women and children in the province was fairer,and the distribution of population was more fair than the distribution of geographical area.Central part of Jiangsu was more fair than southern and northern,besides,combined with the Theil Index,in terms of pediatrics,the differences mainly came from intra-group,and the differences was mainly in the northern areas.In terms of obstetrics,the differences in the distribution of health personnel by population mainly came from the differences between groups,and the difference was mainly in southern Jiangsu.The shortage study showed that the number of pediatricians Jiangsu was 18,300,and the number of obstetrics was 25,900.The average number of doctors in shortage in each city was about 1,404 and 1,991.The regions with the most shortages were Suzhou,Xuzhou and Nanjing,while the lesser were Taizhou,Yangzhou and Zhenjiang.Conclusion:In the context of the"all-round two-child" policy,the distribution of pediatricians and obstetricians was fairly fair according to population,but there were differences between regions.There was a shortage of women and children,the total number of establishments was insufficient,salary and health services were cheaper,and job satisfaction was low.To this end,it was recommended to optimize the planning of regional health talents,formulate new standards for the establishment of women and children’s institutions,reform the salary system and promulgate talent introduction policies,also strengthen talent cultivation and introduction.In addition,using the "Internet&medical consortium" innovative talent management methods,exploring the establishment of a maternity and child specialist alliance,which would consolidate the construction of pediatricians and obstetricians,and promote the development of high-quality healthy Jiangsu.更多还原