两种政府投入方式对村卫生室公共卫生服务影响分析

Impacts of two government funding approaches on public health service functions of village health clinics

目的探讨政府购买服务和直接投入两种方式对村卫生室的激励效应。方法以贵州省24个县村卫生室为样本，了解政府购买服务和直接投入两种方式下村卫生室公共卫生服务开展情况及村民满意度。结果除传染病报告、健康讲座、健康档案外，购买服务组的大部分公共卫生服务项目指标优于直接投入组（P〈0．05）；两组除设施条件、服务态度的村民满意度评分差异无统计学意义外，购买服务组其他维度及综合评分均高于直接投入组（P〈0．05）。结论政府购买服务对提高村卫生室服务效率具有较大潜力，但需进一步打破垄断，合理确定购买项目和方式，并构建科学的监管机制，以达到激励相容效应。

Objective To study the incentives created by both government service purchase mode and direct funding mode on village clinics. Methods Sampling on village clinics in 24 counties in Guizhou province, to learn their public health services and villagers＂ satisfaction under both modes. Results Except for the infectious disease report, health lectures and health records, values of most public health service indexes of the government purchase services group are better than those of the direct investment one （P〈0. 05）. Villagers＂ satisfaction scores for facilities and service attitude showed no significant difference between the two modes, but the purchase services mode was better than direct funding one in other dimensions and comprehensive scores （P〈 0.05）. Conclusion Government purchase of health services has a great potential to improve the service efficiency of village clinics. It is, however, imperative to further break the monopoly, identify reasonable purchasing projects and approaches, and construct scientific supervision mechanisms to achieve incentive-compatible effects.