基层医改后哈密地区乡镇卫生院运营效率研究  

Operation Efficiency of Rural Health Centers in Hami Prefecture After Health Care Reform at Basic Level

作　　者：明延飞 黄蓉[1] 张艳春[2] 秦江梅[2] 

机构地区：[1]石河子大学医学院预防医学系,新疆石河子市832000 [2]石河子大学医学院卫生部卫生发展研究中心

出　　处：《中国全科医学》2015年第7期759-763,共5页Chinese General Practice

摘　　要：目的了解基层卫生综合改革后哈密地区乡镇卫生院的运营效率情况。方法哈密地区共37所乡镇卫生院,通过发放设计好的调查表由卫生院相关负责人填写2009—2012年本机构运行的相关数据,剔除数据不完整的机构,对余下34所乡镇卫生院进行分析,其中哈密市15所、巴里坤县13所、伊吾县6所。采用服务当量标准化法,分别建立基本医疗综合指标和公共卫生综合指标;运用比率法分析卫技人员人均工作效率;建立以基本医疗为产出的基本医疗模型和以基本医疗与公共卫生为产出的总体模型,采用数据包络分析(DEA)-Malmquist指数法分析生产率变动情况。结果 2009—2012年卫技人员人均基本医疗服务量、人均公共卫生服务量和人均总收入分别以7.3%、11.6%和19.0%的速度增长;基本医疗模型和总体模型的全要素生产率分别提高了6.3%和5.2%,技术分别提高了5.5%和6.0%,基本医疗模型的技术效率提高了0.8%,总体模型的技术效率下降了0.7%。结论基层医改后哈密地区乡镇卫生院全要素生产率在两种模型下均有所提高,但是其提高过分依赖于技术的提高;应通过加强医生队伍建设、提高服务能力、实施分级诊疗、注重公共卫生服务等方式提高技术效率,从而实现基层医疗机构的合理发展。Objective To investigate operation efficiency of rural health service centers in Hami Prefecture after comprehensive reform in health care service at basic level. Methods Self- designed questionnaires were completed by directors of 37 rural health service centers. Relevant data of the centers from 2009 to 2012 were obtained. Valid questionnaires from 34 centers were collected,including 15 centers in Hami City,13 centers in Barkol County and 6 centers in Yiwu County. We used method of standardized service equivalent to establish aggregative indicators of basic medical care and public health care. Ratio method was used to analyze average work efficiency per health worker. Basic medical model with medical care as output and overall model with medical care and public health care together as output were established, and DEA- Malmquist index method was employed to analyze changes in productivity. Results The average amount of basic medical service,public health service,and total income per health worker increased annually by 7. 3%,11. 6% and 19. 0% from 2009 to 2012. Under the basic medical model and the overall model,the total factor productivity increased by 6. 3% and 5. 2%,and technology productivity increased by 5. 5% and 6. 0%. Technology efficiency increased by 0. 8% under the basic medical model and decreased by 0. 7% under the total model. Conclusion After comprehensive health care reform,the total factor productivity of the rural health centers in Hami Prefecture increased in both models. But it is excessively dependent on technology improvement,in response to which we suggest that technology efficiency be promoted by recruiting and training of qualified health workers,improving service ability,grading health care,promoting public health care services,in order to achieve healthy development of health care settings at basic level.

关 键 词：医院 乡村 乡村卫生服务 卫生保健改革 效率 

分 类 号：R197[医药卫生—卫生事业管理]