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扩大外科人员的规模

Kimberly M Daniels¹, Johanna N Riesel², John G Meara¹

¹Boston Children's Hospital, Department of Plastic and Oral Surgery, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.

Lancet (London, England)

|August 28, 2015

概括

预计到2030年全球每10万人口中就有20名外科医生, 在中低收入国家,任务转移可以减少40%的成本和培训时间.

科学领域:

全球健康
卫生工作人员规划
外科人员发展

背景情况:

每10万人口中有不到20名专业外科医生,麻醉师和产科医生 (SAO) 的国家面临较差的健康结果.
为了到2030年实现目标人数密度,需要大幅扩大外科工作人员.
之前的研究没有量化全球外科人员扩张的成本,提供者要求或时间表.

研究的目的:

估计到2030年实现全球外科人员密度目标所需的成本,提供者数量和时间.
比较使用专业外科医生,麻醉师和产科医生 (SAO) 的劳动力扩张策略与结合任务转移的混合模型.
为全球卫生保健系统制定战略规划.

主要方法:

利用世卫组织全球外科工作人员数据库的SAO密度.
应用人口增长和假设的退休率 (1%或10%) 来预测劳动力需求.
模拟了两个场景:单独的SAO和混合的SAO/关联的临床医生模型,其比率为2:1或4:1.
通过与人均医疗保健支出相关的回归分析估计的培训成本.
根据平均培训时间计算所需的人类年.

主要成果:

到2030年实现每10万人的SAO需要1,272,586名新供应商 (退休率为1%),耗资71至1460亿美元.
低收入和中低收入国家需要最大规模的扩张, 需要另外806,352名提供者.
与SAO-only模型相比,混合模型的临床助理比例大大降低了成本 (中位数为7.57美元/人) 和培训时间 (20472人/年).
任务转移模型加快了劳动力入职率的增长,与仅使用SAO模型相比减少了一半以上.

结论:

低中等收入国家面临的最大挑战是扩大外科人员数量.
在这些国家,任务转移可以减少约40%的成本和培训时间.
仅仅实现目标劳动力密度并不能保证优质护理或农村接入; 公平提供安全,负担得起的外科服务仍然至关重要.

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