深圳市老年残疾及精神病人社区健康管理服务成本分析

Cost of community health care management for the elderly,the disabled and psychiatric patients in Shenzhen city

目的 测算老年人、重症精神病患者和残疾人健康管理服务成本。为开展上述人群社区健康管理、制订政府经费投入政策提供参考依据。方法 2013年10—12月,通过文献研究及专题讨论建立备选指标库;经两轮德尔菲法专家咨询,确定重点人群社区健康管理的服务标准项目内容及工作步骤;随机抽取60家社康中心进行现场调查,测定各项服务工作时间、2013年服务量等。结果 60家社康2013年老年人、精神病人、残疾人健康管理累计调整工作时间分别为82 519.6、17 945.8、9 293.7;按调查社康、全市社康、基层专业公共卫生机构当年在编人员平均收入水平和专家建议的4种人力成本价格,得出老年人健康管理人均成本为6.7~8.6元/人年,单位成本为248.4~320.2元/人年;重症精神疾病患者管理人均成本为1.4~1.8元/人年,单位成本为1 567.1~2 034.2元/人年;社区康复人均成本为0.7元~0.9元/人年,单位成本为754.4~978.8元/人年。老年人健康管理、重症精神疾病患者管理、社区康复服务项目分别应占10项基本公共卫生服务总经费的9.6%、2.1%、1.1%。结论 政府财政应对社区老年人、精神病人、残疾人等重点人群社区健康管理服务经费予以全额补助。

Objective To estimate the cost of community health care management for the elderly,the disabled and psychiatric patients in Shenzhen city and to provide references for improvement in governmental financial support to community health management service. Methods An index database was established with the literature reviewand panel discussions and the content of standardized community basic public health service was determined with a two-round Delphi method. Then 60 community health centers were selected with stratified random sampling for a field survey on time and items of community health care service in 2013. Results For the community health centers surveyed,the adjusted mean cumulative working hours of health care service in 2013 were 82 519. 6,17 945. 8,and 9 293. 7 for the elderly,psychiatric patients,and the disabled; the average community population- and service client-based health management service cost per person-year ranged 6. 7- 8. 6 Yuan（ RMB） and 248. 4- 320. 2 Yuan for the elderly,1. 4- 1. 8 Yuan and 1 567. 1- 2034. 2 Yuan for psychiatric patients,and 0. 7- 0. 9 Yuan and 754. 4- 978. 8 Yuan for rehabilitation of the disabled,respectively,according to different income standards for the 60 community health centers surveyed and for all the community health centers and grass-roots public health institutions in Shenzhen city and the human cost price recommended by the experts. Averagely,the fund allocation for old people health management service,psychiatric patients health management service,and community-based rehabilitation service accounted for 9. 6%,2. 1%,and 1. 1% of the total fund for basic community health service of the community health centers. Conclusion The government should make full compensation for the cost of old people and psychiatric patients health management and community-based rehabilitation service