健康乡村建设长路漫漫

乡村振兴战略深入实施，改善乡村居民健康任重道远。目前，城乡卫生健康事业发展尚存显著差距，农村卫生健康服务存在明显短板，乡村居民的健康需求得不到有效满足。为了更好地维护农村居民健康，提供更优质的医疗服务，国家卫健委同其他十三个部委近期发布《关于推进健康乡村建设的指导意见》，大力推动乡村医疗服务卫生机构建设，着力提升乡村医疗服务水平，加强乡村居民医疗保障服务。《指导意见》特别提出将村卫生室纳入基本医保定点范围，加大医保基金支持力度，让农村老百姓看得起病。

包括村卫生室在内的基层医疗服务机构发挥着保护乡村居民健康的重要作用。将村卫生室纳入医保报销将方便乡村居民就近获取所需的医疗服务，减轻乡村居民就医经济负担。然而，目前村卫生室的医疗水平十分有限，很难满足乡村居民大多数医疗需求。许多农村患者不得不在医疗水平更高的城镇医疗机构就医，增加了就医的时间和金钱成本。还有许多农村患者由于经济压力而选择不进行必要的检验和治疗，往往耽误病情，造成更大的健康损害和经济损失。

许多村卫生室的基础设施条件较城镇基层医疗机构有很大的差距，且卫生条件堪忧。药品供给方面，许多村卫生室配置药品种类和数量较少，无法满足慢性病患者长期用药需求。为解决乡村药品供给问题，一些地方开始推动集采药品进入村卫生室。今年七月，江西省医保局发文在全省范围开展集采中选药品进村卫生室，按照中选价“零差率”销售。村卫生室销售集采药品将助力乡村患者用上优质廉价的药品。然而，村卫生室的信息化水平普遍较低，接入集采系统和医保报销系统需要配置计算机、网络并开展相关培训，无疑增加了村卫生室的运营成本。

除了硬件设备缺失外，村卫生室还缺乏专业的人才队伍。虽然每年有许多大学生来到村卫生室实习，但大多数学生实习结束后并不会选择留在村卫生室工作。医学生受到的系统医学教育和培训很难在乡村进行充分的实践，而且村卫生室的晋升机会也比城镇里大医院要少很多。目前村卫生室的村医大多数年龄较大，很难应对村卫生室纳入集采和医保所需的信息化工作。与城镇医疗机构相比，村卫生室的工资待遇更低，很难吸引或留住人才。

实现健康乡村目前面临种种实际的问题，亟需政策支持提升乡村医疗硬件水平，增强乡村卫生机构吸引人才的力度，合理提升村医待遇，拓宽村医职业道路，为乡村医生提供所需的保障和补助。这些问题需要政策制定者重点关注。

As China continues to implement its rural revitalisation strategy, improving the health of rural residents has been elevated as a priority. Currently, there is still a significant development gap between urban and rural health services, affecting the system’s ability to meet the health needs of the rural population. To safeguard the health of rural residents and provide better medical services, the National Health Commission (NHC) and 13 other ministries and departments recently issued the Guiding Opinions on Improving Rural Health, aiming to improve capacity building for medical services and health institutions in rural areas while strengthening healthcare security for residents. According to the Guiding Opinions, village clinics will be granted access to basic medical insurance (BMI) reimbursements. In addition, the policy calls for increased support to make medical services more affordable for rural residents.

Grassroots medical institutions, including village clinics, play an important role in protecting the health of rural residents. Implementing BMI reimbursement at the level of village clinics will improve the accessibility of medical service provision and help alleviate some of the economic burden. However, the medical services currently provided at this level are failing to meet the needs of most rural residents. Many rural patients have no choice but to seek treatment in urban medical institutions, which invariably means having to spend more time and money. Some rural residents may even decide not to undergo necessary tests and treatments due to the financial burden, which could often lead to greater adverse health effects and economic losses in the long term.

Many village clinics lack the level of infrastructure enjoyed by their urban counterparts. Sanitary conditions are often not up to standard either. Many of these clinics tend to be equipped with fewer types of drugs and in smaller quantities, insufficient for meeting the long-term drug needs of patients with chronic diseases. To improve drug supply in rural areas, some local authorities have begun to promote volume-based procurement (VBP) drugs at village clinics. In July, the Jiangxi Provincial Healthcare Security Bureau issued a document allowing village clinics to procure and sell VBP drugs across the province. This will enable rural patients to access high-quality and affordable drugs. However, many village clinics, especially those in less developed areas, may not be equipped with computers, networks and personnel needed to access VBP and BMI systems. A lack of necessary telecommunications infrastructure may hinder village clinics’ access to policy incentives, in turn delaying patients’ access to healthcare.

Another challenge faced by rural areas is the worsening talent drain. Although many medical students work at village clinics as interns every year, most of them choose not to stay after their internships are finished. Due to the relative lack of patients, medical students may find fewer opportunities to put their education and training to practice in rural settings. Additionally, village clinics cannot offer the same career prospects that urban hospitals can. At present, most doctors employed by village clinics tend to be elderly and less accustomed to using new digital technologies to access VBP and BMI systems. Moreover, doctors at village clinics have much lower salaries compared with their urban counterparts, making it even harder for village clinics to attract skilled personnel.

These issues need to be focused on, and many practical problems must be taken into consideration when improving healthcare in rural areas. Policy support should be directed at improving medical infrastructure at the grassroots level. In addition, efforts are needed to strengthen the ability of rural medical institutions to attract and retain talents.