健康乡村建设视阈下乡村医生队伍脆弱性形成机理与治理策略研究—以山东省为例

The healthy village construction is one of the key ways to implement the two strategies of Rural Revitalization and Healthy China. It has put forward new and higher requirements for village health services. At present, the vulnerability of the village clinic doctors is increasing, the weakness and failure of village clinic doctors' function are highlighted, which has formed a prominent contradiction with the healthy village construction. Therefore, to effectively govern the village clinic doctors' vulnerability is not only an urgent requirement to strengthen rural health service network, but also the meaning of healthy village construction. This study will be developed follow the link of definition of connotation-current description-analysis of the vulnerability formation mechanism- prediction of the vulnerability future state- development of governance strategy. Qualitative and quantitative methods will be adopted to define the connotation of the village clinic doctors' vulnerability from disturbing force and response force under the perspective of healthy village construction, and clarify its components; then describe the status of village clinic doctors' vulnerability, and identify the main contributing factors; analyze its formation mechanism, predict its future development scenario, and design the comprehensive governance strategy of village clinic doctors' vulnerability from two levels: the resolution of the status of vulnerability and preparation for the future of vulnerability. This study will provide theoretical reference and support for the policy optimization and improvement of village clinic doctors' related policies, which has important practical significance to consolidate the rural health service network and promote the healthy village construction.

健康乡村建设是落实乡村振兴和健康中国两大战略的关键路径之一，其对村级卫生服务提出了新的更高的要求。当前村医队伍脆弱性不断加剧，功能弱化和失效问题凸显，与健康乡村建设的新要求形成了突出矛盾。因此，有效治理村医队伍的脆弱性既是筑牢农村医疗卫生服务网底的迫切要求，也是健康乡村建设的题中之义。本研究遵循内涵界定-现状描述-脆弱性形成机理分析-脆弱性未来状态预测-治理策略研制的思路，采用定性与定量相结合的方法，从扰动力和应对力两个维度界定健康乡村建设视阈下村医队伍脆弱性的内涵，明确其构成要素；然后综合描述村医队伍脆弱性的现状，并识别主要贡献因素；分析脆弱性形成机理，预测其未来的发展情景，从脆弱性现状的解决和未来的准备两个层面，设计综合治理策略。本研究将为乡村医生相关政策的优化与完善提供理论借鉴和支持，对于巩固农村卫生服务网底，推进健康乡村建设，具有重要的实践意义。

乡村医生是我国农村医疗卫生服务网的网底，长期以来，在保障农村居民健康方面发挥了重要作用。然而，受多方因素影响，乡村医生队伍的脆弱性不断加剧，与健康乡村建设形成了突出矛盾。本研究综合运用社会学、管理学、灾害学的理论与方法，遵循概念界定-研究维度构建-现状分析与评价-脆弱性产生及影响机制分析-脆弱性发展情景分析-应对策略研制的研究思路，定性与定量相结合，界定了乡村医生队伍脆弱性的内涵，并研制了测量工具，描述了新医改背景下山东省乡村医生队伍脆弱性的现状，厘清了脆弱性产生的机理，预测了其未来发展情景，并从扰动力缩减、脆弱性预备和脆弱性恢复三个方面研制了治理策略。. 研究显示，78.7%的村医认为自身面临的扰动力较大，环境源扰动的贡献高于工作源扰动，分别为61%和39%。85.3%的村医认为自身的应对力较高，但经济性支持偏低，仅为6.4%。乡村医生的脆弱性指数为0.49±0.06分，“危机”型脆弱性占比最大，为35.41%。50岁以下、初中及以下学历、工作40年以下、非一体化管理的村医的脆弱性水平相对较高。乡村医生队伍的脆弱性是在面临的扰动和具备的应对力共同作用下，四类互动效应综合作用的结果，其未来发展呈现慢性恶化情景的概率最大，为38.9%。. 课题组依托本项目发表论文17篇，其中SSCI/SCI论文2篇，北大核心期刊论文14篇；会议论文5篇；出版专著1部，在德国HTAi2019国际大会等国内外学术会议上作报告和壁报展示9次；获各类奖项13项。培养毕业博士1名，毕业硕士4名，毕业本科生2名，在读硕士2名。研究成果引起国家卫健委卫生发展研究中心、清华大学等单位的重视，并得到一定程度的应用。