北京市平谷区社区卫生服务机构经济运行及补偿机制分析

Analysis of Compensation System of Community Health Service Facilities of Pinggu District of Beijing Based on Economic System

目的分析北京市平谷区社区卫生服务机构经济运行状况,发现补偿机制相关问题,为社区卫生服务发展提供政策建议。方法对2011—2013年财务年报相关数据进行统计描述和对比分析,了解社区卫生服务机构收支及其结构变化和运行效率等。结果 2011—2013年平谷区社区卫生服务机构总收入年平均增长速度为9.3%,政府补助收入占机构总收入的一半以上;通过医保结算的资金占医疗收入比例分别为21.4%、43.4%和29.3%,低于全国平均水平(68.5%),一般诊疗费收入占医疗收入比不足0.1%。药占比一直维持在90.0%以上,医务人员技术性服务收入仅占医疗收入的7.9%(2013年);各年度收支比分别为0.36、0.46和0.41,每职工平均医疗收入呈下降趋势,反映机构资金运行效率有所降低。结论政府财政支持依然是社区卫生服务机构正常运转的重要保障;社区卫生服务机构服务手段比较局限,服务价格偏低;机构运行效率降低,人员激励机制需进一步加强。建议提高医疗保险基金的补偿作用;提高服务能力,调整医疗服务价格;强化绩效考核与人员激励,提高机构运行效率。

OBJECTIVES Basing on economic operation of Community Health Service（CHS） Facilities in Pinggu District of Beijing,this paper is to analyze investment system of CHS and put forward policy recommendations for CHS reform and sustainable development.METHODS With data of annual financial report 2011—2013 of Pinggu, the paper made statistical description and analysis to investi-gate the balance,strncture changes and operation efficency of community health service institutions. RESULTS From 2011 to 2013 an-nual growth rate of the gross revenue of CHS facilities was 9.3%, of which government investment accounted for more than 50%. 2011—2013, money from health insurance shared 21.4%,43.4% and 29.3% respectively, far lower than that of the average level of China（68.5%）. The percentage of general fees on examinations in health service revenue kept below 0.1%. Revenue from medicines account-ed for over 90% in health service revenues, while the revenue from technical service delivery only accounted for 7.9%（2013）. The ra-tios of revenue and expenditure were 0.36,0.46 and 0.41 from 2011 to 2013, and the revenue per health worker decreased year byyear, which reflected the efficiency of CHS facilities went down. CONCLUSIONS Government investment was still the main supportfor CHS, but health insurance role was not in full play. Technical service delivery was limited, while the price the service was too lowto reflect health workers＇ contribution. The CHS facilities were not under cost effective and efficiency was in need of improvement.RECOMMENDATIONS Government support should be sustained and health insurance should play a more effective role in funding com-munity healthcare. Health service capacities needed to be strengthened and prices of some service itmes should be promoted. Improveincentive system of CHS workers and facilities to make the facilities more cost effective;Beijing.