我国公立医疗卫生机构绩效考核指标对比分析

Comparative analysis of performance evaluation indexes of public medical institutions in China

公立医疗卫生机构改革是我国深化医药卫生体制改革的重点和难点,加强其绩效考核是推进改革的重要抓手。笔者通过对比分析2019年以来我国三级公立医院、二级公立医院和基层医疗卫生机构绩效考核政策文件,梳理3个考核指标体系的异同和规律,分析其对医疗卫生机构管理的影响,为完善绩效考核工作提供参考。3个政策均希望通过绩效考核指标引导各级医疗机构加强运营管理和人才培养以实现可持续发展;主要引导三级公立医院由规模扩张型转向质量效益型,引导二级公立医院大力提升医疗服务能力,引导基层医疗卫生机构做好基本医疗和公共卫生服务。但对二级公立医院的考核缺乏分级诊疗相关指标和对考核结果的运用,基层医疗卫生机构考核指标中国家监测指标占比仅为23.8%,增加了基层填报压力。今后应动态调整并持续完善绩效考核指标体系及监测方法,强化考核结果的运用和配套政策制定。

The reform of public medical institutions is a critical and difficult breakthrough in furthering the healthcare system reform in China,for which the performance appraisal of public hospitals can serve an important role.The performance policy documents of tertiary public hospitals,secondary public hospitals and primary medical and health institutions in China since 2019 were compared and analyzed,to systematically identify the similarities and differences and development rules of the three evaluation index systems.The study analyzed the impacts of the three systems on the management of medical institutions and provided reference suggestions for improving their performance evaluation.It was found that all the three systems aim at guiding tertiary public hospitals to evolve from the pattern centering on scale expansion to that on quality and benefits,guiding secondary ones to improve their capacity of medical services,and guiding primary medical institutions to focus on basic medical and public health services.However,these systems lack indexes on hierarchical diagnosis and treatment for secondary hospitals and application of examination results,while national surveillance indexes on primary ones accounted for only 23.8%of all.It is recommended to dynamically adjust both the performance evaluation index system and the surveillance methods,and to enhance the application of examination results and development of supporting policies as well.