| 1. Research Objectives and SignificanceThis study is a component of project "research of determination and tactics on the key issues in the main health fields of Chinese health cause", which was granted by the Fund for doctors of national of Ministry of Education(20020246078) and the state distinguished youth fund (79925002) .The importance of the policy is indubitable, the quality of the policy will determines the rise and decline of the health cause, it is a rational goal of the policy to pursue high straight value. The policy of high value comes from making scientifically; it not merely needs effective policy methodology to make the policy scientifically, need mutual supplement with each other's advantages between policy researcher and policy maker too.But in reality, there are lots of obstacles to restrain the policy, there are estrangement and disparity between the requirement in theory and theoperation in reality, estrangement and disparity between the theoretical requirement and actual research, the estrangement and disparity exist between researcher and policy maker; the estrangement and disparity between research and policy. But the last two estrangements and disparity seem more obvious. The policy researcher and policy maker do things in bis own way separatelyt.The parent project thinks the hygiene system is one of the organic components of the society; its own composition is very complicated. From the point of function, the hygiene system can be divided into such fields as medical treatment, prevention, keep-fit, recovery, etc., each field has numerous questions, the formation and development of these questions are often influenced synthetically by many kinds of factors, and each research of problem is different in development and the degree solved, if want to really solve these problems, wihich need the researcher and the policymaker work jointly.The research meaning of the parent project is to reach these objects from development strategy aspect of hygiene industry:firstly, Analyse the main social concern existing in the hygiene field, and a series of new problems appearing with change of the social environment; according to severity of all kinds of problems, the degree of paying close attention to and the priority, define the key problem needing to have priority to solve among the numerous problems; secondly, Confirm the research development and potential blank of the key problem, such as if the origin of the key problem and function mechanism are clear, if corresponding feasibility analysis is carried out,etc; thirdly,, according to the scientific procedure of policy making, carry on the thematic research in policy about a certain focus question, on the basis of analysing the origin and function mechanism of the question sequentially, propose solving tactics and thinking about the this problem, thus erect the bridge between the research and decision so to remedy the estrangement between them, improve policy efficiency, solve the subject matter that each hygiene field exists, bring about an continuous advance in coordination of the national health cause.As an important part of the parent project, this research aims at making clear the questions existing in the field of hygiene at the basic level of city in clear specific period, define the key problem need be solved priorily, analyse research development and defect of the key problem, provide researcher the evidence toimportant point, the focus and blank of the research, offer the cut entry thinking clue to policymaker, then make the goal clear, set up an interdynamic platformfor both sides.Research content includes "theoretical demonstration" and "tactful research" two parts.The part of "theoretical demonstration" is formed by three research links: At first through the analysis of basic functions, operation laws, evolution, analysis, policy environments of pecific field to define the scope of field accurately; Then collect, enumerate, sum up, define the question that exists in this field at present and new question that may appear in future, explicate the importance, severity and priority of the problem, and then confirm the key problem and focus question; Finally, know the main research results and research blank to such respects as each focus problem's influence factor, origin, function mechanism, thinking of policy,etc, development and defects of the olicy scheme, scheme enforcement and evalution solveing each problem.The main content of "tactful research" is, following the logical way of thinking of "the scientific procedure of policy formulation ", depending on the research results of "the formualtion and research technique of public policy", according to the principle of standard disparity analysis, by absorbing the reasonable part of the present research, and utilizing the sample data to carries on the simulation, explicate the root and function mechanism of the focus question, develop the strategy, the policy mentality and the operation plan solving the fous question, makes up the remaining blank and the flaw in the certain degree. 2. Materials and Methods2.1 Theoretical DemonstrationThe parent project is guided with scientific procedure of policy formulation, according to process from problem discovery to problem solution, every step pursue layer according to following the progressives way of "whether is mentioned or not-the elaboration method-elaboration degree-elaboration effect", draw up the literature review questionnaire and the data collection table. By testing the reliability and validity of the questionnaire, the results are satisfying.With the established index system, depending on the research results of "the formualtion and research technique of public policy", using the standard disparity analytic method as the instruction method, carries on to comments and analysis of the relevant literatures collected, compare the present research condition and the ideal situation, so to get the place need to study further.2.2 Tatical ResearchAiming at the focus question "the overall quality of health manpower in city grass-roots level is not high", selects 9,682 medical institutions by the multi- stages sampling method, and collect the data with the convention statistical data extraction process, simultaneously carries on the intention investigation to the 2,544 leaderss and 3,328 staff in the sample organization. Using the above material, qualitatively reason and qualitatively prove the root, direct influence factors, indirect influence factors and function mechanism of the focus, and develop policy way of thinking to slove it. 3. Main Resluts3.1 Question DefinitionBy reading and commenting the obtained literature carefully and extensively, comprehensively collect and record the question mentioned in the literature, summarize and induce the different form and content of the each question, forms 60 kinds of question in city grads-roots health domain of our country. According to the dimension "the submodule-concept-target" Provided by the "the health system macro cmodel", reorganize, clsssify the above 60 questions into different submodel, finally forms 30 kind of questions.3.2 Rank the Questions3.2.1 Rank the Question by the ImportanceFollow the principle of the health system macro cmodel, relying on the problem systematic picture of city grass-roots health field, according to 9 scale laws, mark for the importances between 30 kinds of problem through expert consulting, and get the right vector of problem with level analysis, rank the problem according to right vector to carry out row order, the former four important problems are 2nd problem, 6th problem, 27th problem, and 29th problem in sequence.3.2.2 Rank the Question by the SeriousnessUsing the percentage of mention by literature to express the scope of problem seriousness, and choosing such four indexes as research scope, the rank level of researcher and research project source and discussion length to reflect the depth of problem seriousness, synthesize a comprehensive depth coefficient by composing the four indexes, and then rank the 30 kinds of problem with mention frequency and depth coefficient, the former four important problems are 2nd problem, 6th problem, 24th problem, and 28th problem in sequence.3.2.3 Rank the Question by Comprehensive IndexCarry out cluster analysis about the 30 kinds of problem respectively according to importance and seriousness, and divide them into 4 kinds on the basis o the cluster results, namely important and serious, important not serious, serious not important, not serious also not important. The 2nd, 6th, 28th and 29th problems belong to the first kind; the 10nd, 14th and 27th problems belong to the second kind; the 5"d, 19th 24th and 25th problems belong to the third kind; and the left 19 problems belong to the kind of not serious also not important.Adopting the routine-add-arithmetic-average method to calculate the serious index and the important index of every problem, and calculate the weight of the serious index and the important index, so to get the solution priority of every problem, by which rank the 30 kinds of problem order, the former four prior problems are 2nd problem, 6th problem, 28th problem, and 29th problem in sequence.3.3 Research Condition AnalysisBased on the above analysis, choose the three prior problems, 2nd problem, 6th problem and 28th problem, at the same time, select the 2nd problem, 6th problem and 24th problem according the mentin frequency, synthesize the two results and choose the 2nd problem, 6th problem, 24th problem and 28th problems as the focus problem of research.Aiming at the four focus problems, following the scientific procedure of policy formulation, according to the goal gap model, read and comment the research results of present literature, and analyse the following contents in orderfirstly, whether the root, influencing factor and function mechanism of the focus problem is clear or not;secondly, whether have formed policy way of thinking according to root, influencing factor and function mechanism; thirdly, the formed strategy and measure are permanently cure, or merely alleviate the symptoms,or both; fourthly, whether have restraints, advantages and disadvantages, power resistance and feasibility analysis;fifthly, whether the crucial technology, enforcement step, difficulty and condition is clear;in the end, whether the implement effect is appraisesd objectively and ssystematicly.3.3.1 The Current Research Condition of Root and Function MechanismBy Commenting the literature, the research about the root and function mechanism of each keyproblems, loods disperse and summarization with experience, lack systematicness and specific aim, prior order unclear, though it looks cleare basically though summary and induction, the urgentance and necessity of solving the problem is unclear, deep level root and function mechanism excavation needs strengthen, the logicality, scientificity, maneuverability and rationality of the research need strengthen, and the present research lack comprehensive systematic demonstration yet.3.3.2 The Current Research Condition of Policy Thinking WayBased on the Document comment,the trains of policy thinking solving the focus problem are discussion and suggestion that made by the author about each problem, mostly proposed with intuition and experience,and the root and role mechanism are not carried out, its logicality, scientificity, maneuverability and rationality of the research are hard to make one accept; the quantitative systematic research of the restraint condition in conducted process, power, resistance, crucial technology as well as the responsibility of related aspects is nearly blank.3.3.3 The Current Research Condition of Policy SchemeThough there are 57 documents propsing the enforcement to solves focus problem, the majority of which are based on the influencing factor, root and function mechanism of particular focus problem is unclear; he policy way of thinking is made not directing to root and role mechanism, some of which are merely alleviate the symptoms, and not proved systematically, not carrying out an analysis of the restrain condition, power and obstruction, the crucial technology and the responsibility of different aspects d. Therefore, the feasibility of these schemes are poor, lack appraisement index system used to evaluate the implement effect, can not carry out scientific appraisement for policy effect, offer evidence for the direction of the policy.When facing the numerous problems, domestic research present individual and disperse, often excessly emphasize or stress particular theme or problem, mainly comment with experience intuition, lack for the demonstration of focus problem and the problem seriousnesss, and lack for the scientific reasonable demonstration of the influencing factor, root and role mechanism of role mechanism of problem, so the suggestion and measure proposed arise corresponding defect as to the logicality, scientificity, maneuverabilit ,rationality, and prospect, in general, the policy research of city grass-roots health lag behind the process of the macro-economics reform of our country,and behind the city grass-roots health reform of our country, present reform policy guide the situation of research.3.4 Ttactful Research3.4.1 Demonstration with Intention and Sample DataSample organization data prove that, grass-roots health manpower is mainly compose by low educational background and elementary titles; age structure is not reasonable; the majority of the staff are medical major, special field, lack the people with economic and files majority yet; people business level is low, lack high technology, excellent talent, overall quality is not higher; people flow is not reasonable, high quality talent run off serious; the leadership and staff highly agree with the above-mentioned expression form.3.4.2 The Root and Role Mechansim of the Particular ProblemFollowing scientific procedure of policy formulation, on the basis of qualitative and quantitativedemonstration of the focus problem expression, according the 1 logic relation and b order of the submodel in the health system macro model, analyse the possible reason, reasonable reason and feasible reason of focus problem step by setp, and then go from the easy to the difficult and complicated, excavate and approach the root of focus problem, the root of the focus problem is lower social value position and unreasonable wages assignment system.Based on above analysis, induce the fuction mechanism model of the key problem "the overall quality of health manpower in city grass-roots health field of our country, the basic intension and explanation of the modle is as follows:Since the social value of grass-roots health cause society is low, the service value of medical staff do not be embodied, and the current personnel assignment system is not reasonable, so lead to the following results: on the one hand grass-roots health organization is hard to attract excellent talent, and inherent talent run off seriously; on the other hand, plenty of non-technical and low quality people gush in. The existing management system in grass-roots health organization is not perfect, at the same time, iniulenced by the bad socail ideology, as well as drived by economic benefit, some medical staff psychologies lose balance, the discrepancy of wage scale is too small, equalitarianism phenomenon is serious, so they pursue economic benefits partially, overlook social benefit, do not go emphasize the raising of self qualit; in addition, the training system is not perfect, training content lack specific aim, so cause the overall quality of grass-roots health manpower is so low, arouse service quality to drop, satisfactory rate of resident reduce, cause the unsatisfaction and blame from the government, customer's, payment and such social different aspects grow, form vicious circle in the end.3.4.3 The Purpose and TenetTo solve focus problem-'the overall quality of city grass-roots health manpower is low", must carry out the helath institution personnel assignment system reform. So should manifest the purpose of reform: on the basis of eliminateing the problems of the low social value location, the un reasonable wages essential factor and the too small range, forming an effective encourage and restrain mechanism that can reserve and attract talent, and let talent flow reasonably.According to purpose of the health cause assignment system reform, may determine specific goal of the reform: make the value position of city grass-roots health people clear, and determines the assignment factors, decide the suitable ncome gap, determine the criteria of entrance and appraisal.Determine the basic principle that should be followed when developing the policy thinking way: equal principle, fair and comparable priciple, normal increase principle and effective restraint principle.3.4.4 Policy Scheme Aiming at the ProblemAt first, determine the income composition of medical staff well as the suitable proportion fo each part, 90% above sample medical organization leader think, wages should include basic wages, post wages annual merit wages and efficiency, and the each proportion of each part is 26-30%, 40-50%, 5% and 16-20% respectively.Following the policy goals and principles, refereing assignmeng factors abroad as well as the domestic reform experience, determinate 9 essential factors and the corresponding percentage that the medical...
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