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Article(id=1240633245537194002, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401065, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1704297600000, receivedDateStr=2024-01-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773719615586, onlineDateStr=2026-03-17, pubDate=1716566400000, pubDateStr=2024-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773719615586, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773719615586, creator=13701087609, updateTime=1773719615586, updator=13701087609, issue=Issue{id=1240633237542851387, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773719613680, creator=13701087609, updateTime=1773720039302, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240635022806405370, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240635022806405371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1810, endPage=1814, ext={EN=ArticleExt(id=1240633246329917509, articleId=1240633245537194002, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the influencing factors and improvement paths of service capacity in Guangxi township health centers based on fsQCA configuration perspective, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the influencing factors and improvement paths of the service capacity of standardized township health centers in Guangxi under the background of "high-quality service at the grassroots level", providing useful reference for further deepening reform and promoting the healthy development of rural medical and health systems.

Methods

By the end of 2021, township health centers that have reached the recommended standard of "quality service primary line" service ability were selected as the research samples, and the coupled coordination degree model was combined with fuzzy set qualitative comparative analysis method to carry out empirical analysis.

Results

Single factors cannot constitute a necessary condition for improving or decreasing the service capacity of township health centers. There are a total of four configuration paths for improving the service capacity of township health centers in Guangxi, among which the core sufficient conditions for playing a leading role are the number of high-level practicing (assistant) physicians, the number of registered nurses, and coupling coordination scheduling. The overall consistency of the solution is 0.920 (≥0.8), and the model has strong explanatory power.

Conclusion

The improvement of service capacity in township health centers in Guangxi is facilitated by the synergistic effect of multiple factors both internally and externally. The optimization and expansion of grassroots talent teams is the core combination element for the improvement of service capacity in township health centers, and the coupling and coordinated development of medical resource allocation and economy is the key element for the improvement of service capacity.

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目的

分析“优质服务基层行”背景下广西达标乡镇卫生院服务能力的影响因素及提升路径，为进一步深化改革促进乡村医疗卫生体系健康发展提供有益借鉴。

方法

以截至2021年底达到“优质服务基层行”服务能力推荐标准的乡镇卫生院为研究样本，结合耦合协调度模型并运用模糊集定性比较分析法开展实证分析。

结果

单因素均不能构成乡镇卫生院服务能力提升或下降的必要条件，广西乡镇卫生院服务能力提升的组态路径共有4条，其中发挥主导作用的核心充分条件均为高水平执业（助理）医师数、注册护士数以及耦合协调度，总体解的一致性为0.920（≥0.8），模型解释力较强。

结论

广西乡镇卫生院服务能力提升是多要素内外协同效应促成的，其中基层人才队伍优化扩容是乡镇卫生院服务能力提升的核心组合要件，医疗资源配置与经济的耦合协调发展是服务能力提升的关键要素。

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覃娴静，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=j5hStGqZ6x8tnsBDwgUblA==, magXml=QUCELZ5opKSqIhviFLUo1w==, pdfUrl=null, pdf=WD0PFnCKSU29u2uygaaPFg==, pdfFileSize=664838, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=HcA9Kh7ouXzHxoWvD/YU6Q==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=QmVualVaR/Bpczb2tTPG9A==, mapNumber=null, authorCompany=null, fund=null, authors=

黄凌波（1999—），男，硕士在读，研究方向：卫生资源配置

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黄凌波（1999—），男，硕士在读，研究方向：卫生资源配置

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黄凌波（1999—），男，硕士在读，研究方向：卫生资源配置

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Modern Preventive Medicine, 2023, 50(11): 2031-2036., articleTitle=Study on evaluation of operation efficiency of township health centers inShandong Province under the background of Healthy China, refAbstract=null)], funds=[Fund(id=1240633255100207679, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, awardId=GXZC2023-C3-001424-GTZX, language=CN, fundingSource=2023年度广西特色新型智库联盟重大专题研究项目(GXZC2023-C3-001424-GTZX), fundOrder=null, country=null), Fund(id=1240633255209259590, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, awardId=2020JJB180002, language=CN, fundingSource=广西自然基金青年科学基金项目(2020JJB180002), fundOrder=null, country=null), Fund(id=1240633255309922892, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, awardId=DC2300001785, language=CN, fundingSource=广西医科大学优秀博士人才科研基金资助项目(DC2300001785), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240633247948918990, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, xref=1., ext=[AuthorCompanyExt(id=1240633247953113295, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, companyId=1240633247948918990, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Health and Health Policy Research Center, Guangxi Medical University (Guangxi High-end think tank construction and cultivation unit), Nanning, Guangxi 530021, China), AuthorCompanyExt(id=1240633247961501904, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, companyId=1240633247948918990, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广西医科大学卫生与健康政策研究中心（广西高端智库建设培育单位），广西 南宁 530021)]), AuthorCompany(id=1240633248053776603, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, xref=2., ext=[AuthorCompanyExt(id=1240633248057970908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, companyId=1240633248053776603, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广西医科大学信息与管理学院)])], figs=[ArticleFig(id=1240633252759785984, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, language=EN, label=Fig.1, caption=Service capacity driving mechanism model of township health center, figureFileSmall=aRSQwFJ6CbEOimD5nfekqg==, figureFileBig=HcA9Kh7ouXzHxoWvD/YU6Q==, tableContent=null), ArticleFig(id=1240633252894003721, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, language=CN, label=图1, caption=乡镇卫生院服务能力驱动机制模型, figureFileSmall=aRSQwFJ6CbEOimD5nfekqg==, figureFileBig=HcA9Kh7ouXzHxoWvD/YU6Q==, tableContent=null), ArticleFig(id=1240633254479450646, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, language=EN, label=Table 1, caption=

Calibration of fuzzy set variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类型二级变量指标编码完全隶属交叉点完全不隶属
结果变量服务能力Y0.5830.3060.097
执业（助理）医师数（人）X1643721
注册护士数（人）X2874825
财政拨款收入（千元）X314 889.47 0294 253
条件变量业务用房面积（m2）X410 939.25 9353 071.2
万元以上设备台数（台）X5179.47120.8
实有床位数（张）X623013062.6
耦合协调度X70.6130.4640.312
), ArticleFig(id=1240633254575919645, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, language=CN, label=表1, caption=

模糊集变量的校准点

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类型二级变量指标编码完全隶属交叉点完全不隶属
结果变量服务能力Y0.5830.3060.097
执业（助理）医师数（人）X1643721
注册护士数（人）X2874825
财政拨款收入（千元）X314 889.47 0294 253
条件变量业务用房面积（m2）X410 939.25 9353 071.2
万元以上设备台数（台）X5179.47120.8
实有床位数（张）X623013062.6
耦合协调度X70.6130.4640.312
), ArticleFig(id=1240633254668194340, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633245537194002, language=EN, label=Table 2, caption=

Necessity analysis of individual conditions

, figureFileSmall=null, figureFileBig=null, tableContent=
条件变量结果变量
Y~Y
一致性覆盖度一致性覆盖度
X10.8260.8220.4350.457
~X10.4550.4330.8300.834
X20.8410.8230.4510.466
~X20.4550.4400.8290.846
X30.6040.6250.5720.624
~X30.6370.5850.6570.637
X40.6220.6450.5600.613
~X40.6270.5740.6760.654
X50.6320.6290.5610.589
~X50.5870.5590.6460.650
X60.6300.6200.6030.627
~X60.6200.5970.6340.644
X70.7790.7590.4790.492
~X70.4780.4650.7650.785
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单个条件的必要性分析

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条件变量结果变量
Y~Y
一致性覆盖度一致性覆盖度
X10.8260.8220.4350.457
~X10.4550.4330.8300.834
X20.8410.8230.4510.466
~X20.4550.4400.8290.846
X30.6040.6250.5720.624
~X30.6370.5850.6570.637
X40.6220.6450.5600.613
~X40.6270.5740.6760.654
X50.6320.6290.5610.589
~X50.5870.5590.6460.650
X60.6300.6200.6030.627
~X60.6200.5970.6340.644
X70.7790.7590.4790.492
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Configuration of high service capacity of township health center

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条件变量H1H2H3H4
X1：执业（助理）医师数●●●●
X2：注册护士数●●●●
X3：财政拨款收入○○
X4：业务用房面积▲▲○
X5：万元以上设备台数○▲
X6：实有床位数○○▲▲
X7：耦合协调度●●●●
一致性0.9150.9090.9370.958
原始覆盖度0.3350.3820.2990.258
唯一覆盖度0.0190.0870.0730.039
总体一致性0.920
总体覆盖度0.566
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乡镇卫生院高服务能力的组态

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条件变量H1H2H3H4
X1：执业（助理）医师数●●●●
X2：注册护士数●●●●
X3：财政拨款收入○○
X4：业务用房面积▲▲○
X5：万元以上设备台数○▲
X6：实有床位数○○▲▲
X7：耦合协调度●●●●
一致性0.9150.9090.9370.958
原始覆盖度0.3350.3820.2990.258
唯一覆盖度0.0190.0870.0730.039
总体一致性0.920
总体覆盖度0.566
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基于fsQCA组态视角的广西乡镇卫生院服务能力的影响因素与提升路径研究
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黄凌波 1, 2 , 徐诗琦 1, 2 , 刘佩芸 1, 2 , 蒙珊珊 1, 2 , 康静 1, 2 , 冯启明 1, 2 , 覃娴静 1, 2
现代预防医学 | 基层卫生服务 2024,51(10): 1810-1814
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现代预防医学 | 基层卫生服务 2024, 51(10): 1810-1814
基于fsQCA组态视角的广西乡镇卫生院服务能力的影响因素与提升路径研究
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黄凌波1, 2, 徐诗琦1, 2, 刘佩芸1, 2, 蒙珊珊1, 2, 康静1, 2, 冯启明1, 2, 覃娴静1, 2
作者信息
  • 1.广西医科大学卫生与健康政策研究中心（广西高端智库建设培育单位），广西 南宁 530021
  • 2.广西医科大学信息与管理学院

    • 黄凌波（1999—），男，硕士在读，研究方向：卫生资源配置

通讯作者:

覃娴静，E-mail：
Research on the influencing factors and improvement paths of service capacity in Guangxi township health centers based on fsQCA configuration perspective
Ling-bo HUANG1, 2, Shi-qi XU1, 2, Pei-yun LIU1, 2, Shan-shan MENG1, 2, Jing KANG1, 2, Qi-ming FENG1, 2, Xian-jing QIN1, 2
Affiliations
  • Health and Health Policy Research Center, Guangxi Medical University (Guangxi High-end think tank construction and cultivation unit), Nanning, Guangxi 530021, China
出版时间: 2024-05-25 doi: 10.20043/j.cnki.MPM.202401065
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摘要
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目的

分析“优质服务基层行”背景下广西达标乡镇卫生院服务能力的影响因素及提升路径，为进一步深化改革促进乡村医疗卫生体系健康发展提供有益借鉴。

方法

以截至2021年底达到“优质服务基层行”服务能力推荐标准的乡镇卫生院为研究样本，结合耦合协调度模型并运用模糊集定性比较分析法开展实证分析。

结果

单因素均不能构成乡镇卫生院服务能力提升或下降的必要条件，广西乡镇卫生院服务能力提升的组态路径共有4条，其中发挥主导作用的核心充分条件均为高水平执业（助理）医师数、注册护士数以及耦合协调度，总体解的一致性为0.920（≥0.8），模型解释力较强。

结论

广西乡镇卫生院服务能力提升是多要素内外协同效应促成的，其中基层人才队伍优化扩容是乡镇卫生院服务能力提升的核心组合要件，医疗资源配置与经济的耦合协调发展是服务能力提升的关键要素。

乡镇卫生院  /  卫生资源配置  /  服务能力
Objective

To analyze the influencing factors and improvement paths of the service capacity of standardized township health centers in Guangxi under the background of "high-quality service at the grassroots level", providing useful reference for further deepening reform and promoting the healthy development of rural medical and health systems.

Methods

By the end of 2021, township health centers that have reached the recommended standard of "quality service primary line" service ability were selected as the research samples, and the coupled coordination degree model was combined with fuzzy set qualitative comparative analysis method to carry out empirical analysis.

Results

Single factors cannot constitute a necessary condition for improving or decreasing the service capacity of township health centers. There are a total of four configuration paths for improving the service capacity of township health centers in Guangxi, among which the core sufficient conditions for playing a leading role are the number of high-level practicing (assistant) physicians, the number of registered nurses, and coupling coordination scheduling. The overall consistency of the solution is 0.920 (≥0.8), and the model has strong explanatory power.

Conclusion

The improvement of service capacity in township health centers in Guangxi is facilitated by the synergistic effect of multiple factors both internally and externally. The optimization and expansion of grassroots talent teams is the core combination element for the improvement of service capacity in township health centers, and the coupling and coordinated development of medical resource allocation and economy is the key element for the improvement of service capacity.

Township health centers  /  Health resource allocation  /  Service capability
黄凌波, 徐诗琦, 刘佩芸, 蒙珊珊, 康静, 冯启明, 覃娴静. 基于fsQCA组态视角的广西乡镇卫生院服务能力的影响因素与提升路径研究. 现代预防医学, 2024 , 51 (10) : 1810 -1814 . DOI: 10.20043/j.cnki.MPM.202401065
Ling-bo HUANG, Shi-qi XU, Pei-yun LIU, Shan-shan MENG, Jing KANG, Qi-ming FENG, Xian-jing QIN. Research on the influencing factors and improvement paths of service capacity in Guangxi township health centers based on fsQCA configuration perspective[J]. Modern Preventive Medicine, 2024 , 51 (10) : 1810 -1814 . DOI: 10.20043/j.cnki.MPM.202401065
正文
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自2018年明确开展“优质服务基层行”活动以来，广西的乡镇卫生院不断补短板、强弱项，稳步提升服务能力并取得了阶段性成效[1]，2022年起将用3年时间对已达标尤其是达到推荐标准的机构开展复核评价“回头看”。同时，广西是西部边疆少数民族地区，基层医疗卫生发展相对薄弱，乡镇卫生院作为三级医疗卫生服务网的枢纽，其服务水平仍有待提高[1-2]。因此，有必要探讨总结活动开展以来已达标乡镇卫生院服务能力的影响机制与提升路径，进一步发挥《乡镇卫生院服务能力评价指南（2023版）》的导向作用。以往学者主要通过医疗资源投入的公平、效率等方式对乡镇卫生院服务能力进行探讨[3-5]，但容易忽略不同维度内部要素间相互影响以及内外环境的互动。基于此，本研究综合运用定量与定性相结合的方式，采用模糊集定性比较分析法从组态视角分析医疗卫生资源的配置对乡镇卫生院服务能力提升的主导作用及影响机制，以期为进一步深化改革促进乡村医疗卫生体系健康发展提供有益借鉴。
1　资料与方法
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1.1　资料来源
本研究选取截至2021年底在“优质服务基层行”活动中服务能力达到推荐标准的乡镇卫生院为研究样本，排除其中数据缺失的4家，最终纳入115家，其中乡镇卫生院医疗卫生资源配置的数据来源于卫生健康统计信息系统，区域经济水平的数据来源于《2022广西统计年鉴》。
1.2　研究方法
1.2.1　耦合协调度模型
本研究借鉴容量耦合概念及模型，将乡镇卫生院医疗资源配置与区域经济发展水平视为两个系统，测算两系统间耦合协调度，用以评价相互影响、协调促进的动态依赖关系[6]。借鉴相关学者研究成果[4,7-8]，并依据国家卫生健康委的《基层医疗卫生机构发展和服务国家级绩效评价方案（2022）》，结合指标的代表性、典型性与可获得性原则，分别从人、财、物力三个方面选取执业医师（助理）数、注册护士数、财政拨款收入、业务用房面积、万元以上设备台数、实有床位数作为衡量乡镇卫生院医疗卫生资源配置的指标；选取地区GDP、一般公共预算收入、人均可支配收入、人均GDP作为衡量地方经济发展水平的指标。耦合协调度计算的具体公式如下：
其中公式（1）中，μ1为医疗资源配置子系统的综合评价指数、μ2为地方经济水平子系统的综合评价指数，计算得到两个系统的耦合度C；公式（2）、（3）中，T为两个系统的综合评价指数，α、β分别为两者的贡献系数，且α+β=1，以此计算得到两个系统的耦合协调度D。D的取值范围为0~1，0≤D≤0.4为失调衰退区间，0.4<D≤0.6为过渡调和区间，0.6<D≤1为协调发展区间[7]。
1.2.2　模糊集定性比较分析法
模糊集定性比较分析（fuzzy-set Qualitative Comparative Analysis, fsQCA）是近年来社会学及管理学领域新兴的中小样本数据研究方法，在医疗卫生领域亦具备较好的研究前景[9]。本研究通过fsQCA组态视角解决了使用一般定量研究无法得出多因素组合的困境，能够探究乡镇卫生院资源配置的前因变量组合是否能充分地产生服务能力提升的结果，并比较分析某一组态或条件是否出现主导作用。
一般而言，fsQCA研究中条件的数量保持在6~8条的合适水平，以实现条件数量与案例数量、分析结果简约性之间的平衡[10]。本研究以上述乡镇卫生院医疗卫生资源配置的指标以及耦合协调度作为组态分析的条件变量，以诊疗人次数和出院人数的综合评价指数作为组态分析的结果变量衡量乡镇卫生院的服务能力水平[6]，构建研究框架见图1。
1.3　统计学方法
本研究首先采用Excel 2021对数据进行整理与清洗，计算出耦合协调度D；其次进行变量的校准；最后将通过fsQCA4.1软件进行必要性检验、组态充分性分析以及稳健性检验，明确核心影响因素。
2　结果分析
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2.1　耦合协调度分析
在达标的115家乡镇卫生院中，医疗卫生资源配置与地方经济发展水平达到协调发展区间的数量最少，仅有15家，占13.04%；处于过渡调和区间的乡镇卫生院数量最多，有68家，占59.13%；而处于失调衰退区间的乡镇卫生院有32家，占27.83%。进一步分析发现，达到协调发展区间的乡镇卫生院，其服务能力也较高；而处于失调衰退区间的乡镇卫生院，其服务能力也较差。
2.2　模糊集定性比较分析
2.2.1　数据校准
采用直接校准法分别将变量描述性统计的90%分位数、中位数、10%分位数设定为完全隶属、交叉点、完全不隶属的锚点，校准后的集合隶属于0~1，见表1。此外，为避免案例隶属度恰好为0.50而导致计算过程中的数据丢失，本文将得到的隶属度统一加上0.001常数。
2.2.2　单个条件的必要性分析
必要性检验显示，单个条件变量对乡镇卫生院高/非高水平服务能力的必要条件一致性均小于0.9，表明这7个条件变量均不能单独构成乡镇卫生院服务能力提升或下降的必要条件，见表2。同时这也说明乡镇卫生院服务能力提升的是诸多复杂因素共同作用的结果，因此有必要进一步进行多个变量组态分析。
2.2.3　组态分析
本研究将一致性阈值设定为0.8，频数阈值设定为2，PRI阈值设定为0.7，最终输出的组态充分性分析结果显示，广西乡镇卫生院服务能力的提升路径共有4条，H1~H4总体解的一致性为0.920（≥0.8），表明在满足解的条件组态案例中，有92%的案例呈现出较高水平服务能力，可说明本研究组态分析结果解释力较强；总体解的覆盖度为0.566（≥0.5），表明组态可以解释56.6%的高水平服务能力案例，见表3。其中，4条高水平组态路径中发挥主导作用的核心条件均为执业（助理）医师数、注册护士数以及耦合协调度，因此互为二阶等价组态。
2.2.4　稳健性检验
QCA是一种集合论方法，轻微改变操作所产生的结果不会改变已有的实质解释。因此，通过分别调整校准锚点、原始一致性阈值、PRI阈值验证结果的稳健性，得到的组态与现有组态解释基本一致，可说明本研究组态分析结果较为稳健。
3　讨论与建议
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3.1　基层人才队伍优化扩容是乡镇卫生院服务能力提升的核心组合要件
通过组态分析结果可知，执业（助理）医师数以及注册护士数是乡镇卫生院服务能力提升路径中的核心充分条件，在不同的组态路径中都持续地发挥着主导作用。也就是说，通过加强基层人才队伍建设与优化人力资源配置对于推动乡镇卫生院服务能力提升的促进作用较大。这与2023年8月广西壮族自治区人民政府办公厅印发的《关于进一步深化改革促进广西乡村医疗卫生体系健康发展若干措施》（桂政办发〔2023〕53号）中强调深入开展“优质服务基层行”活动，加强乡村医疗卫生人才队伍建设的政策目标导向相一致。同时结合现状来看，虽然目前乡镇卫生院卫生人员总数逐年增加，但人才短缺、招聘困难、断层老龄化的现象仍是其发展中面临的突出问题[11]，并存在着缺乏具有相应职称和资质的卫生技术人员操作设备的情况，难以有效将医疗卫生资源转化为较优的医疗服务[12]。因此，仍需进一步加强乡镇卫生院引才留才的投入与培养，优化人才队伍规模、结构和能力与当地人民群众健康服务需求相适应。
政府层面，完善并扩大乡镇卫生院农村订单定向免费医学生培养规模，特别是加强壮瑶等少数民族农村地区卫生人力资源的投入与培养，多措并举充实乡镇卫生院的人才队伍，使人才“招得来”、“留得住”[12]。医共体层面，通过推行“县聘乡用”盘活用好县域编制资源并完善绩效管理激励方案，拓宽人才的流动共享空间，调动医务人员下沉的积极性[13]。乡镇卫生院层面，加大对乡村医疗卫生人才激励政策的贯彻力度，结合本单位特点制定奖励性绩效工资分配办法，完善提高乡镇卫生院人员收入和待遇保障机制。
3.2　乡镇卫生院医疗资源配置与经济的耦合协调发展是服务能力提升的关键要素
地方经济水平是基层医疗体系建立健全的基础，而医疗资源配置的优化也有助于进一步推动经济水平发展，二者相辅相成、相互依存[7]。通过结果分析可知，一方面，乡镇卫生院医疗资源配置与地方经济水平发展的耦合协调度是实现高水平乡镇卫生院服务能力的核心条件，达到协调发展区间的乡镇卫生院，其服务能力也较高，处于失调衰退区间的乡镇卫生院，其服务能力也较差，而目前只有少部分乡镇卫生院能勉强达到协调发展区间，大多数乡镇卫生院仍处于过渡调和区间和失调衰退区间。另一方面，在不同的高水平组态路径中，财政拨款、业务用房、设备以及床位数仅作为边缘辅助条件存在，这提示着特别是在医疗卫生资源短缺、经济水平相对落后的县区，乡镇卫生院单纯靠政府拨款、扩院区、添设备、增床位难以从根本上解决问题。因此，在注重乡镇卫生院扩容发展建设的同时，也要进一步优化医疗资源配置水平与地方经济水平的耦合协调发展。同样的，协调发展的乡镇卫生院也能吸引更多优质的人才，从而进一步促进当地的发展建设。
各地政府相关部门应以优化资源配置和控制医疗成本为重点，以服务人口和需求相适应为原则[14]，建立与当地经济发展水平相协调的乡村医疗卫生体系地方投入机制，统筹规划县域内医疗资源配置的数量和布局，因地制宜将达到推荐标准的乡镇卫生院打造成具有一定辐射带动作用的县域医疗卫生次中心。此外，自治区层面也应加大统筹力度，对于经济欠发达地区的乡镇卫生院也应加大政策倾斜和经费支持，促进乡村医疗卫生体系健康、均衡、可持续发展。
3.3　多要素内外协同效应促成乡镇卫生院服务能力提升
经过必要性检验可知，乡镇卫生院服务能力提升或下降并非完全取决于单一要素，而是多因素协同效应共同作用的结果，这也与既往的研究结果相一致[14]。对于不同规模、地区经济水平的乡镇卫生院来说，虽然驱动其服务能力提升的实践路径具有多重选择性，但提升服务能力的维度是“多重并发”、“殊途同归”的[15]。这主要体现在满足执业（助理）医师、注册护士以及耦合协调度为核心条件的情况下，辅之以不同的边缘条件搭配亦能形成促进乡镇卫生院服务能力提升的动力来源，而如若在缺乏这些核心条件，即使辅之以其他条件也难以促进乡镇卫生院服务能力的提升。换言之，如果乡镇卫生院自身拥有较为充足的人力资源，且整体医疗资源配置与区域经济水平具有良好的协同性，那么内部要素间的互动匹配以及内外要素的协同发展就能够最大化发挥其合力，更好地实现服务能力的提升。
因此，各地政府需切实结合不同的政策工具，因地制宜探索符合当地乡镇卫生院的发展道路，在发挥卫生人力资源配置与环境相融合的核心作用的同时，也要科学动态调整物力、财力等多重条件的协同匹配，促进乡镇卫生院规模与服务利用相适应，投入规模与资源利用率的同步发展，进一步拓展服务能力提升的动力来源和提升路径[16]。
基金
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  • 2023年度广西特色新型智库联盟重大专题研究项目(GXZC2023-C3-001424-GTZX)
  • 广西自然基金青年科学基金项目(2020JJB180002)
  • 广西医科大学优秀博士人才科研基金资助项目(DC2300001785)
文献
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2024年第51卷第10期
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doi: 10.20043/j.cnki.MPM.202401065
  • 接收时间：2024-01-04
  • 首发时间：2026-03-17
  • 出版时间：2024-05-25
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  • 收稿日期：2024-01-04
基金
2023年度广西特色新型智库联盟重大专题研究项目(GXZC2023-C3-001424-GTZX)
广西自然基金青年科学基金项目(2020JJB180002)
广西医科大学优秀博士人才科研基金资助项目(DC2300001785)
作者信息
    1.广西医科大学卫生与健康政策研究中心（广西高端智库建设培育单位），广西 南宁 530021
    2.广西医科大学信息与管理学院

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Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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