重庆市基本公共卫生服务人力时间成本测算研究

Research on the Measurement of Public Health Service Manpower Costs of Chongqing

目的探讨重庆市基本公共卫生服务标准流程所需的人力时间成本。方法采取随机抽样的方法在重庆市九龙坡区城市与农村分别选取2个社区卫生服务中心、2个乡镇卫生院及1所妇幼保健医院,并在参与单位选取一定数量的调查对象,对各项基本公共卫生服务（城乡居民健康档案、健康教育、预防接种、0~6岁儿童健康管理、孕产妇健康管理和新生儿访视、老年人健康管理、高血压健康管理、2型糖尿病患者健康管理、重性精神疾病管理、传染病及突发公共卫生事件报告和处理服务、卫生监督协管服务、残疾人健康管理、婚前检查、35岁以上育龄妇女检查、艾滋病管理及社区诊断）所需人力时间成本进行测算。人力时间测算采用标准服务流程进行测算。结果完成九龙坡区12项基本公共卫生服务重点人群管理每万居民需医务人员8.4名。按九龙坡区2011年基本公共卫生服务各类重点人群绩效考核指标需医务人员799名,若按照重庆市2011年绩效考核指标需医务人员459名。完成九龙坡区全人群服务项目需医务人员83名,即每万居民需0.76名医务人员。完成九龙坡区16项基本公共卫生服务,每万居民需医务人员9名。九龙坡区基本公共卫生服务重点人群管理需医务人员911名,全人群服务需医务人员83名,因此提供16项基本公共卫生服务需医务人员994名。根据九龙坡区基本公共卫生服务各类重点人群所占的比例确定所需医务人员数量的比例为40（建档）∶23（高血压）∶9（糖尿病）∶10（老年人）∶1（残疾人）∶1（精神病患者）∶4（儿童计免）∶1（婚前检查）∶2（儿童保健）∶7（35岁以上育龄妇女保健）∶2（孕产妇产前健康管理及产后访视）。提供重点人群服务与全人群服务项目需要的医务人员数量比为10∶1。结论目前九龙坡区基本公共卫生服务的医务人员数量还不能满足完成标准服务工作的要求,应进一步增加医务人员数量,保障基本公共卫生服务工作顺利完成。

Objective To research on the costs of the time that public health service workers often spend in finishing a standard flow. Methods Random sampling was used to choose a certain amount of participants from two community sanitary service centers, two township health centers and one maternity and child health care hospital located at Jiulongpo district, Chongqing. Service standard operating procedures were used to measure the manpower cost of each public health service（ health record of the urban and rural residents,health education,vaccination,health management of children under 6 years old,the pregnant women including neonatel visiting,the elderly,the disabled,the patients with high blood pressure,the patients with type Ⅱ diabetes mellitus and severely-stricken mental patients,report and processing about infectious diseases and public health emergency,cooperation with hygiene supervision,premarital examination,physical check-up of childbearing women above 35 and AIDS management and diagnosis）. Results The research showed that residents per 10 thousand only needed 8. 4 general practitioners（ GP） on average for 12 kinds of public health services directed at the important population in the Jiulongpo dis-trict. According to the performance evaluation indicators of basic public health service package of Jiulongpo,the number was 799 GP. According to the performance evaluation indicators of basic public health service package of Chongqing,the number was 459 GP. Completing the whole covered service project of Jiulongpo,83 GP were needed,that was 0. 76 GP per 10 thousand residents. Completing 16 items of basic public health services needs 9 GP per 10 thousand residents. The research results showed that the number of GP needed： 911 for the important population,83 for the whole population and 994 while offering the 16 kinds of public health services. According to the proportion of each type of population in the whole,the proportions of the number of GP needed in each service were： 40（ files）,23（ high blood pressure）,9（ diabetes）,10（ the elderly）,1（ the disabled）,1（ mental patients）,1（ children vaccination）,1（ premarital examination）,2（ children health care）,7（ childbearing women above 35） and 2（ pregnant women）. The proportion of the number of GP for the important population and the whole population was 10∶ 1. Conclusion The medical staff number can not meet the needs of the basic public health service project of Jiulongpo. So the administrative department of public health needs to increase the staffing number,in order to guarantee the basic public health services.