社区基本公共卫生服务经费预测研究

The budget prediction of basic public health service in the community

目的在测算深圳市社康中心开展的各项基本公共卫生服务成本的基础上预测下一年度所需经费。方法通过特尔斐专家咨询法界定社区基本公共卫生服务的流程及标准;然后从深圳市全部社康中心中随机抽取60家社康中心,对其中负责开展基本公共卫生服务的医护人员进行问卷调查,测定各项基本公共卫生服务的成本,以此为基础建立方程模型来预测2015年所需经费。结果调查社康中心提供不同服务项目差异较大,部分服务开展情况已达到国家标准(如预防接种率达98%以上),部分服务达标率较低(如高血压患者规范管理率为15.0%,老年人健康管理的规范管理率为32.9%)。不同服务对象单位成本亦存在较大不同,按照不同管理目标(高、中、低)及调查社康中心在编人员平均收入75.3元/h为人力成本价格,预测2015年深圳全市基本公共卫生服务经费总额及人均成本为:高16.4亿元,人均109.4元/人年;中14.2亿元,人均94.6元/人年;低9.7亿元,人均64.8元/人年。结论目前深圳市开展社区基本公共卫生服务存在经费补偿不足的问题,所需经费远超现行45元/人年标准;要达到中等目标要求,2015年经费至少为95.0元/人年。

Objective To measure the cost of basic public health service and predict the budget of basic public health service in next year in the community health care centers of Shenzhen city. Methods The workflow and standards of basic public health service were set up by Delphi method. Sixty community health centers were sampled according to the proportion of 10% from all CHCs of Shenzhen city by a stratified random sampling,which were investigated by questionnaire to calculate the service cost to predict the budget in 2015. Results The service providing of the investigated CHCs varied a lot. Some services were up to the national standards（ such as vaccination rate is above 98%）,and there were still a big gap between some services and national standards（ for example,the normative management rate of hypertension patients is15. 0%,of old people is 32. 9%）. The unit costs of different services varied a lot,too. According to the income standards of the 60 community health centers we investigated,which was 75. 3 Yuan per hour as the human resource cost price,we predicted the total cost and average cost per person of Shenzhen in 2015 as follows： high level 1. 64 billion Yuan and109. 4 Yuan per person each year,middle level 1. 42 billion Yuan and 94. 6 Yuan per person each year,low level 0. 97 billion Yuan and 64. 8 Yuan per person each year. Conclusion The cost of community public health service was not paid enough. The cost far exceeded the current standard of 45 Yuan per person each year. To meet the requirement of middle level target,the average cost in 2015 should at least reach to 95. 0 Yuan per person each year.