全面预算管理下的社区卫生服务中心人力成本测算策略与实证研究

Strategy and Empirical Study on Labor Costs in Community Health Service Centers under Comprehensive Budget Management

目的核算上海市黄浦区老西门街道社区卫生服务中心提供的卫生服务工作量,并构建全面预算管理下的人力成本测算方法。方法于2016年10月—2017年9月,分3个阶段对社区卫生服务的人力成本进行测算:邀请上海市黄浦区老西门街道社区卫生服务中心各业务科室负责人共10名参加调研,以采集机构目前正在开展的社区卫生服务项目,并以"单人可完成的操作步骤为最小项目单元"为原则对服务项目进行细分;参照德尔菲法,对各业务科室的服务执行人实施2轮问卷调查,要求其对相应服务项目在基本人力消耗与耗时、技术难度、风险程度3个维度上进行评价,评价结果换算后获得单位服务的标化工作量价值;收集社区卫生服务中心2017年1—6月的服务工作量和人员绩效支出数据,以测算单位标化工作量的人力成本价值。结果社区卫生服务中心目前开展的服务可分为5类,即诊疗类、护理类、医技类、公共卫生类及其他类,服务细分项目共960项。2017年1—6月,社区卫生服务的人力成本为0.72元/单位标化工作量。其中,全科类服务为1.05元/单位标化工作量、中医类服务为0.80元/单位标化工作量,护理类服务为1.13元/单位标化工作量,公共卫生类服务为0.37元/单位标化工作量。结论本研究构建了一套基于标化工作量的社区卫生服务中心人力成本测算方法,可用于指导社区的预算支出管理。社区公共卫生服务类的人力成本预算处于严重偏低状态,应根据卫生服务人力成本测算结果调整各类服务的预算支出。

Objective To calculate the workload of health services in Laoximen Community Health Service Center in Huangpu District,Shanghai,and to construct a calculation method of labor cost under the comprehensive budget management.Methods The labor cost of community health services was estimated in three stages from October 2016 to September 2017.Ten heads of departments in Laoximen Community Health Service Center were invited to collect information of ongoing community health services.These services were subdivided according to the principle that one service unit can be completed by one person;two-round questionnaire survey under Delphi method was carried out on physicians from various departments to evaluate three dimensions in terms of workload of health services,including the labor and time consumption,technical difficulties and risks.The standardized workload value of unit services was calculated by results;the unit labor cost of standard workload was calculated by the historical data including workload and staff performance in the community health service center between January and June 2017.Results Five types of community health services were carried out in the center:clinics,nursing,medical technology,public health and other categories,with a total of 960 items.The labor cost in the community health service center was￥0.72/unit standardization workload between January and June 2017.The labor cost of clinics,traditional Chinese medicine,nursing and public health were￥1.05,￥0.80,￥1.13 and￥0.37/unit standardization workload,respectively.Conclusion This study constructs a labor cost calculation method based on the standardized workload of the community health service center,which can be used to guide the community's budget expenditure management.The budget for labor costs in community public health services is highly underestimated.The community should adjust the budget of each service category based on the results of labor cost measurement in health services.