社区卫生服务中心不同收支两条线管理模式下的服务效率分析——基于北京市远郊区县的实证研究

Analysis on Efficiency of Community Health Centers of Different Separated Management Model of Income and Expenditure

目的探讨收支两条线对农村基层卫生机构服务效率的影响,为提高机构效率和改善收支两条线的改革提供实证依据和政策建议。方法按收支两条线的3种管理模式分组,采用数据包络分析方法(data envelopementanalysis,DEA)比较不同模式下2008和2009年北京10个远郊区县社区卫生服务机构的相对效率。结果 2009年,收支挂钩、部分挂钩和不挂钩3种模式下DEA得分有效的机构分别占72.73%、63.46%和59.26%。收支挂钩模式下的总体效率要高于另外2种模式。3种模式均存在规模效率递增。结论投入与产出挂钩的管理模式有利于基层医疗机构效率的提高;医改深化收支管理方式改革的同时,需要重视配套的绩效管理和激励机制;北京远郊区县的社区卫生服务机构均存在投入不足的问题,增加投入能获得递增的规模收益。

Objectives To explore whether changing management method on rural community health centers(CHCs) will have impact on the efficiency of health service provision in these centers.The finding would serve to provide evidence for future reform on CHCs.Methods The income and expenditure separated management have three management sub-models.This study used data envelopment analysis(DEA) in rural CHCs of ten counties in Beijing in 2008 and 2009,to analyze whether the three management sub-models adopted by different CHCs causing discrepancy on service provision efficiency.Results Three management sub-models are: 1.income linking to expenditure 2.income partially linking to expenditure 3.total separation between income and expenditure.Among these health centers using three different management sub-models,the percentage of health centers who have valid DEA results were 72.73%,63.46% and 59.26%.Therefore the health centers using the first sub-model demonstrate had better efficiency performance compared to the other two sub-models.For all these centers,the amount of health service provision in these centers was positively related to the efficiency performance.Conclusions Promotion of the first health management sub-model will help improve the efficiency of health service provision in these health centers.In the course of health reform,the government policy should consider establishing suitable performance related health management tool to incentive their performance.Meanwhile,in the suburb of Beijing rural health centers often face the challenge of insufficient government investment.The research elaborates that increasing government funding can improve efficiency of rural community health centers as well.