| Objective:To state the current status of rural health human resources integration in Fujian Province.Summarizing and comparing several kind of integration modes and clarifying the effects of integration,and the problems and major obstacles in the process,then analyzing the willingness and influencing factors of rural health personnel to participate in the integration of health human resources.We will propose targeted recommendations for the improvement of modes mentioned above.Methods:Using the literature research method and interview method,We will state the current situation of health human resources in the township and village level,and conclude the specific practices and main difficulties of the rural health human resources integration modes and summarize them.Using questionnaire survey and discrete choice experiment method to collect the willingness of hospital doctors and township hospital doctors to participate in the integration of rural health human resources and its influencing factors.150 county hospital doctors in Fuzhou,Sanming,Ningde and Nanping cities were investigated by stratified sampling,171 doctors from township hospitals in Fuzhou,Sanming,Longyan,Nanping and Ningde were surveyed.We analyzed the data with the descriptive statistics and the Mixed logit method,so that to understand the monetary value of the work attributes of the doctors in the county hospital and the doctors in the township hospitals,and the changes in the work selection ratio of the surveyed subjects when the work attribute level changes.Result:(1)There are two main forms of health human resources integration models in the province: Document-guided integration model of health human resources and integrated mode of independent exploration.(1)Document-guided integration model of health human resourcesmainly includes the rural health service integrated managementand the county hospitals to send doctors to the township hospitals for technical assistance(county-township mode).Due to the fact that the financial subsidies are not in place,the “seven unification” rural health service integration management work is difficult to advance,and currently only the “two unifications” can be realized;Due to the limited degree of interest,the level of township hospitals,etc.,some county hospitals have not really provided technical assistance to township hospitals.However,the implementation of the technical assistance provided by the county hospitals to the township hospitals will contribute to the improvement of the medical service level and technical capabilities of the township hospitals.(2)The integration of self-exploration mainly has two main forms,one is the township hospitals to send doctors to the “out of country doctor village”(township-village mode),the other is nearby village doctors go to “out of country doctor village”(village-village mode)to provide medical and health services.Although the integration model of self-exploration encounters problems and difficulties such as low enthusiasm of doctors and the restrictions on the practice location of village doctors,it can achieve certain results for solving the problem of medical treatment for villagers in “out of country doctor village”.(2)The job preferences of county hospital doctors and township hospitals and the factors affecting their participating in rural health human resources integration are as follows:(1)The job preferences of doctors in county hospitals and doctors in township hospitals are affected by many factors.Doctors in county hospitals had significant preference for salary,preparation,training opportunities and promotion period.Doctors in township hospital had significant preference for salary,preparation,go to “out of country doctor village”and provide health services,promotion period and priority promotion.(2)The respondents all preferred the income attribute.Among the non-economic factors,the most popular among the county hospital doctors and the township hospital doctors were the promotion period(?=1.9)and the preparation conditions(?=1.7)respectively.(3)Both county hospital doctors and township hospital doctors had job preference heterogeneity.For example,although 74% of county hospital doctors do not prefer to provide technical assistance to township hospitals,26% of doctors are on the opposite.Although 75% of township health hospital doctors do not prefer to provide services to villagers in the “out of country doctor village”,but the remaining 25% are on the opposite.(4)The job attributes of the county hospital doctors and township hospital doctors with the highest monetary value are the promotion period(3544.21 yuan/month)and the preparation(2442.41 yuan/month)respectively.(5)The highest value of job selection in the county hospital doctors and township hospital doctors after the change in the job attribute level is the promotion period(21.46%)and the preparation(20.94%)respectively.Conclusion:The urbanization process,the operation mode of village clinics and the lack of village doctors produced many“out of country doctor village”in Fujian Province,moreover,there is a shortage of health talents in township health centers.Therefore,there is a need for integration of health human resources and the existing rural health human resources should be fully utilized.In addition to the integrated management of rural health services,the other three integration modes have been implemented,which will play a role in improving the capacity of doctors in township hospitals and alleviating the problem of“out of country doctor village”.Considering the efficiency of public resource allocation and the variety of forms and effects,it is necessary to further standardize and improve the integration modes based on geographical location,resident population and specific conditions of township hospitals step by step.in the meantime,we should pay attention to the wishes of the participants,especially the small group of people who are willing to participate. |
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