目的:探讨浙江省近年基层医疗卫生机构公共卫生人才的现状及未来5年的需求.方法:采用分层抽样方法,对浙江省30个县(市、区)开展问卷调查.结果:30个县(市、区)494家基层医疗卫生机构在岗公共卫生人员共525人.各地区公共卫生人才招聘困难,尤其是经济欠发达地区,其应招聘而未招聘率达94.0％.未招满的主要原因是没有预防医学专业毕业生应聘.未来5年基层医疗卫生机构对公共卫生人才的需求仍在不断增长.结论:浙江省基层医疗卫生机构公共卫生人才紧缺,尤其是经济欠发达地区.针对目前“招聘难,需求大”的困境,我省急需增加应用型基层公共卫生人才的培养与输入.

Objective To explore the economic performance after the performance‐based reform at primary medical institutions in Zhejiang Province and put forward measures for improving primary medical services .Methods Questionnaire investigation was conducted among 84 primary medical institutions with staff over 20 .The financial statements of these institutions during 2009‐2014 were collected and studied as well .Results The average outpatients and emergency patients in 2014 increased 113.3% than that in 2009 .The total usage times of laboratory tests and other auxiliary examinations also increased(55.7% and 103.1% ,respectively ) ,yet with a decrease of inpatients.Moreover ,the proportion of income from traditional Chinese medicine (TCM )in gross income increased from 9.39% in 2009 to 17.14% in 2014 .The cost‐profit ratio of TCM drugs at half of such institutions exceeded 120% . Conclusions The performance‐based reform has motivated medical staffs of primary medical institutions and effectively vitalized such institutions.Rules and regulations of these institutions require further improvement .

目的 了解基层医疗机构医生对绩效考核工资制度的评价及其影响因素.方法 随机抽取浙江省不同经济发展水平的27家基层医疗机构的579名医生进行问卷调查,应用logistic回归分析影响因素.结果 反映比较突出的问题为:(1)工资总额核定标准较低,总量封顶.(2)公共卫生经费纳入绩效工资总额.(3)绩效工资缺乏增长机制.在不同人群中,男性、本科及以上、在编职工和临床专业医师认为存在问题较严重.结论 基层医疗机构的岗位绩效考核制度有待完善,制定考核方案时应考虑各岗位的职责特征.

Objective To learn the main problems of performance salary system in primary healthcare institutions after the implement of recent performance salary system guiding opinion in Zhejiang Province.Methods Purposive sampling method was used to separately select 2 counties from high,average and poor economic level regions in Zhejiang Province. Questionnaire survey was conducted among 100 leaders of 84 primary healthcare institutions which the number of staffs is larger than 20.The survey contents included demographic characteristics and the assessment of performance appraisal and performance salary system,which embraced workload,the change of work income and enthusiasm,the incentive function, component ratio and existing problem of performance salary system.Results The average income general increased, however,the staffs working enthusiasm should be further improved.Some problems still exist,such as the public health funds were brought into the total performance salary,and the gross payroll levels were low as well as the performance salary was lack of increasing mechanism.The TCM was the prior development business and contribute most to the revenue and expenditure surplus of primary healthcare institutions.Conclusion The performance salary system should be further improved and the operating effect evaluation in phases and stages should be developed.The decoction pieces should be selled without added profit,and the service ability of primary traditional Chinese medicine should be further strengthened.

We herein overviewed the history,achievement and plan of "the twelfth-five" program for the development of key medical disciplines in Zhejiang Province.We summarized the practice and characteristics of establishing of the key medical discipline in the Zhejiang Province,and a systemic survey was conducted on the effectiveness of the program.We then proposed several improvements strategies including academic training,multidiscipline coordination,and fund managements to eventually establish the new pattern of discipline development.

A study of the quality assurance system building made at the training bases in Zhejiang since 2011 found the following.Five management systems on training quality have been established, covering basic clinical conditions, training management, faculty management and training, training assessment,and training incentives.PDCA is called into play for continuous improvement and perfection to develop a training quality management system of local features and continuous improvement.

目的：总结浙江省基层卫生适宜技术推广平台建设的做法，并以心血管病防治为例，提出基层卫生适宜技术推广平台在心血管病防治中的作用和意义。方法对浙江省开展心血管防治适宜技术推广的基层卫生适宜技术示范基地进行调查。结果利用基层卫生适宜技术推广平台，开展心血管病综合防治工作，可以有效降低心血管疾病及其并发症带来的危害，具有明显的经济效益和社会效益。

目的:评价2012年浙江省卫生技术人员配置的公平性,为政府优化资源配置提供实证依据.方法:采用统计描述、Lorenz曲线和Gini系数等方法,从人口与地理分布角度来评价.结果:浙江省各类卫生技术人员按服务人口配置的Gini系数均低于0.2,按服务面积配置的Gini系数均低于0.3.结论:浙江省1 1个地市卫生技术人员资源配置不均衡,存在区域性差异,但总体上处于相对公平状态,结构亟待改善,人口公平性优于地理公平性.

浙江省基层医疗卫生机构的绩效管理制度已经全面实施并取得了一定的成效,但仍存在一些问题,建议进一步加大政府投入,提高基层医疗卫生机构医务人员绩效工资的总体水平;引进第三方考核机制,完善绩效考评体系;建立完善医疗分级就诊制度,对基层医疗卫生机构按照执业能力和水平进行分级管理;引进医疗保险机制,用保险机构的监督促进基层医疗卫生机构的公共服务职能最大化.

This paper analyzed the current situation of key disciplines development in 72 private and county-level hospitals in Zhejiang province, and explore the key members' attitude to the development of key disciplines. The results showed that county-level hospital has better subject leader and research resources than private hospital. So political suggestions have been put forward from four aspects to the development of key disciplines in county-level and private hospitals. The first is strengthening government investment;the second is improving comprehensive level;the third is strengthen personnel training;the fourth is strengthen process management.

对浙江省基层卫生适宜技术示范基地建设情况开展了调研,结果显示:浙江省于2009年启动“1+X”模式的基层卫生适宜技术示范基地建设,现已建成六大类78家示范基地,取得了良好的社会和经济效益;基层卫生适宜技术示范基地的建设离不开政策的推动、科研成果的保障、信息化建设的支撑.

Objective This study reviewed the approach of general practice teacher training in Zhejiang Province, evaluated the training effect and summarized training experience. It aimed to put forward recommendations for future training and teaching staff improvement. Methods There is an urgent need to increase excellent teaching staff of general practice,in order to promote the training system of general practitioner. And a training approach is designed to improve trainees' comprehensive ability. We recruited 218 trainees who received the whole training and assigned them to complete questionnaires. Their satisfaction degree about the training and ability improvement after the training were investigated. Results Among 218 subjects,95. 4%(208/218)were satisfied with the training teachers;93. 5%(204/218) were satisfied with organization and management;93. 1%(203/218) were satisfied with the rotation arrangement;69. 3%(151/218) were satisfied with the textbook;and 94. 0%(205/218) were satisfied with the overall effect. The trainees who had improvement in fundamental understanding of general practice,clinical competence and teaching ability accounted for 95. 4%(208/218),94. 9%(207/218) and 93. 5%(204/218)respectively. Conclusion Most trainees thought the expected effect of the training was achieved,and their teaching and professional ability were improved after the training. Problems still exist,including deficiencies in the textbook,the lack of time of receiving training due to busy work,and the lack of benefit and allowance during the training.

Objective To evaluate the current status and equity of health human resource allocation in Zhejiang in2012, and provide reference for regional health planning. Method Descriptive statistics, the Lorenz curve and the Gini coefficient were adopted. Result The number of health professionals,licensed(assistant) physicians and registered nurses per one thousand persons in Zhejiang were higher than the national average level. However,the doctor-to-nurse ratio and proportion of nurses in health professionals were lower than the national average level. The doctor to nurse ratio was inversed and geographic difference was significant. The equity of demographic distribution was superior to the geographical distribution. Conclusion The allocation of health human resources in Zhejiang was relatively fair. However,the structure needs to be improved and attention should be paid to the equity of geographical distribution.

This paper studies actual cost and standard cost of traditional Chinese medicine(TCM)acupuncture treatment and compares them with the charge standards,which can provide a reference for adjusting the price standard of acupuncture treatment project in different levels of TCM hospitals in Zhejiang province.

Since the implementing directed education of rural community doctors in Zhejiang, the stages of pilot, generalization and implementation had been processed, the target of “to reach, to get down, to use and to stay” was closely abounded for primary practical medical personnel, the integrated policy of key points as “recruitment, training and usage” had been designed and implemented, the ordered development of directed education for rural community doctors was secured, the varieties of health service demand from grass-roots were meted, the “bottleneck” problem of shorting primary personnel is relieved and the sustainable development of rural health enterprise were improved and supported.

This paper collected treatment cost and effectiveness data of Chinese medicine or western medicine in treatment of the same disease in grassroots medical institutions through retrospective study.Cost-effectiveness analysis was used to analyze treatment costs for the patients who were treated by Chinese medicine or western medicine with same treatment effectiveness.Chinese medicine service was cheap,which was proven by empirical research.Therefore,it was suggested to promote the utilization of Chinese medicine in grassroots medical institutions.

Objective To put forward a reasonable proposal based on the research on operation effects of health resources integration in Yuyao,Zhejiang.Methods A survey was conducted in Center for Clinical Laboratory,16township hospitals,and among 80residents,and we had discussion with relevant personnel.Results The number of outpatient,inpatients and surgery patients had a certain increase compared with pre-pilot in township hospitals,and the proportions of growth were 12%,6%and 20%respectively.From 2009to 2011,the revenue of Center for Clinical Laboratory increased significantly,and the proportion of personnel expenses and material costs to revenue decreased from 90.3%to62.7%.The survey showed that 97.5%of the residents trusted in present results of clinical tests,and 96.3%felt costs lower than before.Conclusions The health resource integration reform enhanced the capacity and quality of primary health care services,reduced the medical costs,improved the resource efficiency,and promoted the complementary functions of hospitals and primary health care institutions,which can be promoted in those areas with developed economies and convenient transportation.At the same time we should increase the financial transfer payments to help less developed areas.

基层医疗卫生事业单位实施绩效工资制度,是推进医药卫生体制改革的一项重要举措,对促进基层医疗卫生机构回归公益性具有十分重要的意义.浙江省从2010年7月起,大力推进基层医疗卫生机构绩效工资改革,至2011年底,各县(市、区)均出台了具体的实施方案和绩效考核办法,取得了良好成效.但同时,诸如医务人员工作积极性下降等一些问题也逐渐凸现出来[1-2].本课题组在浙江省开展了基层医疗卫生机构绩效考核实施情况调查,以进一步完善基层医疗卫生机构绩效考核机制.