基层和公共卫生人员工作偏好研究

目的：通过分析当前基层和公共卫生人员工作偏好,为建立合理的基层卫生激励机制提供依据。方法：基于离散选择实验的方法,利用条件Logistic回归进行分析。结果：所有纳入分析的工作属性都具有统计学意义,基层和公共卫生人员在做出工作选择时,不仅考虑收入,还会考虑其他非经济因素,如工作条件、职业发展机会等。收入提高是当前基层和公共卫生人员最重要的偏好。结论：为了留住和吸引卫生人员在基层工作,政策制定者需要切实改善基层和公共卫生人员的工资待遇,同时采取其它非经济激励措施,提高他们的工作积极性。     

基层和公共卫生人员工作行为影响因素分析

目的：分析我国城乡基层和公共卫生人员工作行为影响因素,为建立合理有效的基层和公共卫生人员激励机制提供依据。方法：对样本村卫生室、乡镇卫生院、县疾病预防与控制机构、社区卫生服务机构所有在岗医生、护士、公共卫生人员进行问卷调查,共调查1020名城乡基层卫生人员。结果：基层和公共卫生人员除了看重经济收入和福利等经济激励因素外,对工作条件、职业发展状况、群众的认可和尊重等非经济激励因素也非常重视。不同属性的基层和公共卫生人员具有不同的行为影响因素偏好。结论：在保证基层和公共卫生人员收入和福利改善的基础上,重视提供良好的工作环境和职业发展平台,并且加强执业保护和医德建设。     

农村基层卫生人员对激励因素偏好及影响因素分析

目的 探讨乡镇卫生院和村卫生室人员对各种激励因素的偏好程度及其相关因素.方法 选择经济发展水平不同的2个农村县,共调查乡镇卫生院人员213人,村卫生室工作人员251人,利用自编问卷进行激励因素偏好及影响因素调查.结果 2县乡镇卫生院和村卫生室人员对各类激励因素的偏好程度不同,对物质条件的偏好程度最高(物质条件因子均数为4.10),对管理和发展的需求水平次之(3.87),对社会环境的偏好程度最低(3.52);多元线性回归分析结果表明,农村基层卫生人员的工作地区、年龄、性别和学历水平影响其对物质条件、管理和发展、社会环境的偏好程度.结论 能满足农村基层人员对物质条件需求的经济激励机制是提高他们工作绩效的有效手段,非经济激励制度可满足农村卫生人员对个人发展、良好管理或社会环境的偏好,其激励作用不容忽视.     

西部地区医务人员工作满意度因子分析

目的:了解西部地区医务人员对工作的满意度,探讨影响西部地区医务人员工作满意度关键因素,为制定中国西部地区基层卫生工作人员的激励机制提供一定的参考依据.方法:利用WHO项目“中国西部贫困地区卫生工作人员激励机制研究”在宁夏、内蒙古、陕西三个省份的课题调研数据,采用因子分析法对医务人员的工作满意度进行研究,寻找对西部地区医务人员工作满意度的主要影响因素.结果:月薪、津贴、保险、工作量的大小、在岗培训、事业的发展机会、人际关系是影响工作满意度的主要因素.结论:卫生管理部门在提高医务工作人员工作满意度时,应向上述5方面倾斜,制定有效的激励措施提高基层医务人员的工作积极性及满意度.     

山东省地市级疾控人员工作偏好研究：基于离散选择实验

目的：探讨地市级疾病预防控制中心人员的工作偏好,为制定有效的激励机制提供依据。方法：本研究采用分层抽样和立意抽样相结合的方法,线上调研山东省6个地市级疾控机构的455名工作人员,利用混合Logit模型和潜在类别模型分析数据,并计算支付意愿和相对重要性。结果：混合Logit模型中,收入、福利水平、编制、工作量、群众的认可与尊重、个人职业发展机会和培训机会均对疾控人员的工作偏好有显著影响(P<0.05),其中编制(β=2.636)和收入(β=0.083)等保健因素较激励因素影响程度大。潜在类别模型显示,相对年轻、月收入较低的疾控人群更重视收入;年龄较大、月收入较高的疾控人群更重视编制。结论：地市级疾控人员偏好有编制、收入较高、福利水平很好、群众认可且尊重、工作量少、个人职业发展机会较多和培训机会丰富的工作。建议合理控制并动态调整编制总量,平衡编制内外工作条件的差异;增加对疾控的财政投入,改善薪酬绩效体系;同时重视保健因素和激励因素,多种手段共同激励疾控人员发展;对不同类别的疾控人员采用差异化的激励措施。     

陕西省F县基层卫生人员职业倦怠现状及影响因素分析

目的了解陕西省基层卫生人员职业倦怠情况及其影响因素。方法采用多阶段分层整群抽样方法,抽取陕西省F县171名基层卫生人员,对其进行问卷调查。采用Logistic回归分析研究对象的疲倦程度及其影响因素。结果共调查基层卫生人员167人,其中城镇147人,乡村20人。城镇及乡村卫生工作人员在职称、合同签订情况以及职工类型方面有显著差异,同时二者均产生了明显的职业倦怠。职业焦虑、工作压力、影响家庭以及职称评定与职业倦怠相关,城乡间工作压力差异显著。结论职业倦怠同多种因素相关,城镇卫生人员职业压力明显高于乡村,因此,政府应该投入更多资源用于减低卫生工作人员的工作压力、改善医疗环境,同时卫生工作人员也应该调节自身心理状态,减轻焦虑。     

农村卫生服务人员激励机制和工作动机分析

目的:分析在目前激励机制下农村卫生服务人员内在工作动机作用因素的现状及存在的问题,提出农村卫生服务人员激励机制改革的政策建议。方法:定量问卷调查收集数据,根据研究目的综合运用统计描述、单因素分析和因子分析。结果:不同类型农村卫生服务人员对激励机制的认知有所不同。但大部分农村卫生人员认为当前激励机制下,农村基层卫生服务工作并不能赋予他们价值观中偏好的收入、福利保障和良好的工作环境;总体上农村卫生服务人员的个性倾向于努力工作,但工作能力比较欠缺。结论:农村卫生服务人员激励机制的改革应从多方面入手,重点是提高收入和福利待遇、改善设备配置和加强培训。     

贵州省基层医疗机构卫生人员激励因素研究

目的探索贵州省基层医疗机构卫生人员的激励因素,为制定合理激励政策提供科学依据。方法采用因子分析法探讨激励相关因素,提取激励因素的公因子,利用多元线性回归分析影响卫生人员卫生政策整体满意度的激励因素。结果因子分析结果显示,贵州省基层医疗机构卫生人员激励因素可归为社会认同、管理与工作自主权、工作压力、收入、培训发展、工作荣誉感、人际关系及居住条件等八类;多重线性回归结果显示,对卫生人员卫生政策满意度影响的激励因素,从大到小排序依次是收入、管理与工作自主权、培训发展、人际关系、社会认同、工作荣誉感、居住条件。结论针对贵州省基层医疗机构卫生人员应主要采取正强化措施为主的激励措施。     

新一轮医改以来我国基层卫生人力资源现状及问题分析

目的:分析新一轮医改以来我国基层卫生人才资源现状和问题,为稳定基层卫生人才队伍提供参考。方法:运用描述性统计分析和公平性分析方法,分析我国基层医疗卫生人员的数量、结构和分布公平性。结果:基层卫生人员数量显著增加,人员素质有所提升;以省为单位的东中西部地区基层卫生人员Gini系数和泰尔指数均不断减小;东部地区内部的差异是影响总体差异的主要因素。结论:我国基层卫生人才队伍仍存在人员数量不足和流失并存、职称结构失衡以及城乡、地区差距较大等问题;主要原因有激励机制不合理、人员配置行政化、医改部分措施的协同作用有待进一步发挥等;建议进一步改革收入分配制度、提高基层治理能力和加强政策协同,以吸引和稳定基层卫生人才队伍。     

基层医护人员卫生适宜技术学习和使用偏好研究

目的研究影响基层医务人员采纳卫生适宜技术的因素,为改善卫生适宜技术推广工作提供政策依据、完善卫生适宜技术推广理论体系提供理论依据。方法以离散选择实验的方法调查北京市朝阳区城区、近郊区和远郊区,选取十家社区卫生服务中心抽取296名医护人员进行调查,选择数据采用离散选择模型进行估计。结果 MNL模型估计结果表明对个人收入的影响、技术预期疗效、个人发展机会、专项激励机制、患者对技术的认可程度、技术学习和使用难度的系数有统计学显著性,这些属性对医护人员学习和使用卫生适宜技术的行为有影响。结论在卫生适宜技术推广工作中切合实际提高基层医护人员的收入,提供更多激励和个人发展的机会;筛选出易被基层医护人员掌握并操作简便,疗效高的卫生适宜技术供医护人员学习和使用;同时,要加强卫生适宜技术的宣传教育工作,提高群众对卫生适宜技术的信任度和认可程度。     

乡镇卫生院人员对非经济激励因素的满意度分析

目的:通过分析乡镇卫生院人员对各项非经济激励因素的满意度,为制定符合农村卫生人员实情的激励措施提供依据。方法:定量调查和定性访谈相结合。结果:除工作环境满意度外,样本地区乡镇卫生院人员对其他非经济激励因素的不满意度都较高。结论:上级卫生部门以及乡镇卫生院自身应重视非经济激励因素的作用,努力消除员工的不满,促进员工的工作积极性。     

Getting doctors into the bush: General Practitioners' preferences for rural location

A key policy issue in many countries is the maldistribution of doctors across geographic areas, which has important effects on equity of access and health care costs. Many government programs and incentive schemes have been established to encourage doctors to practise in rural areas. However, there is little robust evidence of the effectiveness of such incentive schemes. The aim of this study is to examine the preferences of general practitioners (GPs) for rural location using a discrete choice experiment. This is used to estimate the probabilities of moving to a rural area, and the size of financial incentives GPs would require to move there. GPs were asked to choose between two job options or to stay at their current job as part of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. 3727 GPs completed the experiment. Sixty five per cent of GPs chose to stay where they were in all choices presented to them. Moving to an inland town with less than 5000 population and reasonable levels of other job characteristics would require incentives equivalent to 64% of current average annual personal earnings ($116,000). Moving to a town with a population between 5000 and 20,000 people would require incentives of at least 37% of current annual earnings, around $68,000. The size of incentives depends not only on the area but also on the characteristics of the job. The least attractive rural job package would require incentives of at least 130% of annual earnings, around $237,000. It is important to begin to tailor incentive packages to the characteristics of jobs and of rural areas.     

不同岗位序列员工工作满意度及主要激励因素研究

目的探讨综合医院不同岗位序列员工工作满意度及激励策略。方法选取某三甲医院1 740名员工,采用方差分析比较不同岗位序列员工满意度差异。采用最小二乘法计算不同岗位序列员工满意度各条目得分。采用主成分分析法计算不同岗位序列员工满意度各构成指标在相应岗位总体满意度中的权重系数。结果医生、护士群体的工作满意度相对较低,技术员的满意度相对较高。各岗位激励指标,医生为“职称评定制度”、“保障部门支持”和“付出回报匹配”;护士为“绩效工资分配”、“职业安全保障”、“付出回报匹配”和“参与管理机会”;技术员为“职称评定制     

Motivating health workers for the provision of directly observed treatment to TB patients in rural China: does cash incentive work? A qualitative study

As a key component of DOTS (directly observed treatment, short course) strategy, DOT is essential in the prevention of drug‐resistant tuberculosis. However, DOT had very poor implementation in rural areas of China. One major reason to this problem was the lack of incentives for DOT providers. In 2005, the Chinese Minister of Health released an incentive strategy that aimed to improve the DOT performance of rural health workers by providing allowances. Our study used a qualitative method to explore the practical impact of this incentive strategy in motivating rural DOT providers, and searched for other potential incentive measures as well. A total of 16 focus group discussions were carried out among 102 rural health workers in eight counties of China. A semi‐structured theme outline was used to collect the perception, attitude and experiences of health workers toward the DOT implementation as well as the cash incentive strategy. Findings showed that DOT allowance had some incentive effect to DOT providers, but its extent was circumscribed by the small amount and operational problems. Raising DOT allowance and removing existing barriers to DOT provision might result in a greater motivational impact, particularly in less developed areas of China, where health workers were more likely to encounter financial and other obstacles in delivering DOT services to TB patients in rural areas. Copyright © 2013 John Wiley & Sons, Ltd.     

A Framework and Action Agenda for Quality Improvement in Rural Health Care

PURPOSE: The Agency for Healthcare Research and Quality and the federal Office of Rural Health Policy collaborated to convene an expert group to address issues of quality improvement in the rural health care environment. OUTCOMES: The group identified issues, barriers, and opportunities related to bringing rural health care into the mainstream of the national quality "revolution." A framework for rural quality and specific action steps was proposed. Recommendations were made in the areas of workforce, organizational performance, measurement, dissemination of innovation, and external factors impacting quality. Specific recommendations included fostering development of rural consortia, relevant quality measures for the rural environment, technical assistance capacity, appropriate financial incentives, leadership capacity, and databases.     

乡镇卫生院人员对激励机制的满意度研究

目的了解乡镇卫生院员工对激励制度现状的满意度。方法从经济发展水平不同的2个县中抽取8个乡镇,共调查8家乡镇卫生院的员工213人。结果大部分乡镇卫生院员工对收入水平、福利保障状况持不满意的态度。对管理环境、职业发展等其他激励因素,持中立态度的员工比例较高。结论为提高乡镇卫生院员工的工作积极性,应首先加大政府的卫生投入力度,并切实将投入转化为卫生技术人员收入和福利水平的提高。在此基础上,结合改进人员培训体系、改善支付方式和完善机构技术设备等其他激励方式。     

我国基层卫生人才队伍建设的进展与挑战

近年来,国家和各地积极采取措施,加强基层医疗卫生人才队伍建设。以基层医疗卫生人才支持计划为抓手,将强化基层作为今后卫生人才工作的指导原则和重要任务,基层卫生人才培养开发、评价使用、流动配置以及激励保障机制不断创新,基层卫生人才发展的政策环境逐步得到完善。同时,我国基层卫生人才队伍建设的任务依然十分艰巨,需要进一步完善政策,通过项目和工程,加强吸引和稳定基层卫生人才队伍。     

Health‐personnel recruitment and retention target policy for health care providers in the rural communities: A retrospective investigation at Pudong New Area of Shanghai in China

To tackle the shortage of health personnel in the rural areas of Pudong New Area of Shanghai, the local government issued an incentive policy as one of the medical reforms. The current investigation focused on the relevant incentive measures and their corresponding effects and problems with a view to providing referential and useful experiences for those who are engaged in addressing the same problem at home and abroad. The details of the incentive policy were derived from the government document, and the related data about the flow of the rural community health care providers, from the institutional investigation. As indicated by the current investigation, the incentive policy produced some positive effect in attracting health care providers to work in the rural community health centers, especially general practitioners, nurses, MS/MD degree holders, and intermediate professional title holders to be employed in the farther ones. However, it was turned out that the population of high quality health care providers was still not sufficient enough to cover the whole rural areas, which suggested that it was still hard to draw such qualified medical individuals. To conclude in the current investigation, we made three recommendations for the policymakers to take into account in terms of policy maintenance, benefits for health personnel, and guarantee of their lawful rights and interests.     

村卫生室人员激励因素现状研究

对两个样本县185家卫生室、251名村卫生室人员的调查结果显示：目前,村卫生室人员收入水平低,收入分配方式鼓励人员创收,村卫生室人员社会保障水平低,设备配置不能满足工作需要,上级监管部门的奖惩制度设计不合理,培训次数低于人员期望,村卫生室人员职业发展空间有限等。因此,对村卫生室人员的激励制度改革应从多个方面着手,以提高农村基层卫生人员的工作动力。