公立医院财政投入模型构建与补助标准测算

Development of the fiscal input model for public hospitals and calculation of subsidy standard

目的探索建立科学合理的公立医院财政投入机制，以充分发挥财政资金的政策引导作用及使用效率。方法通过文献评阅、专家咨询论证等研究方法，建立了公立医院财政基本补助投入模型，并根据上海市宝山区4家公立医院的历史运行数据，测算了具体的补助标准。结果公立医院财政基本补助应根据核定床位数、门急诊量、住院床日、手术人次、重点服务项目以及工作的质量和效率确定。上海市宝山区每核定床位、每门急诊人次、每住院床日、每手术人次的补偿标准参考值应分别为42096元、27．9元、104．9元、244元；住院危重患者告危重补偿100元／床日，临床路径管理患者补偿300元／例，接产医院孕产妇保健管理补偿150元／人次。结论公立医院财政基本补助模型克服了单纯根据医院规模或根据医院工作量进行财政投入的弊端，并建立了推动重点服务项目有效开展的激励机制，可以改善公立医院的运行机制，促进其回归公益性。

Objective To explore a scientific and reasonable fiscal input mechanism for public hospitals, in order to fully leverage the policy guidance and efficiency of such funding. Methods With literature review, expert consultation and demonstration, a basic subsidy model for public hospitals was established. According to the past operation data of 4 public hospitals in Baoshan district of Shanghai, the study figured out specific subsidy standards. Results The basic subsidy for public hospitals should be determined according to the number of approved beds, the number of outpatients and emergency visits, hospital bed days, surgeries, key services, and the quality and efficiency of work. In Baoshan district, the standard reference value of subsidy for each approved bed, each outpatient and emergency visit, each bed- day, each surgical operation is 42 096 yuan, 27. 9 yuan, 104. 9 yuan and 244 yuan respectively. The standard value of subsidy is 100 yuan per bed for critically ill inpatients. For patients under clinical pathway management, the subsidy is 300 yuan per case, and for hospital maternal care, it is 150 yuan per person. Conclusions The basic subsidy model for public hospitals has overcome the shortcomings of fiscal input based on hospital scale or hospital workload, and established an incentive mechanism to promote the implementation of key services. These measures can improve the operation mechanism of public hospitals and encourage them to play their role of public welfare as designed.