社区卫生服务机构基本医疗服务成本及经费预测研究

摘要

Objective To measure the costs of primary health services in the community for developing government compensation standard and prediction of budget in 201 5.Methods Literature review and panel discussions were used to build the index database.A two-round Delphi expert consultation determined the work to do and steps for community healthcare standards.60 community health centers were sampled by stratified random sampling for survey,and the work hours,workload and service volume of respective services in 2013 were measured according to the service standards of primary care.Results The community primary care consists of the categories of outpatient services,nursing care, laboratory tests and drug management,totaling 20 services and 88 working procedures.The total work hours of primary healthcare service at 60 community health centers were 2 557 187.9 hours,which is adjusted to 2 959 21 5.1 hours based on workload coefficients.Based on the income standards of employees at the community health centers investigated,and the human cost price which was recommended by the experts,the total costs of primary healthcare of the 60 centers were 245 million,248 million and 318 million respectively,and the average cost was 71.0 yuan,71.8 yuan and 92.1 yuan per visit respectively.By such standards,the government should subsidize 38.9 ~ 60.0 yuan per visit to the centers.The total expenditure of primary healthcare of all communities in Shenzhen in 201 5 was predicted to be 314 to 407 million,for which the government is expected to subsidize 1.68~2.58 billion.Conclusion The subsidies for community primary healthcare fall short as the cost per visit runs up in 2013 to 71.0 yuan per visit or more,far above the current subsidy of 32.1 yuan per person.The subsidy per visit should be made 50.0 yuan in 201 5.%目的：测算社区基本医疗服务成本,制定政府补偿标准,预测2015年经费。方法通过文献研究及专题讨论建立备选指标库；通过2轮德尔菲法专家咨询,确定社区基本医疗服务标准的工作内容和步骤；随机抽取60家社区健康服务中心进行现场调查,按照服务标准测定基本医疗每项具体服务内容的工作时间、工作强度和2013年服务量等。结果社区基本医疗服务可分为门诊服务、护理服务、检验检查、药品管理4大类,20项服务内容,88个工作步骤。60家社区健康服务中心2013年度基本医疗服务工作时间累计为2557187.9小时。使用工作强度系数调整后工作时间为2959215.1小时(调整时)。按调查社区健康服务中心、全市社区健康服务中心在编人员收入标准和专家建议的人力成本价格,得到60家社区健康服务中心基本医疗服务成本分别为2.45亿元、2.48亿元和3.18亿元,次均成本分别为71.0元/人次、71.8元/人次和92.1元/人次。按上述标准政府应增加补贴38.9~60.0元/人次。预测2015年深圳市全市社区基本医疗费用为31.4~40.7亿元。政府应补贴16.8~25.8亿元。结论社区基本医疗补偿不足,次均成本至少71.0元/人次,远高于当前实际补偿(32.1元/人次)。建议2015年基本医疗服务次均补偿标准为50.0元/人次。