重庆市基本公共卫生服务绩效考核的效果评价

Effect Evaluation of Performance Examinations of Basic Public Health Services in Chongqing

目的对重庆市基层医疗卫生机构实施基本公共卫生服务绩效考核前后自身发展状况进行调查,评价实施效果。方法按照分层随机抽样方法选择4个区(县)20个基层医疗卫生机构,采用自制问卷与专题小组访谈相结合的方法收集资料。结果 15家机构实行基药制度,19家机构实行绩效考核,4家机构实行收支两条线管理,3家机构以社区卫生服务中心为第一名称注册。实施绩效考核和基药制度的14个机构其实施绩效考核后与上年同期比较基本公共卫生服务工作量减少,机构人均基本公共卫生服务人次数从196.00次/人减少至69.71次/人,差异有统计学意义(P<0.01)。总收支节余从188.0万元下降到39.5万元,差异有统计学意义(P<0.05)。业务收支节余、药物利润、门急诊和住院次均费用持平,差异无统计学意义(P>0.05)。职工人均月收入从2 029.43元下降至1 893.35元,差异有统计学意义(P<0.05)。而财政补助从73.51万元下降至45.36万元,差异有统计学意义(P<0.05)。结论重庆市基本公共卫生服务绩效考核体系没有完全建立,绩效考核尚未发挥激励作用。尽快建立科学有效的基本公共卫生服务绩效考核指标体系,积极推进基层医疗机构综合配套改革迫在眉睫。

Objective To investigate the self - development conditions of primary health organizations before and after implementation of performance examinations, and assess the effects. Methods Twenty primary health organizations were chosen from 4 districts by stratified random sampling, and a self - made questionnaire was used in combination with special group interviews for data collection. Results Totally 15 health organizations carried out essential drug system, 19 got performance examination, 4 implemented two - way management of income and expense, and 3 registered by taking community health service center as their first name. After implementation of performance of examination the working amount of basic health services in 14 organizations, in which the performance examination and essential drug system were implemented, was decreased on the year before, with the average person - time of basic health services in the organization reduced from 196. 00 times to 69. 71 times per capita （ P 〈 0. 01 ）. The total balance of financial revenue and expenditure dropped from RMB 1 880 000 yuan to 395 000 yuan （P 〈 0.05 ）. However, the balance of business payments, drug profit, average service costs of clinic and emergence and hospitalization remained flat （ P 〉 0. 05 ）. Tile monthly income per capita of the staff decreased from RMB 2 029. 43 to 1 893.35 yuan （ P 〈 0. 05）. And the financial aids went down from RMB 735 100 to 453 600 yuan （P 〈0. 01 ）. Conclusion The performance examination systems of basic public health services has not been established completely, and the examination has not played a motivating role. It is urgent to set up as soon as possible a scientific and effective indicator system of performance examinations for basic public health services and to impel actively a complete set of reform in primary medical institutions.