Study on Shanghai Rural Doctor and Service Pattern Reform

1.Research Objective and SignificanceRural doctor emerged in the 1960s in our country.At that time to solve the condition which the countryside area lacked in medical personnel and medicine,the government decided to positive raise(short-term medical service knowledge training) the half-time farm and half-time medical work primary rural sanitation personnel, they were called as "barefoot doctor" in 1968.After several year's fast development, quantity of national barefoot doctor reached 1,560,000 in 1975,every thousand farmers had 2.5 barefoot doctors in average.In 1985,ministry of health unified stipulated that "barefoot doctor" renamed as rural doctor,all village medical personnel must participates in the test,everyone through the test passer,awarded rural doctor certificate;Takes a test unqualified and has not participated in the tester to be called as the health worker.In 1986,640,000 people were award rural doctor certificate,and the other 650,000 people did not pass the qualifications test,equaled 1,290,000 people,which reduced approximately half compared 2,400,000 village medical personnel in 1985.The data which ministry of health announced until 2003,national rural doctor altogether had 791856 people, average each village had 1.25 rural doctors or the health workers.rural doctor in Shanghai was born in the mid-1950s,at that time to respond Chairman Mao to develop the patriotic health campaign and "must certainly eliminate snail fever" the summons vigorously,in view of condition which lacked in doctor and medicine,each village elected one who have certain cultural youth to trains to the county or the township medical short-term for one month,to learn some medicine knowledge and some simple common diseases prevented and controlled method,thus became initial rural doctor - - the hygienic health care worker.In the early 60s,the party and the government proposed that put the policy which medical and health work's key point went to the countryside,the Shanghai urban health medical service troop goes to the country to run 6 month-long training classes in abundance,propped up and developed this rural doctor team,they became "barefoot doctor" enlivened on the village land,also agricultural also medicine.Up to the 70s,particularly after the party's 11 Third Session,to enhance the level of rural doctor,the Shanghai suburbs various Health schools conducted training one year system off-job training class, basically each village has one rural doctor to enter the medium health school off-job training one year.In the early 90s,to carries out ministry of health draw up "Rural doctor education Ten Year Plan",Shanghai rural doctor troop's raise has stepped onto systematized,standardized medium medical education track,it put the new vitality and the vigor for this team.No matter is national or Shanghai rural doctor troop's development,has well solved the problem which at that time the countryside area lacked in doctors and medicine,rural doctor once was been honored as "China's three big magic weapons" together with the cooperative medical treatment and third-level health service network by the World Health Organization,achievement "Only model of developing country solute health funds" positively to developing country recommendation.Along with social economy's rapidly development,Especially Shanghai as national economic development center,the countryside resident's living standard and the health service demand enhances unceasingly,rural doctor troop's service whether can also adapt the time development,satisfies the rapidly developing social economy, enhances unceasingly countryside resident living standard and healthcare demand need? To adapt the time development,ministry of health and the Shanghai Medical department also once carried on training and the education to rural doctor,to make it systematization and the standardization,but still had the research marked that,at present between our rural doctor provides the service and the physical demand has the very great distance.How does develop rural doctor troop? Its service pattern and content whether can meet these demand and need? In order to the current rural doctor's service pattern and content can adapt this situation,many researchers and practitioner propose that the staff of the villages and towns public health center which medical level higher(or community health service center) may completely substitutes for rural doctor,the genuine villages and towns integration management;Also some people proposed that realizes the integrated management,but r retains the ural doctor troop,makes it standardization through the professional training,and completes substitutes gradually along with incumbent rural doctor retires unceasingly? In Shanghai,the national economic development center,rural doctor troop what course to follow from? The countryside is the basis of our country economic development, the social stability and the national powerful.The countryside health system,for our country public health's development and the countryside area's stability,has made the achievement which attracts worldwide attention.The research on the new time Shanghai village level health service's pattern, provides present situation of the service workes,direction and the demand of the construction development,to improves the countryside resident to go see a doctor, provides satisfy service,and strengthens the countryside public health and the basic medical service system construction,plans to construct and develop the Shanghai socialism new suburb health services structure earnestly.The research wants to answer these questions:(1) under the new times and the new situation,how does present situation of Shanghai rural doctor troop and the service pattern?(2) Whether does rural doctor service's pattern and content satisfies the need of the new times and the new situation?(3) to adapt the time and the situation development,makes Shanghai rural doctor troop to standardize gradually, what are Shanghai rural doctor ideal service content,pattern,the ideal pattern strategy and the support program? Realizes finally the science the basis of the further practice reform which serves for Shanghai rural doctor.2.Material and methodThis research investigated the present situation of rural doctor's troop and the service pattern by standard-disparity analytic method and the inventory survey method,has analyzed the Shanghai rural doctor's troop present situation and the service pattern present situation,as well as the intention of the rural health served organizer and tenderer about the reform development regarding of present rural doctor, to serve provides the science model to further consummate Shanghai rural doctor serves.The data source method including the literature canonical parse method,the intention investigation,rural doctor troop's inventory survey,rural doctor's work diary record and so on.The research sample investigation method is:From the 10 suburbs(county) in Shanghai,extracts Baoshan,Jiading,Minhang,Songjiang,Qingpu,Nanhui,Fengxian, Chongming suburbs(county),using "the biggest difference sampling method", according to the lamination entire group random sampling's principle to extract sample villages and towns,concrete is:according to average per person GDP (statistical caliber) the height,governs each village and town of sample area divides into three levels,draw an item at random one town in each level,thus each sample area extracts three towns.Likewise,governs the sample towns the village divides into three levels according to average per person GDP(statistical caliber) the height, extracts one village in each stochastic level.Each sample area altogether extracts three towns,each sample towns extract three villages.This research investigated 8 suburbs, 24 towns,72 villages,725 countryside residents,health service organizer and tenderer 312 people,bureau chief/ in charge of bureau chief 15 people,mayor/ in charge of mayor 25 people,the prevention health care branch and the cooperative medical treatment manages 32 people,director of towns public health center /vice-president 42 people,rural doctor 137 people.3.Main resultsRural doctor's manpower quantity relative insufficiency,aging,qualities of title,school record and income is low Compares with the hygienic service demand which grows day by day the people, manpower quantity of Shanghai rural doctor relative insufficiency;The average age is 48.6 years old,50-60 years old age section reaches as high as 46.7%,the aging tendency is strict.On the title constitution,have not any intelligence village medical personnel accounts for13.5%, rural doctor accounts for 19.9%;It with " Instruction Opinion on Rural sanitation Reform And Development" "to 2010,rural doctor transform to disciple assistant doctor in the majority of countryside area";On the school record constitution,rural doctor above secondary technical school accounts for 49.6%,it with the request of Central Committee of the State Council Decision about Hygienic Reform And Development "to 2000,nation 80%rural doctor achieve secondary technical school level" " disparity is big;Average yearly income of rural doctor who investigated is￥14400.0,72.8%rural sanitations serve organizer and intendent believed that,compares with their work's intensity and investment,their income is somewhat low.we suggest that through enlarges govern investment dynamics,articularly area and town government,adopts measure of training or the attraction young,the high quality talented person enter rural doctor troop,enhances rural doctor's income and safeguard level,to stabilize and develop the rural doctor troop.Rural doctor srvice efficiency to be somewhat low,has phenomenon of "Value medical service,contempt prevention"Shanghai rural doctor service efficiency is not high,they provides servicing time to occupy 50%in one day of 8 hour,and working strength is not also too high,may through enhance doctor working efficiency and working load to alleviate the present situation.At the same time,rural doctor mainly provided the medical service,the time has accounted for 55.7%,but srvice items about the countryside community infectious disease prevents and controls,sanitary supervision,ptriotic health campaign and health education accounted for the operating time proportion insufficient 10%. Analyzing the operating time,it still has phenomenon of "Value medical service, contempt prevention".We suggeste that we may implements the measure which e nhances the government attention,enhance the rural doctor's income and the treatment,strengthen inspection and appraisal,to raises the efficiency and work load to alleviate the present situation which rural doctor's quantity insufficient,to adjust source of rural doctor's income structure,and make it apart completely from income of the village clinic,Safeguard public health service project which the low income in village clinic obtains the government sum total allocation and so on,to reverses phenomenon of "Value medical service,contempt prevention".The frequency of rural doctor visits to serve is very high,and the service mode of rural doctor visits to serve maintains good,but availability of rural doctor visits to serve needs to enhance76.0%sample villages implement the service mode which rural doctor within call provides in 24 hours.Each village clinic visits to serve every day equally 1.3 times,each rural doctor visits to serve 0.6 times,the frequency of rural doctor serves is higher.According to this calculation,the times of each doctor visits to serve is every year 226.8 times,there are 4183 rural doctors in Shanghai,thus it needs to provide visits to serve 948704 times the whole year.The frequency of rural doctor visits to serve is very high,visits to serve and so on nimble service mode maintains unites.Rural doctor service content is medical service primarily.They have a house call from 0:00 am to 24:00 pm,the frequency of making a house call from 6:00 am to 6:00 pm is highest(87.8%).And the service content by the medical service majority (48.3%),next is the service of chronic disease prevents and controls(31.6%),the third is the health care of the frail crowd(11.6%).However,availability of rural doctor visits to serve needs to enhance.The distance from village clinic to visits the service point is 1.7 kilometers at average,it is 23.4 minutes each kilometer that from receiving call to visit to provide service at average.Riding instead of walking tool mainly by the bicycle(48.1%),storage battery car or the motorcycle primarily(35.6%),and various areas(county) differs from others.Which also to have certain disparity with "walks 15 minutes to reach the suitable sanitary equipment" by World Health Organization.The rural doctor's service meets the countryside residents' need basically, but hardware of the village clinic,rural doctor's quantity and quality and so on must be further strengthenShanghai rural doctor's present service including service content,service way, quality and manner,and so on.Even if under the situation which the current society and the economic depth development,People's living standard enhance unceasingly,it can meet the general countryside resident's health service need,countryside resident's d egree of satisfaction has achieved 98.3%.76.0%investigated villages carried out "within call servicing time",it meets the countryside resident medical service need ultimately.The service pattern which 8 hour work routine and 5 days working-day system is unable to meet the current countryside resident health service need,which is not feasible at present(96.6%countryside resident approved).While rural doctor meets the countryside resident health service need basically, which still not allow to neglect is hardware construction of the village clinic,like as equipment facility,medical equipment's renewal,rural doctor's quantity and quality, village clinic service items scope too small.The hygienic related department should consider how to release the related policy,solves the problem promptly,to meet all countryside resident's basic sanitation health care need at the greatest degree.Implements town and village integration management,to train the rural doctor,retires unceasingly along with the retirement of low-quality rural doctor,to make it standardThe intention diagnosis to rural sanitation serves organizer and tenderer result proved that Shanghai rural doctor troop can follow the time development,be able to meet people's basic health need.As for present rural doctor service not be able to meet countryside resident's demand,they should be displaced by doctor of Community health service center(town level public health center),personnel who be investigated holds the denial viewpoint(75.7%by survey thought not feasible).Under Shanghai current environment,the ideal pattern is training rural doctor to make they standardization,it does not need to substitute(98.3%by survey approved),may through enhance government's value degree and strengthens the policy safeguard,to realize town and village integration,the village clinic retains by the community health service station form,provides 24 hours service within call,carry out the appointment system to rural doctor,hire according to qualification,competes hires the post,perfect rural doctor's appraisal and inspection mechanism,and clear about rural doctor's status,increases rural doctor's income,enhances rural doctor's safeguard level, strengthen training to rural doctor,which will be becomes the retent and stable this troop's reform trend,which is also the rural sanitation serves organizer and tenderer ideal reform mode.Certainly,it should also become Shanghai rural doctor serve pattern the development direction.Implements town and village integration management,shanghai rural doctor troop standardization needs the strategy and the support programIn order to guarantee Shanghai rural doctor serves can follow the social economy development,meets the countryside resident's basic healthcare service need,if related department,adopt the town village health service integration management,limit rural doctor for the villages and towns institution establishes,integrates the towns public health center(community health service center) the global administration,along with the junior middle school and the following school record's retirement,supplemented unceasingly the regular medical education and the training personnel enter this troop to realize substitute gradually,then needs to complete the substitution the time limit is 19 years,5 years later may substitute 839 people,to achieve half of the substitution goal.In order to meet the countryside resident's medical care need,towns public health center medical personnel must undertake the duty of making a house call t, according to the above substitution situation,at present each town Public health center 5 years later needs to undertake number of time of making a house call is 2103 times every year,19 year later which is 3595 times.If along with the non-title rural doctor's retirement,supplemented unceasingly the regular medical education and training personnel enter this troop to realize substitute gradually,then needs to complete the substitution time limit is 20 years,15 years later may substitute 353 people,achieves half of the substitution goal.In order to meet the countryside resident's medical care need,the town public health center medical personnel must undertake the duty of making a house call,according to the above substitution situation,15 years later each town public health center needs to undertake number of time of making a house call is 687 times every year,20 year later which is 1098 times.At the same time,to guarantee that enhances rural doctor's income and the safeguard level,make rural doctor's income to enhance to the ideal level,needs to increase invests the personnel funds￥4434.1,among of them,the area finance needs to invest￥23,247,000,the town finance need to invest￥28,742,000,the village collective will reduce disburses￥475.1,the village clinic source of income will reduces￥2,899,000.If considered that solves rural doctor to care for the age,the medical service and the unemployment question,safeguards rural doctor the social security to achieve the current town public health center(community health service center) medical personnel's level,which needs on rural doctor personnel funds foundation,to increase invests￥77,002,000,among of them,the area finance￥31,053,000,the town finance￥40,109,000,the village collective increases￥3,154,000,the village clinic income increases￥2,686,000.4.Main discussion and insufficiencyain discussionA.This research belongs to the utility exploration research,bases in Shanghai, from rural doctor troop basic situation investigation,to the service content's detailed diary record and analysis,to the organizer,the tenderer and consumer's intention investigation and the analysis again,discusses systematically and comprehensively Shanghai rural doctor troop,the service content,and the service mode question,it is the more systematic and more comprehensive and more thorough research in national similar research.At the same time,the qualitative investigation and quantitative investigation has guaranteed findings reliability and feasibility,may provide science basis for the further practice reform of Shanghai rural doctor serve pattern.B.The research on the inventory survey foundation,rests on Shanghai rural doctor troop and service present situation,as well as the rural sanitation serves organizer and tenderer consistent approval rural doctor development model,carries on different reform mode discussion,surveys diagnosing and treating work load which rural doctor troop reform needs to undertake,as well as all levels government should undertake responsibility and essential investment dynamics.Which is rarer of the similar research,is thorough discussion part.Research insufficiencyA.This research bases merely on Shanghai,so it obtains the findings only on behalf of Shanghai,may provide the science support for Shanghai rural doctor serve pattern further reform.This research only restricted in reference at the national other areas,if the time and resources be limited,this research has not carried on other local research,which will become myself further research direction.B.According to rural doctor development model of Shanghai rural sanitation organizer and tenderer consistent approval,related reckoning data in this research's may provide the science support for Shanghai rural doctor serve pattern.Certainly, realizes its pattern also possibly to have other reckoning method,sunch as influencing factor's discussion,forecast according to influencing factor's change and so on.This article is for the purpose of offering a few ordinary introductory remarks so that others may offer their valuable ideas,while provides science support's for the practice, attracts more researchers to invest into rural doctor troop's research,makes the contribution positively for our country rural sanitation enterprise's development.