摘要
目的通过核定社区卫生标化工作项目,确定标化工作量,建立政府基于标化工作量的资源投入与分配机制,并建立以标化工作量为基础的岗位设置、财政补偿制度和社区医务人员的薪酬分配机制.方法选取上海中心城区、城郊区和远郊区的65家社区卫生服务中心作为样本单位,进行问卷调查,调查内容包括社区医疗卫生支出情况、标化工作量等.以标化工作量测算为基础,对上海社区卫生服务项目成本进行测算.结果上海中心城区、城郊区和远郊区的人员支出占医疗总支出的比例,分别是71.60%、72.13%和73.14%.不同地域,标化工作量单位成本不同,城郊区和远郊区的单位标化工作量成本要明显高于中心城区.实际的财政补偿比改革设定的目标补偿低20%.结论基于标化工作量的基本公共卫生服务经费投入可有效实现区域间的服务均等化,促进资源有效配置;同时,从需方角度估算区域标化工作总量,进而确定理想的经费投入,为区域服务经费投入设定了上限,可有效避免资源浪费.
Objective To determine the standardized workload first of all. Then based on such workload, to establish the government′s resource input and allocation mechanism, and build the post setup, a fiscal compensation system, and the salary distribution mechanism of community medical staff. Methods This study selected 65 community health centers in Shanghai′s downtown area, suburban area and outer suburbs as sample units to investigate with questionnaires such indicators as community medical and health expenditure, standardized workload among others.With the measured workload as basis, item costs of health services at Shanghai′s communities were calculated. Results That of downtown, suburban and suburban areas accounted for 71.60%, 72.13% and 73.14% respectively of the total expenditure on health care.The unit cost of standardized workload varies with areas, while that in suburban and suburban areas was significantly higher than that downtown.The actual fiscal compensation was 20% lower than the target compensation as designed in the reform. Conclusions The ideal investment of basic public health services based on standardized workload can effectively realize the equalization of services among areas and promote effective allocation of resources.At the same time, estimates of the total standardized workload from the perspective of the demand side, and determination of an ideal investment ceiling for the investment of areas′ services budgets, can effectively minimize the waste of resources.
作者
张安
黄萍
Zhang An;Huang Ping(School of Public Health, Shanghai University of Chinese Medicine, Shanghai 201203, China)
出处
《中华医院管理杂志》
CSCD
北大核心
2019年第8期674-677,共4页
Chinese Journal of Hospital Administration
基金
上海市卫生和计划生育委员会委托课题(2018HP08,2017HP04)
上海市属高校应用型本科试点专业建设项目(沪教委高〔2017〕57号).
