湖南省妇幼公共卫生服务项目成本测算研究

The cost estimation and evaluation of the public health service program for maternal and child health agency in Hunan province

目的测算湖南省妇幼保健机构妇幼公共卫生服务项目成本投入现状,建立成本资源数据库,并分析各级妇幼保健机构项目成本投入-产出相对有效率,为政府制定合理的财政经费补偿机制提供依据。方法通过问卷调查收集湖南省9个不同级别的妇幼保健机构财务报表和工作量表等数据进行成本测算分析,计算人均成本和工时成本等指标,最后通过数据包络分析评价各机构项目成本投入-产出的相对有效率。结果妇幼保健机构妇幼公共卫生服务项目平均年总成本为396.18万元,呈现省、市、县逐步下降趋势,市级机构财政补助缺口较大。省级妇幼保健机构中各服务项目直接成本所占比例为74.9%~93.3%、市级为34.9%~82.1%、县级为71.3%~90.3%。省、市、县三级机构项目年人均成本分别为0.12元/人、3.3元/人和0.77元/人,市级机构人均成本最大。数据包络分析发现各机构中均存在部分服务项目的相对有效率〈1,需针对性加强项目管理。结论政府财政在妇幼公共卫生服务方面投入不足,市级开展妇幼公共卫生成本与市级财政对妇幼保健的总投入差距较大,西部、中部地区财政补助缺口较大。根据功能定位明确不同级别服务项目划分和确定投入标准,成本测算分析需进一步细化;数据包络分析结果可为妇幼公共卫生服务项目成本调查和保健服务持续改进提供依据。

Objective To estimate the cost of public health service program in Maternal and Child Health（ MCH） institution in Hunan Province,establish cost resource database and analyze the relative cost input-output efficiency of MCH,in order to provide support for government to develop a reasonable financial compensation mechanism. Method The data of financial reports and work record from 9 MCH institutions were collected by questionnaires survey,and calculate the index of cost-per-person and cost-per-hour,then data envelopment analysis（ DEA） was used to calculate the relative input-output efficiency of MCH projects. Results The average total cost of public health service program of in MCH institution was 3. 9618 million yuan,and it showed the decreasing tendency of Province-Municipality-County,and the financial assistance of municipal-agency was insufficient. The direct labor costs domain in the service project of each level organization,where the proportion of the provincial-agency ranged from 74. 9% to 93. 3%,the municipal-agency ranged from 34. 9% to 82. 1%,while the county-agency ranged from 71. 3% to 90. 3%. From the aspect of average labor cost of each level organization,the service cost of per person in provincial-agency was 0. 12 yuan,municipal-agency was3. 3 yuan,while county-agency was 0. 77 yuan,and municipal-agency has the biggest cost. The result from DEA found that part of program＇s relative input-output efficiency was less than 1. Conclusions We need to increase financial assistance efforts for maternal and child public health services agencies,especially for municipal-agency and the agencies form the west and central region. We should define distinct level of division and capital investment according to different function orientation,and further refine the cost estimation analysis. Data envelopment analysis results can provide the scientific basis for the cost estimation and program-improve work for the public health service program for Maternal and Child Health Agency.