在市场经济条件下,对于我国公立医疗机构之间的人员流动来说,除了地区之间的流动以外,省、市、县和社区机构之间的流动也是重要的一个现象.级别愈高的医院其等级也往往越高(等级相关系数0.77,P=0.00),高等级医院可能意味着更高的收入和更好的发展机会,于是可以推论,人员可能会有从低级别医院向高级别医院流动的趋势.

Objective To make clear status quo of employees,flow among public medical institutions(PMI)of China. Methods 376 PMIs had been sampled by stratified and cluster sampling method to investigate flow employees' person- nel data and shifting direction,which were employed to analyze basic condition and makings' changing trend of flow employees among different areas.Results There existed phenomenon of employees' flow from midwest to east area.In past 5 years,the employees' makings in middle and east PMIs had improved notablely,though from the aspect of edu- cational background,the employees' makings in west PMIs had also improved,synthesized analysis found it negative, and the employees' makings gap between midwest and east PMIs manifested the aggrandized trend.Conclusion The above status quo of employees' flow among different areas would aggravate the medical resources' unbalance in differ- ent areas and be harm to sustainable development of medical facilities in midwest area.

OBJECTIVE To set the manpower allocation criteria of center of disease prevention and control. METHODS Expected allocation manpower criteria was obtained through adjusting the current manpower allocation of disease prevention and control centers. The principle was to fulfill public function and promote professional efficiency. RESULTS Based on function requirement, in 3 - 5 years, the manpower allocation criteria of center of disease prevention and control at provincial-level is 336 persons, at city-level is 102 persons, and at county-level is 33 persons, that means in whole country 140016 persons should be needed. In 10 years, the manpower allocation criteria of center of disease prevention and control at provincial-level is 386 persons, at city-level is 112 persons, and at county-level is 38 persons, that means in whole country 159086 persons should be needed. CONCLUSION The manpower allocation criteria advanced in the study indicated that current manpower quantity should be greatly reduced. It is an inevitable trend that disease prevention and control centers reduce the staff quantity and promote their quality.

为了明确我国公立医疗机构制度改革的目的、目标和模式,该研究通过总结、比较国内外公立医疗机构分配制度的相关资料,组织专家小组讨论,对卫生从业人员进行意向调查,提出我国分配制度改革应当提高医疗机构人员的价值定位、完善分配要素、适当拉开收入差距、确定准入和考核标准;遵循平等、公平可比、正常增资和有效约束的原则;同时认为理想的工资结构组合包括基本工资、岗位工资、年功工资和绩效工资四部分,其中,基本工资占21.0%,岗位工资占47.3%,年功工资占6.5%,绩效工资占25.2%。

基层卫生机构在城市主要是指一级医院或社区卫生服务中心,在农村主要是指乡镇卫生院和村卫生室.政府举办的乡(镇)卫生院、城市社区卫生服务中心设置预防保健组织,按服务人口、工作项目等因素核定预防保健人员,开展疾病预防控制工作.基层卫生机构的预防保健人员是我国国家、省、市、县四级疾病预防控制中心体系的一个重要补充,是疾病预防控制中心落实具体工作的一个重要载体.在明确各级疾病预防控制中心公共职能的基础上,进而界定基层卫生机构的疾病预防控制职能和工作项目,对于明晰疾病预防控制中心与基层卫生机构的关系,明晰基层卫生机构疾病诊治和疾病防制之间的区别,具有重大的意义[1].

OBJECTIVE:To explicate the operational proportion of public function and items of the centers of disease prevention and control (CDC).METHODS:161 CDC have been investigated by two-stage stratified sampling to provide the information about the operation of the public function and items of CDC.RESULTS:(1) The average operational proportion investigated CDC is 71.7%, the province level 92.0%, the city level 73.7%, the county level 68.5%. East areas 76.5%, middle areas 71.5%, west areas 68.1%. (2) The operational proportion of disease prevention and control function and emergency treatment function were higher, but that of epidemic situation report and information management of health relative factor, inspection and control of health relative factor, and the laboratory examination and evaluation were lower.CONCLUSION:Public function and items were rather poorly carried out by the centers of prevention and control in China, especially those in middle and west areas, and those in counties.

OBJECTIVE:To compare the human resources allocation of CDC in different areas and different levels.METHODS:By stratified cluster sampling we get 70 CDC's manpower data, which come from different areas(east, middle part, west)and different levels (province, city, county).RESULTS:(1) The average number of CDC's staff is 62. (2)CDC of province level are understaffed by 15%, while CDC of county level are overstaffed by 3%, and CDC of county level are overstaffed by 12%. (3) Structure of age: The average age of CDC's staff is 62, people under 35 years old in CDC is 39.4%, people above 55 years old is 3.5% (4) Structure of education: People with graduate degree are only 0.8%, and people come from technicalsecondary school are 57.0%. (5) Structure of specialty: A majority of people's majors are clinical medicine, and the percent of people having a non-medical-major are 36.6%. (6) Area distributing. Distribution of average quality score of staff are imbalance in different areas, the average quality score of staff in east area are 1.07 times than that in middle area, and 1.12 times than that in west area.

目的机构意向论证课题组研制的疾病预防控制中心公共职能项目.方法采用分层随机抽样法,在全国范围内抽取161个疾病预防控制中心,征求样本机构对课题组研制的疾病预防控制中心公共职能项目的认同意见.结果各级各地疾病预防控制中心普遍认可课题组研制的疾病预防控制中心公共职能项目,认可比例至少在90.0%以上.结论本次研究确认了疾病预防控制中心应承担的公共职能项目,为进一步根据职能项目测算落实疾病预防控制中心人力需求奠定了基础.

OBJECTIVE:To demonstrate the cause of public health service delivery insufficiency of disease prevention and control system of China. METHODS:205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various causes of public health service delivery insufficiency of disease prevention and control system of China. RESULTS:Literatures review demonstrated that the financing from government to disease prevention and control system of China was insufficiency and show lower efficiency, which has been agreed by 99.3% of CDC. Literatures review demonstrated that the financing administration idea of permitting charging service caused the fee-for-service played a key role in the economic reimbursement of various levels of CDC, which has been agreed by 96.0% of CDC. CONCLUSION:The causes of public health service delivery insufficiency of disease prevention and control system of China were the government financing insufficiency and the defective administration strategies.

OBJECTIVE:To develop and demonstrate the reform steps of reestablishing disease prevention and control system of China.METHODS:A model named "strategies of fulfilling public functions of disease prevention and control system of China" has been employed to develop reform steps. 154 centers for disease prevention and control (CDC) have been sampled to consult the opinions about the reform steps developed by research team.RESULTS:To reestablish the disease prevention and control system of China, the following reform steps should be kept to: (1) increase government's attention to disease prevention and control, (2) insure feasible government investment to disease prevention and control, (3) increase the stability and efficiency of government financing, (4) reform management system to enhance the operation efficiency of the CDC, (5) revise labor regulation to attract and stabilize specialists, (6) be carefully to dispose the non-public-service now delivered by the CDC. The consent percent of all sampling CDC was 98.7%.

为分析疾病预防控制中心存在的人才流失现象.运用三阶段分层抽样方法,获取全国东、中、西省、市县各地区各级别70个疾病预防控制中心、278家医院5年的人员调动情况,运用卫生人力综合素质计算方法计算人员素质.结果表明我国疾病控制中心调入人员的平均素质分为5.54,调出人员的平均素质分为6.62,调入调出比值为0.84,存在着明显的人才流失现象;从不同级别角度讲,各级疾病控制中心的人才流失均比同级医院要严重;从不同地区角度讲,各地区疾病控制中心的人才流失同样比同地区医院要严重.

OBJECTIVE:To evaluate the implementation of public function and items of the centers of disease prevention and control(CDC).METHODS:161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree.RESULTS:1. For investigated centers, the average rate of function implementation is 42.9% ,with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level; while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. 2. Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study.CONCLUSION:The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.

目的在明确各级各地疾病预防控制中心(CDC)已开展公共职能项目的基础上,分析这些开展项目的操作程度.方法运用分层抽样方法,对全国161个疾病预防控制中的公共职能项目的操作情况进行了调查分析.结果(1)各级各地CDC已开展公共职能项目的平均操作程度为57.6%;其中东部地区为61.8%,中部地区为61.5%,西部地区为50.2%;省级为60.7%,市级为57.3%,县级为57.6%.(2)按照七项公共职能分别进行分析,已开展疾病预防与控制公共职能项目操作程度为65.1%;突发公共卫生事件应急处置为73.2%;疫情报告及健康相关因素信息管理为53.8%、健康危害因素监测与控制为48.3%;实验室检测与评价为51.7%;健康教育与健康促进为48.1%;技术指导与应用研究为64.0%.结论各级各地疾病预防控制中心已开展公共职能项目的操作程度普遍不高.已开展公共职能项目中操作程度最好的是突发公共卫生事件应急处置,最差的是健康教育与健康促进和健康危害因素监测与控制.

This paper introduced the following study results of the project of "reestablishing the disease control and prevention system of China" in brief: (1) the chief problem existed in disease control and prevention system of China is the lower fulfilling level of public functions. (2) the parents of this chief problem are the lower financing level and the lower managing responsibility of government. (3) to reestablish the disease control and prevention system of China, government should increase the investment and strengthen management, which may need the following preconditions: more government recognitions to the disease control and prevention, more government investment, more sustainable government investment, higher efficiency of CDC, more competitive salary system to recruit specialists, more reliable disposal about non-public-product provided by CDC. (4) the public functions of CDC could be defined as 7 categories and 255 items. (5) according to the calculating method of human resources allocation of CDC which has been developed and demonstrated by the project team, 159086 persons, which is equal to 76.9% of human resources of CDC in 2002, are needed to fulfill all the public function of CDC throughout the country. (6) based on the model of input-output analysis, to exclude the non-public-service of CDC, government should give another yen 10.29 billions on the basis of current 3.9 billions of government investment to CDC.

OBJECTIVE:To develop and demonstrate the strategies to solve the problem of public health service delivery insufficiency of disease prevention and control system of China.METHODS:205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various reform strategies. Based on the causes and mechanism of public health service delivery insufficiency of disease prevention and control system, the logic analysis has been employed to develop fundamental strategies, which has been demonstrated by 154 CDC using intention questionnaires.RESULTS:There are fundamental strategies to which the agreeing rate for sampling CDC was over 95%: to make sure government should afford the financing function of disease prevention and control and secure the feasible investment for centers of disease prevention and control. Meanwhile, the working efficiency of CDC should be improved through strengthening management and reforming government investing manner.

OBJECTIVE To evaluate the implementation of public function and items of the centers of disease prevention and control (CDC). METHODS 161 centers of disease prevention and control have been investigated by two-stage stratified sampling. The implementation analysis of public function and items of CDC is measured by multiplying average operational proportion and average operational degree. RESULTS (1) For investigated centers, the average rate of function implementation is 42.9%, with 56.0% at provincial level and 43.7% at city level, 41.3% for the county level, while 49.3% in east areas, 45.4% in middle areas and 35.3% in west areas. (2) Among all 7 functional items, the implemented rate of disease prevention and control is 54.3%, 65.8% for emergency treatment, 35.0% for epidemic situation report and information management of health relative factors, 31.3% for inspection and control of health risk factors, 39.1% for the laboratory examination and evaluation, 36.4% for health education and health promotion, and 56.7% for technological guidance and application study. CONCLUSION The implemented degree of public function of CDC was generally lower, varied with regions and levels. Among 7 public functional items, the emergency treatment function had the highest implementation, with the lowest for the inspection and control of health relative factors.