自新医改方案颁布实施以来，乡镇卫生院在减轻人民群众就医费用负担，缓解“看病难、看病贵”等方面作出了应有的贡献，然而，一方面解决了基层群众就医难题，另一方面却引发基层卫生院内部管理上诸多问题。最近，笔者以湖北省竹山县楼台乡卫生院为调查对象，展开了一次关于一线医护队伍在新医改实施后存在问题的调查活动。

From the new medical reform plan has been issued and implemented,Township health center in reduce people's medical expense burden,ease"Difficulties in getting/The doctor your"Etc made due contributions,however,On the one hand the masses to solve the medical problems,On the other hand, has generated grassroots health center on the internal management problems.recently,The export in hubei province tower township public health center for research object,Launched a line of about a medical team in the new medical reform after the implementation of the existing problems of the survey.

　　以竹山县楼台乡卫生院为例，医改前，一个季度的营业额平均为50多万元，而2012年一季度总营业额仅为20多万元；医改前该院有医护人员45人，而现在核定编制仅36人，减去后勤、行政人员，一线医护人员只有24人。楼台乡由原沧浪、楼台、三台3个乡镇合并，辖区面积330平方公里，总人口26584人，现实的乡情与医疗服务机构24名一线医护人员难以形成比例，人民群众本应享受的基本医疗服务就存在着大打折扣的问题。

To export tower township public health center as an example,Before the reform,,A quarter of the average for the turnover of more than ten thousand yuan,In the first quarter of 2012 and the total turnover is only twenty more than ten thousand yuan;Before the reform, the hospital medical staff have 45 people,And now only 36 people and prepare,Minus the logistics/Administrative personnel,A line medical personnel only 24 people.A high building by the original township of sea/tower/Three table 3 townships merged,Jurisdiction covers an area of 330 square kilometers,Has a total population of 26584 people,The reality of medical services and medical staff a line to form scale,People should enjoy basic medical service there is a problem.

　　现在走进乡镇卫生院，经常看见只有几个病人在输液，医生办公室也仅有几个医生在上网或是聊天，走廊里也显得冷冷清清。据竹山县楼台乡卫生院张医生介绍，医改前，他们卫生院平时都有10个左右的病人住院，而现在的住院部基本上是空的，很少有病人住院。主要原因是医改后，乡镇卫生院的职能由片面的追求经济效益向给广大人民群众提供基本医疗服务为主转变，医生没有明确的经济效益和工作任务，他们的工作压力小了，工作热情减了，服务水平和能力也有所减弱。另外，医改前，医院医生每个月工资为1390元，加上年终奖金，一年的收入可达到2.8万元，而医改后，每个月1150元，加上绩效工资，全年收入也仅有2.3万元。医生工作的积极性下降。

Now into the rural hospitals,Often see only a few patients in infusion,The doctor's office is only a few doctors in the Internet or chat,The corridor is also cold and cheerless.According to zhang export tower township public health center is introduced,Before the reform,,Their health centre at ordinary times have ten or so of the patients in hospital,But now the inpatient department is basically empty,There are few patients in hospital.The main reason is that after the reform,The functions of the township health center by the one-sided pursuit of economic benefits to the masses to provide basic medical service is given priority to change,The doctor did not have a clear economic benefits and work assignments,Their work pressure small,Working enthusiasm reduced,The service level and ability also weakened.In addition,Before the reform,,Hospital doctors every monthly wages for 1390 yuan,Plus year-end bonus,A year of income can be up to 28000 yuan,After the reform and,1150 yuan every month,Plus performance wage,Annual income is only 23000 yuan.The doctor work enthusiasm decline.

　　乡镇卫生院承担着基层人民群众健康服务的职能，是基层广大人民群众身体健康的“守护神”，为此建议:制定乡镇卫生院中长期发展规划，确保每个乡镇卫生院培植1—2个乡镇重点专科，进一步强化服务特色，增加乡镇卫生院的知名度，吸纳更多的老百姓就近就医。积极向上争取一批先进仪器设备，解决乡镇卫生院仪器设备老化等问题。适当增加乡镇卫生院的人员编制和财政预算，增加职工工资，缩小分配差距，解决医护人员待遇问题。（陈丹 范祎）

Township health center bear the grassroots people's health service function,The basic people's health"Patron saint",This advice: make township health center long-term development planning,To ensure that every township health center cultivating 1-2 key specialty of villages and towns,Further strengthen the service characteristics,Township health center increased visibility,Absorb more people came near to go to a doctor.Positive for a number of advanced instruments and equipment,To solve the new problems, such as equipment aging.Appropriate increase of township health center staffing and budget,Increase worker pay,Narrow distribution gap,To solve medical personnel treatment problem.(ChenDan FanYi)