系统提升乡镇卫生院政府投入绩效的策略:理论框架与实证分析

Strategy for enhancing the performance of government financial funds on township health center based on system thinking:Conceptual framework and empirical analysis

新医改背景下乡镇卫生院综合改革说明政府对基层卫生投入的长效和保障机制正逐步形成,研究提高财政投入绩效具有重要意义。卫生系统是复杂性系统,本研究运用卫生系统绩效框架和机构治理模式理论,结合对广东省15个县市的现场调研,对乡镇卫生院政府投入绩效可能存在的机构效率、县域三级卫生服务体系整体效率和政府卫生投入方式等问题和原因进行了剖析。最后提出系统性提升乡镇卫生院政府卫生投入绩效,应高度重视县域农村医疗卫生服务体系改革的顶层设计;政府各职能部门间的政策制定应相互契合良性互动;要建立基于县域医疗卫生均等化下的符合卫生规律的财政卫生转移支付模式。

New health reform in China introduced serials policies which transferred township health center from market unit into bureaucratic unit, which means that a long-term and stable government expenditure on primary health care is gradually taking shape. Therefore, improving the performance of government financial funds has become an important and practical problem. As the health system, is a complex system, this study use theoretical frameworks of health system performance and organizational governance model, and carry out key informant interview in 15 counties. We deeply analysis the existing problems and causes of the government investment mechanism at the township health center under the new health reform policies, In the end, the paper proposed the four strategies to systematic enhancing the performance of government financial funds on township health center, well design a top-down policy to plan health resource within a county, promote a smooth coordination across authorities among governments, and establish appropriate government transfer to improve equalization of health care within a county.