基于工分制原理的基本公共卫生服务所需工作量的社区实践

Community Practice for Workload Required in Basic Public Health Services Based on the Principle of Labour Voucher

目的基于工分制原理对基本公共卫生服务项目进行工作量核算,以期为基层医疗机构绩效考核工作提供借鉴。方法依据健康维护对象和执行事件发生率的不同,将基本公共卫生服务划分为2大类、4小类,并结合上海市浦东新区惠南镇数据,运用工分制原理对惠南镇2014年所需四类服务的工作量进行实际演算。结果 232项基本公共卫生服务中,分别获得面向个人开展的服务137项(其中必然性服务有69项,偶然性服务有68项),面向群体开展的服务95项(其中必然性服务有79项,偶然性服务有16项)。工作量演算结果显示,2014年上海市浦东新区惠南镇所需面向个人提供的服务工作量占总工作量的23.03%(4 166 404.24/18 093 257.88),面向群体提供的服务工作量占总工作量的76.97%(13 926 853.64/18 093 257.88),且两者中的必然性服务工作量分别占总工作量的17.04%(3 083 587.13/18 093 257.88)和76.78%(13 892 841.20/18 093 257.88)。结论基本公共卫生服务中所需面向群体提供的服务工作量高于所需面向个人提供的服务工作量,且两者均以必然性服务为主。对基层医疗机构及其员工应以必然性服务为重点、偶然性服务为辅助制定公共卫生服务绩效考核策略。

Objective To calculate the workload of basic public health service items based on the principle of labor voucher,in order to provide references for the performance assessment in primary health care settings. Methods Based on the differences in service objects and incidence rates of events,basic public health services were divided into two groups and four categories. Combined with data from Huinan Town in Pudong New Area of Shanghai,required workloads of the four categories of services in 2014 were calculated by applying the principle of labor voucher. Results Of 232 basic public health services,there were 137 service items for individuals（ 69 items were necessary services and 68 were contingent services） and 95 service items for groups（ 79 items were necessary services and 16 were contingent services）. Results of workload calculation showed that,in2014,the required workload of services for individuals in Huinan accounted for 23. 03%（ 4 166 404. 24 /18 093 257. 88） in total workload,and the work load of services for groups accounted for 76. 97%（ 13 926 853. 64 /18 093 257. 88）; the necessary services took up 17. 04%（ 3 083 587. 13 /18 093 257. 88） and 76. 78%（ 13 892 841. 20 /18 093 257. 88）respectively. Conclusion The work load of services for groups is higher than that for individuals,and the two kinds of services are both mostly necessary services. Primary health care settings and health workers should emphasize on necessary services and take contingent services as an auxiliary part to formulate strategies of the performance assessment of public health services.