不同举办主体社区卫生服务中心服务功能落实情况比较

Comparative Analysis of Service Function Implementation of Community Health Centers with Different Ownerships in China

目的了解2008—2011年不同举办主体社区卫生服务中心的基本医疗和公共卫生服务提供情况和增长趋势。方法收集2011年杭州、合肥、武汉、成都、无锡、铜陵、宝鸡和石河子8个城市90个社区卫生服务中心服务提供数据(包括中心医生日均担负门诊人次数、年均担负住院人次数、健康档案建档率、登记高血压和糖尿病患者数及按要求进行规范化管理人数),进行统计描述与分析。结果 2011年,政府、医疗机构、企业和个人办的社区卫生服务中心医生日均负担门诊人次数分别为22.4、20.8、14.3和19.4人次,医生年均负担住院人次数分别为23.7、47.3、72.5和22.4人次;职工人均管理健康档案份数分别为489、309、289和739份,职工人均规范化管理高血压人数分别为38、22、17和30人,职工人均规范化管理糖尿病人数分别为10.3、6.0、5.4和9.7人;除了政府办社区卫生服务中心医生承担住院服务逐年递减(年均增速为-2.0%),2008—2011年不同举办主体社区卫生服务中心医生承担的门诊服务、住院服务及职工人均管理健康档案、高血压、糖尿病患者的数量均呈现逐年递增趋势(年均增速分别为4.2%、1.6%、20.2%、22.4%及24.6%),尤其是企业和个人办社区卫生服务中心承担基本公共卫生服务工作量增长最快。结论政府办社区卫生服务中心人均承担住院服务逐年递减,与政策导向一致;政府购买公共卫生服务政策对不同举办主体社区卫生服务机构均起到较强的激励作用,特别是个人办的机构;推进不同举办主体机构分类管理,促进社区卫生服务均衡发展。

Objective Compare services rendered by community health service （CHS） centers of different ownerships in terms of essential medical care, public health service and developing tendency. Methods Data （ the numbers per year of out- patients, the discharged patients, the standardized health files, registered patients with hypertension and diabetes as well as the patients following the standardized management） were provided by 90 C/IS centers of 8 cities in China including Hang zhou, Hefei, Wuhan, Chengdu, Wuxi, Tongling, Baoji and Shihezi in 2011. Statistical description and analysis were carried out. Results In 2011, the average daily outpatients of each doctor were 22. 4, 20. 8, 14. 3 and 19. 4 respectively for the gov- ernment- owned, the hospital- owned, enterprise- run and private CHS centers and the average daily discharged patients for each doctor were 23.7, 47.3, 72. 5 and 22.4 for each type of facilities. The average number of health files for each community health worker was 489, 309, 289 and 739, number of hypertension patients managed was 38, 22, 17 and 30, and standard- ized managed diabetes patients were 10. 3, 6. O, 5.4 and 9. 7 respectively for each type of facilities. Except that the inpatient services per capita in government run facilities were decreasing year by year （ -2. 0% ） , the inpatient services, outpatient serv- ices, health files establishment, numbers of patients with hypertension and diabetes were all increasing year by year （4. 2%, 1.6%, 20. 2%, 22.4% and 24. 6% respectively）, especially in enterprise run and private facilities. Conclusion The inpa- tient services per capita for government run facilities were decreasing year by year, which was consistent with the policy orienta- tion ; government purchasing public health services policy played an incentive role for all types of facilities, especially for private ones; sort management should be conducted to facilitate balancing development of CHS facilities of different ownerships.