内蒙古实施乡村卫生服务一体化管理的乡村两级医疗机构经济运行试点研究

Pilot Study on Economic Operation of Township Hospitals and Village Clinics for Implementing Township-Village Integration Management in Inner Mongolia

目的:分析乡村卫生服务一体化管理对乡村两级医疗机构运行的影响,并提出相应的政策建议。方法:收集样本地区卫生统计年报和卫生财务年报数据,采用描述性统计方法分析内蒙古巴彦淖尔市两试点旗县乡村两级医疗机构2010—2013年的经济运行情况。结果:乡村卫生服务一体化管理实施后,乡村两级医疗机构总收入、财政收入增加明显,药品收入占总收入的比重呈下降趋势;总支出整体呈上升趋势,药品支出占总支出比重逐年下降;乡镇卫生院总收支结余率增加,村卫生室总收支结余率下降,药品收支结余率逐年下降,并伴随基本药物零差率制度的实施而为零。结论:乡村卫生服务一体化管理实施之后,乡村两级医疗机构筹资来源得到改善,逐步破除"以药养医"的事实,但由于该制度的实施对两级机构经济运行冲击较大,在提高自身服务能力和水平的同时,需要继续加大财政投入,尤其是对村卫生室的投入。

Objective:To investigate the impacts of township-village integration(TVI) management on the economic operation oftownship hospitals and village clinics after implementing TVI management and propose countermeasures.Methods:Health statistic an-nual report and health financial annual report data of the sample area were collected. Descriptive statistics was conducted to analyzethe data in Bayannur of Inner Mongolia by collecting the economic situation from 2010 to 2013.Results:After the implementation ofTVI management, the increase of the total income and financial income of township level and village level medical institutions in-creased, while the proportion of drug income in total income showed decreasing trend; the total expenditure showed increasing trend,the drug income’s proportion of total income decreased by years with non-implementation of primary drug zero rate.Conclusion:Since the implementation of TVI management, the financing resources of township level and village level medical institutions were im-proved, so as to break down the problem of 'supporting hospitals by drugs'. However, because of the big impact to the two level inti-tutions, it needed to increase financial input, especially the input for village clinics.