北京市社区卫生服务项目成本测算模型构建

Constructing the Cost Estimation Model for Community Health Service Items in Beijing

目的:构建北京市社区卫生服务项目成本测算模型,测算北京市社区卫生服务项目成本。方法:通过文献查阅、专家研讨、现场观察等方法,构建北京市社区卫生服务项目分类及子项目,确定服务当量值;从北京市抽取17家服务功能健全、信息系统相对完善的社区卫生服务中心,利用其过去1年的支出情况和各服务项目服务量的信息,测算了1个标准服务当量的成本。结果:北京市主要的社区卫生服务项目分类共计5大类65项,分别是基本医疗服务项目23项、护理服务项目9项,药剂服务3项,辅助检查项目14项,公共卫生服务18项。以标准服务当量作为参照,急诊服务当量值为3.2,肌肉注射1.2,高血压患者管理服务当量值为8.5。1个标准服务当量的理论成本为11.80元,每服务人口基本公共卫生服务成本(不含药品)49.26元。结论:社区卫生服务项目成本城区和郊区有一定差异,主要表现在人力成本和材料成本;基本公共卫生服务项目补助严重不足;应建立成本测算动态管理机制。

Objective:To build cost estimation model for community health service items in Beijing and estimate the cost of com-munity health service items in Beijing.Methods:Literature review, expert discussion and field observation were applied to constructthe item classification and subitems of community health services in Beijing, so as to define equivalent value of service; 17 communityhealth service centers with complete service function and information system in Beijing were selected, information of the expendituresituation and the service quantity of different service item in the past year were applied to estimate the cost of a standard serviceequivalent.Results:All community health services were divided into 5 categories with 65 specific items which included 23(medicaltreatment), 9(nursing), 3(medicine service), 14(auxiliary examination), and 18(public health). With the comparison of standard equiva-lent, the equivalent of emergency was 3.2, injection was 1.2, case management of patients with HBP was 8.5. The cost of one standardequivalent was 11.80 yuan, and the cost of basic public health services per capita was 49.26 yuan.Conclusion:There existed differ-ences in cost between community health services in urban areas and suburban areas, mainly for cost of human resources and health-care materials; the subsidy of basic public health service item was severe insufficient. It needed to establish a dynamic cost estimationand management system.