江苏省基层医疗卫生机构改革成效研究

Reform Effect of Primary Health Care Institutions in Jiangsu Province

背景基层医疗卫生机构是我国医疗卫生服务体系的网底。江苏省自2014年开始实行综合医改,2015年作为全国4个率先进行省级综合医改试点的省份之一,全面启动医改工作。目的了解江苏省综合医改试点前后基层医疗卫生机构财政投入、队伍建设、能力建设调整情况,为江苏省基层医疗卫生机构改革和发展提供建议与支持。方法数据来源于2012—2016年原江苏省卫生和计划生育委员会调查表,研究开展时间为2017年10—12月。分别从卫生资源条件、医疗服务产出2个维度来评价基层医疗卫生机构的改革成效。选取的卫生资源条件评价指标为财政补助收入、基层医疗卫生机构数量、床位数及卫生技术人员数;选取的医疗服务产出评价指标为医疗收入和药占比、诊疗人次、入院人次。以2014年各指标数值为基础,通过计算定基比分析各指标的变化情况。结果2012—2016年基层医疗卫生机构卫生资源条件、医疗服务产出总体上呈逐年增加趋势,但在全省中的占比逐年下降。根据计算所得定基比,卫生资源条件中财政补助收入的增长较快(2016年定基比为134.84%),医疗服务产出中医疗收入的增长较快(2016年定基比为115.58%)。2012—2014年基层医疗卫生机构床位数年增长率为3.74%,2014—2016年增长率下降为1.82%;2012—2014年基层医疗卫生机构医疗收入年增长率为11.38%,2014—2016年增长率下降为7.51%。2012—2016年基层医疗卫生机构医护比为1∶0.54~1∶0.59。2016年基层医疗卫生机构药占比高于2014、2015年,达55.82%。结论江苏省综合医改试点后,基层医疗卫生机构改革取得了一定成效,但仍有提升空间,应该进一步加大对基层医疗服务能力的提升。

Background Primary health care institutions are the base of China's medical and health service system.Jiangsu Province has implemented comprehensive medical reform since 2014 and as one of the four provinces that took the lead in carrying out the comprehensive provincial medical reform,it started fully the comprehensive medical reform in 2015.Objective To understand the financial input,team building and capacity building of primary health care institutions before and after the pilot comprehensive medical reform in Jiangsu Province,in order to provide suggestions and support for the reform and development of primary health care institutions.Methods The data were derived from the questionnaire of the Jiangsu Provincial Health and Family Planning Commission from 2012 to 2016.The research was carried out from October to December in 2017.The results of primary health care reform were evaluated from two dimensions:health resource conditions and medical service output.The selected evaluation indicators of health resource conditions were financial subsidy income,the number of primary health care institutions,and the number of beds and health technicians;the selected evaluation indicators of medical service output were medical income and drug proportion,and the number of visits and hospital admissions.Based on the values of indicators in 2014,the changes of each indicator were analyzed by calculating the fixed base ratio.Results From 2012 to 2016,the health resource conditions and medical service output in primary health care institutions showed an upward trend,but its proportion in the province decreased year by year.According to the calculated fixed base ratio,the financial subsidy income in health resource conditions increased rapidly(the fixed base ratio was 134.84%in 2016),and the medical income in medical service output increased rapidly(the fixed base ratio was 115.58%in 2016).From 2012 to 2014,the average annual growth rate of beds in primary health care institutions was 3.74%,and it fell to 1.82%from 2014 to 2016.From 2012 to 2014,the annual growth rate of medical income in primary health care institutions was 11.38%,and it decreased to 7.51%from 2014 to 2016.From 2012 to 2016,the ratio of doctors to nurses in primary health care institutions was 1∶0.54-1∶0.59.The drug proportion in primary health care institutions in 2016 was higher than that in 2014 and 2015,reaching 55.82%.Conclusion After the pilot comprehensive medical reform in Jiangsu Province,primary health care institutions have received some achievements,but there is still room for improvement.The service ability to provide primary health care should be further enhanced.