| ObjectiveThis study takes the year of 2015 as the time point for reform,2014 is before reform and 2016 is a year after reform start.To analyze the distribution and changes of health manpower in 36county-level public hospitals in the third batch of county-level public hospitals in Guangxi one year before and one year after the reform start;To compare the health human resources allocation of county public hospitals reformed in the first year after the comprehensive reform start with the corresponding national standards,at the same time based on population area distribution to evaluate public hospital in the three years of health human resources the development and change of fairness and impartiality;To timely discover the problems existing in the allocation of health human resources in county-level public hospitals in the early stage of reform,and to provide reference for optimizing the allocation of health human resources in Guangxi,further deepening reforms,and ensuring the smooth progress of reform.Method Using self-designed questionnaires to investigate 36 county-levelpublic hospitals.The average number,structure,utilization and continuing education of health human resources in 36 county public hospitals from 2014 to2016 and the changes of health human resourceswere analyzed by descriptive analysis in three years.The changes of health human resources in hospitals in three years were analyzed and the current situation of the distribution of health human resources in 2016 was compared with the average level of national public hospitals and the whole Guangxi autonomous region.Lorentz curve and Gini coefficient were used to evaluate the equity of population and area distribution of health human resources in 36 county-level public hospitals.Result 1.From the perspective of the number of health personnel,the total number of health personnel in 36 county public hospitals increased 12.06%,from 18 084 in 2014 to 20 564 in 2016.The average number of health technicians per thousand population increased from 1.34 in 2014 to 1.49 in 2016,and the average number of health technicians per square kilometer increased from 0.181 in 2014 to 0.205 in 2016,which are all lower than the national and regional average level.2.As for the allocation of health personnel,the changes of the allocation of public hospitals in 36 counties are more complicated.The average proportion of assistant practicing doctors with higher education and professional titles in the total number of doctors,the average proportion of health technicians,and the average ratio of health technicians to beds all reached the national average level and standard in 2016;however,the average proportion of staffing personnel fell to 42.9% in 2016 from 46.21% in 2014,and the average proportion of contracted personnel increased from 52.17% in 2014 to 55.66% in 2016.3.From the perspective of the utilization effective of health personnel,the average number of doctors in 36 county public hospitals increased from 9.84 in2014 to 9.94 in 2016,the average number of doctors in hospital decreased from3.72 in 2014 to 3.18 in 2016,and the utilization rate of beds decreased from95.42% in 2014 to 85.14% in 2016.The utilization effective is above the national and regional average level and within the standard range.4.From the perspective of continuing education of health personnel,the training funds for health personnel in 36 county public hospitals increased steadily in the past three years,but the proportion didn't change significantly;the average number of health personnel to higher-level hospitals for further education increased from 14.22 in 2014 to 15.92 in 2016,and the average number of short-term outgoing trainers increased from 151.33 in 2014 to 205.94 in 2016.Compared with other provinces,the situation of continuing education is not optimistic.5.From the point of view of fairness of health personnel allocation,the Gini coefficient of health technicians in 36 county public hospitals declined from 2014 to 2016,mainly in the range of 0.2-0.3,in a fairer state.The Lorentz curve of health technicians became smaller from 2014 to 2016,but the Lorentz curve of medical practitioners(assistants)was more curved than that of health technicians and registered nurses.Conclusion 1.The total number of health personnel in the third batch of reformed county and county public hospitals in Guangxi was increased,but the number was still relatively insufficient,especially the number of assistant practicing doctors.2.The composition of health human resources in the third batch of reformed county and county public hospitals in Guangxi has been greatly improved.The proportion of doctors' professional titles and higher education,the proportion of health personnel and the ratio of health personnel to beds havereached the national standard or the national average level.It showed that the health manpower allocation of the third batch of county public hospitals was better in the early stage of reform.3.The service volume of the third batch of reformed county and county public hospitals in Guangxi was increased,the daily average workload of doctors was also increased,and the doctors' work pressure was increased.At the same time,the utilization rate of beds in county public hospitals was became more reasonable and the efficiency of beds was increased.4.The third batch of reforms in Guangxi has reduced the number of county public hospitals and increased the number of contract appointments,which meets the requirements of the Ministry of Health to deepen the personnel reform mechanism,but at the same time,the growth rate of the number of health personnel has slowed down;the situation of continuing education of health personnel was also poor,and the reform of county public hospitals needs to improve the situation of continuing education of health personnel.5.The fairness of health human resources allocation in the third batch of reformed county and county public hospitals in Guangxi need to be improved,and the fairness of population distribution was better than that of geographical distribution.The fairness of the allocation of assistant practicing doctors was not as good as the health personnel and registered nurses.Reforming the allocation of assistant practicing doctors in county public hospitals needs to be improved. |
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