省域基本公共卫生服务成本效果分析和TOPSIS法综合评价:以湖北省为例

The application of cost-effectiveness analysis and TOPSIS method in the evaluation of basic public health services in provincial region:A study of Hubei province

目的:综合评价省域基本公共卫生服务项目绩效,对进一步完善基本公共卫生服务项目、科学合理评价项目执行状况提出可行的政策建议。方法:采用分层随机抽样,通过机构调查获取湖北省样本地区基本公共卫生服务信息系统数据资料;通过查询政府网站获取相关政策文件;通过专家咨询筛选评价指标,并结合层次分析法确定各指标权重,同时分别运用成本效果分析和加权TOPSIS法,纵向和横向比较评价样本地区基本公共卫生服务项目绩效。结果:实际人均项目补助标准偏低;部分项目成本效果有所改善,尤其是慢性病患者规范化健康管理;各县区基本公共卫生服务项目绩效差异较大,Ci值最高为0.781 1,最低仅为0.269 4。结论与建议:将流动人口纳入基本公共卫生服务经费预算范围,建立动态增长机制;优化基本公共卫生服务绩效考核方案,综合运用成本效果分析和TOPSIS法,通过纵向和横向分析相结合的方法,克服单一方法不足;加大财政投入,推进基层医疗卫生服务体系建设。

Objective： To comprehensively evaluate the provincial basic public health service projects and put forward feasible policy recommendations for further improving the basic public health service projects and propose a more scientific and reasonable evaluation method of the implementation status of the projects. Methods： stratified random sampling method was used to obtain the data on basic public health service information system through institutional survey,and relevant policy documents were obtained from governmental institutions＇ websites. Through Delphi method（-expert consultations）,combined with analytic hierarchy process,evaluation indicators and weights were determined; and cost effect analysis and weighted TOPSIS method were applied to comparatively evaluate the performance of basic public health service projects vertically and horizontally,respectively. Results： The actual per capita project subsidy standard was found to be low; the cost effectiveness of some projects has improved,especially the standardized health management of patients with chronic diseases; and there is still a relatively large disparity of the performance of basic public health service in different counties with the highest Ci value is 0. 7811 while the lowest is only 0. 2694. Conclusions and Suggestions： Based on the evaluation analysis of this study,it was found that it is very meaningful to integrate the floating population into the budget scope and establish a dynamic growth mechanism; optimize the performance appraisal program and comprehensively applying cost effect analysis and TOPSIS method to overcome the defects of a single method; and increase fiscal investment to promote the construction of primary medical institutions.