超大城市卫生体系绩效评价框架构建

Construction of a performance evaluation framework for health systems of mega-cities

目的系统开发超大城市卫生体系绩效评价分析框架和指标体系,为超大城市间医疗卫生服务发展的优劣势比较提供参考,为合理配置卫生资源、推进卫生体系建设提供依据。方法检索相关统计年鉴和国内外相关文件等文献,归纳总结国际卫生体系绩效评价理论框架,在专家咨询的基础上,设计构建适用于我国超大城市的卫生体系绩效评价的四级指标体系。结果共设一级指标3个,包括"投入""过程""结果";二级指标8个,包括卫生筹资(投入)、卫生人力(投入)、机构配置(投入)、医疗服务体系(过程)、公共卫生服务体系(过程)、医疗保障体系(过程)、人群健康状况(结果)、筹资风险保护(结果);三级指标16个。结论超大城市卫生体系绩效比较研究是一项具有创新性和挑战性的工作。建议基于本研究的结果,按照全面性与代表性相结合、可及性和可比性相结合、定性和定量相结合的原则设计指标体系,进一步开展构建城市间卫生体系绩效评价框架研究工作。

Objective To systematically develop the analytical framework and indicator scheme for the performance evaluation for health systems of mega-cities,to provide reference for the comparison of the advantages and disadvantages of the health service development among the cities,and to provide basis for the rationalization of health resources allocation and the improvement of health system.Methods Domestic and international literature such as relevant statistical yearbooks and documents were reviewed,and theoretical frameworks of health system performance evaluation were summarized.On the basis of expert consultation,four-tier indicator scheme in performance evaluation for health system of mega-cities in China was designed and constructed.Results There was three indicators in Tier 1,including input,process and output;tier 2 was composed of eight indicators,including health financing(input),health human resources(input),institutional configuration(input),medical service system(process),public health service system(process),health security system(process),population health outcome(output),financing risk protection(output);tier 3 was composed of sixteen indicators.Conclusion The comparative study of health system performance in mega-cities was innovative and challenging.It is suggested that based on results of this study,the research on the construction of inter-city health system performance evaluation framework be further conducted,combining comprehensiveness and representativeness,accessibility and comparability,qualitative and quantitative approaches in designing the indicator scheme.