北京市朝阳区社区卫生服务中心卫生财政资金投入产出效率分析

Input-output Analysis of the Investment Fund from the Government for Community Health Service Centers in Chaoyang District of Beijing

目的探讨北京市朝阳区社区卫生服务中心卫生财政资金投入产出效率,为社区卫生服务机构优化资源配置提供依据。方法以北京市朝阳区20家财政统筹类社区卫生服务中心、10家社管统筹类社区卫生服务中心为研究对象,基于2015年北京市朝阳区社区卫生服务管理中心内部提供的社区卫生服务中心卫生财政资金投入和产出数据,采用数据包络分析(DEA)法分析朝阳区30家社区卫生服务中心财政资金的投入产出效率。其中,投入指标包括经费投入、在岗职工总数、业务用房面积;产出指标包括公共卫生服务工作量、医疗服务工作量、服务质量综合评分。结果 2015年北京市朝阳区30家社区卫生服务中心综合技术效率、纯技术效率、规模效率平均值均>0.900。其中,15家社区卫生服务中心(10家财政统筹类、5家社管统筹类社区卫生服务中心)综合技术效率为1.000,卫生服务有效,处于规模报酬不变状态。其余15家社区卫生服务中心综合技术效率均<1.000,卫生服务无效,处于规模报酬递减状态。进一步改进效率显示,在投入不变的情况下,非纯技术有效的5家财政统筹类社区卫生服务中心需增加公共卫生服务工作量、医疗服务工作量,同时提高服务质量综合评分,平均分别增加11 371、73 072、1.60分;非纯技术有效的4家社管统筹类社区卫生服务中心需增加公共卫生服务工作量、医疗服务工作量,同时提高服务质量综合评分,平均分别增加81 989、590 544、4.75分。结论 2015年北京市朝阳区30家社区卫生服务中心卫生财政资金投入产出效率总体较高,但50.0%的社区卫生服务中心存在投入冗余和产出不足,应积极采取措施优化资源配置,加强社区卫生服务中心管理水平,提高卫生服务效率。

Objective To investigate the input-output status of the investment fund from the government for community health service centers（CHSCs） in Chaoyang District,providing an evidence for optimizing the resource allocation in CHSCs.Methods The enrolled 30 CHSCs were all from Chaoyang District,Beijing,including 20 receiving two-separateline management for revenue and expenditure（CHSCs with two-separate-line management）,and 10 receiving partial-subsidy management.We collected the internal input-output data of these 30 CHSCs from Community Health Service Management Center of Chaoyang District（CHSMCCD） in 2015,and explored the input-output efficiency using data envelopment analysis（DEA）.The input indicators include investment,total number of employees and area of rooms for delivering medical care.The output indicators consist essential public service workload,medical care workload and comprehensive quality score of services.Results In 2015,the mean comprehensive technical efficiency,mean pure technical efficiency and mean scale efficiency of the 30 CHSCs were all greater than 0.900.To be specific,15 CHSCs（10 CHSCs with two-separate-line management and 5 CHSCs receiving partial-subsidy management owned mean comprehensive technical efficiency of 1.000,efficient services and constant returns to scale,but other 15 ones possessed mean comprehensive technical efficiency of 1.000,inefficient services and decreasing returns to scale.If improving the output efficiency without increasing the investment,5 CHSCs with two-separate-line management but without pure technical efficiency need to increase the essential public service workload,medical care workload,and the comprehensive quality score of services,the average points need to be enhanced are 11 371,73 072,1.60 points,respectively;4 CHSCs managed by CHSMCCD without pure technical efficiency need to enhance the essential public service workload,medical care workload,and the comprehensive quality score of services,with an average increase of 81 989,590 544,4.75 points respectively.Conclusion In 2015,the input-output efficiency of the investment funds from the government for these CHSCs was relatively high,but 50.0% of them had input redundancy and insufficient output.So positive measures should be taken to optimize the health resource allocation,strengthen the management and service efficiency of CHSCs.