Construction of China’s Rural Medical Assistance Model: An Evidence-based Approach_Chinese Journal of Evidence-Based Medicine

Authors：

TAO Tiejun ,  LI Youping , MAO Xiu , JING Yuanyuan , YUAN Zhifang , MENG Yue

Chinese Evidence-based Medicine Center, West China Hospital, Chengdu 610041, China;

Corresponding author：

LI Youping, Email: yzmylab@hotmail.com

Keywords：

Evidence-based medicine; Human resources for health; Questionnaire survey; Aid healthcare; Rural area

DOI：

10.7507/1672-2531.20080040

Video：

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Objective　 In light of problems related to the accessibility and affordability of healthcare, we aimed to investigate the status and causes for the shortage of qualified health human resources in the rural and primary health care setting, and to propose solutions to these problems at the level of health policy system.
Methods　 The principles and methods of evidence-based medicine were applied. We developed the study selection criteria on the basis of the proposed questions, and identified relevant literature from biomedical databases and other additional sources. We graded eligible studies, extracted data, and summarized the data to draw conclusions. In addition, we conducted a survey to refine the proposed solutions.
Results　 We identified 147studies from PubMed and CNKI, of which 30were in English. After summarizing the information, and using knowledge about the human resources for health in primary healthcare in China, we proposed a model of resident doctor aid healthcare. The survey that we conducted to assess such a model included interviewees of top level policy makers, medical students and staff in medical universities. Most of the interviewees (85%) thought it was feasible to develop an aid healthcare system. Among those who disagreed, the lack of corresponding policy was the most common factor.
Conclusions　 It is suggested that the government develop relevant policies and make an attempt to practice the aid healthcare system. Emerging problems could be identified and addressed in practice.

Citation： TAO Tiejun,LI Youping,MAO Xiu,JING Yuanyuan,YUAN Zhifang,MENG Yue. Construction of China’s Rural Medical Assistance Model: An Evidence-based Approach. Chinese Journal of Evidence-Based Medicine, 2008, 08(3): 174-181. doi: 10.7507/1672-2531.20080040 Copy

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1. １Wibulpolprasert S. Human Resources for Health Development in the Context of Health Sector Reform. A training module for the Flagship training courses in Health Sector Reform. Washington DC: World Bank 1997.
2. 于浩, 陈英耀. 浅析美国农村的医师短缺问题. 中华医院管理杂志, 2002, 22(11): 58-60.
3. 美国家庭医师协会,http://www.aafp.org/online/en/home.html.
4. Council on graduate medical education. Fourth report: physician workforce funding recommendation for department of health and human service’ program. US bureau of health professionals.1995.
5. Roger A, Rosenblatt C, Holly A, et al. Shortages of medical personnel at community health centers: implications for planned expansion. JAMA, 2006, 295(9): 1042-1049.
6. Pathman DE, Konrad TR, Ricketts TC. The comparative relation of relation of National Health Service corps and other rural physicians: results of 9-year follow up study. JAMA, 1992, 268: 1552-1588.
7. Murray RB, Wronski I. When the tide goes out: health workforce in rural, remote and Indigenous communities. Med J Aust, 2006, 185(1): 37-38.
8. BTB C, Degani N, Crichton T, et al. Factors influencing family physicians to enter rural practice: does rural or urban background make a difference? Can Fam physicians, 2005, 51: 1246-1247.
9. Crandall LA, Dwyer JW, Duncan RP. Recruitment and retention of rural physicians: issues for the 1990s. Journal of Rural Health, 1990, 6: 19-38.
10. Wibulpolprasert S, Ed: Thailand health profile 1999-2000. Bangkok: Veteran Press 2002.
11. Wibulpolprasert S, Pengbaibon P. Integrated strategies to tackle the inequitable distribution of doctors in Thailand, four decades of experience. Human Resources for Health, 2003, 1: 12.
12. Praboromrajchanok Institute for Health Manpower Development, Ministry of Public Health: Project to increase production of doctors for the rural areas (1995-2005). Bangkok: Proboromrajchanok Institute 1995. mimeograph in Thai.
13. Watanasup W, Thansuhutra K, Sunphitak N, et al. Implication of medical student recruitment on distribution of doctors. Thai Medical Council Bulletin, 1993, 11: 573-577.
14. Pannarunothai S, Srithanrongsawat S. The benchmarks of fairness for health system reform: the tool for national and provincial health development in Thailand. Human Resources for Health Development Journal, 2000, 1: 13-26.
15. 四川大学公共卫生学院, 纪念我国著名公共卫生学家陈志潜先生, http://wcsph.scu.edu.cn/cc-chen/cc-chen1.htm.
16. 郭栉懿, 郭开瑜. 农村三级医学保健网的先驱—陈志潜教授. 现代预防医学, 2003, 30(5): 605-607.
17. 陈劭斌. 论“定县模式”中陈志潜教授的主要思想. 现代预防医学, 2004, 31(5): 651-653.
18. 刘衡川. 以人为本, 防治结合——对陈志潜农村医学实践思想的思考. 现代预防医学, 2004, 31(5): 649-650.
19. 吕勇. 赤脚医生的历史作用和对新型农村合作医疗的启示. 卫生软科学, 2006, 20(4): 346-348.
20. 温益群. 赤脚医生——产生和存在社会文化因素. 云南民族大学学报, 2005, 22(2): 60-63.
21. 谷加恩. 人民公社时期农村合作医疗事业成功的原因剖析. 武汉职业技术学院学报, 2006, 5(1): 28-31.
22. 曹普. 1949-1989中国农村合作医疗制度的演变与评析. 中国云南省委党校学报, 2006, 7(5): 41-45.
23. 张志宽. 农村基层卫生人员的前进方向. 中国乡村医药杂志, 2005, 12(10): 3.
24. 中国国防生网站. 国防生的签约、违约及待遇处理. 2005年11月. http://www.guofangsheng.com/n36c27.aspx.
25. 解放军总政有关负责人详解国防生招收选拔政策. 新华网, 2006年4月. http://news3.xinhuanet.com/edu/2006-04/30/content_4493733.htm.
26. 罗嵇宁, 严飞. 乡村一体化的发展、问题与对策. 中国初级卫生保健, 2005, 19(8): 1-3.
27. 杨九龙, 孟庆跃, 董海东. 农村诊所实施乡村一体化管理利弊谈. 中国卫生事业管理, 1998, 14(6): 324-327.
28. 中国国家改革与发展委员会, 就业和收入分配司, 关于引导和鼓励高校毕业生面向基层就业的意见. 中办发[2005]18号, 2005年6月. http://jys.ndrc.gov.cn/zcfg/t20050714_35931.htm.
29. 师范生免费教育后须服务农村3年, 可边支教边读研. 教育部. http://www.moe.gov.cn/edoas/website18/level3.jsp?tablename=1921&infoid=25621.
30. 卫生部办公厅关于开展专科医师培训试点工作的通知, 2006年3月. 卫生部. http://www.moh.gov.cn/newshtml/11525.htm.
31. 关于加快推进新型农村合作医疗试点工作的通知, 卫农卫发(2006)13号, 2006年1月, 卫生部. http://www.moh.gov.cn/newshtml/11283.htm.
32. 美国专科医师协会, www.abms.org.
33. 美国家庭医师委员会, www.aafp.org/online/en/home.html.
34. Annual report and accounts 2006. http://www.gmc-uk.org/publications/annual_reports/annual_review_2006.pdf.
35. 赵树理, 吕春雷. 澳大利亚的全科医师培训及对我国的启示. 中国全科医学, 2002, 5(10): 842-845.
36. Health manpower. Minstry of Health, Sigpore. http://app.moh.gov.sg/sta/sta0106.asp.
37. Number of physicians by province/territory and specialty, Canada, 2003 published by CMA Masterfile, January 2003, Canadian Medical Association. http://www.cma.ca/staticContent/HTML/N0/l2.statinfo/pdf/A1.pdf.
38. 杨卫生, 程艺. 全科/家庭医学在社区卫生服务中的作用. 中国社区医师, 2002, 8: 4-5.

Chinese Journal of Evidence-Based Medicine

Construction of China’s Rural Medical Assistance Model: An Evidence-based Approach

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