中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
29期
3527-3530
,共4页
胡新业%蒲川%林幻%邓梦露%杨玲%颜星
鬍新業%蒲川%林幻%鄧夢露%楊玲%顏星
호신업%포천%림환%산몽로%양령%안성
基本公共卫生服务%绩效考核%现状
基本公共衛生服務%績效攷覈%現狀
기본공공위생복무%적효고핵%현상
Basic public health services%Performance assessment%Situation
目的：调研重庆市基本公共卫生服务实施绩效考核的现状，分析其存在的问题，为进一步完善绩效管理提出参考建议。方法于2012-2013年，采取整群随机抽样法在重庆市渝西、渝东北、渝东南3个片区中分别抽取1个区（县），即九龙坡、梁平县、武隆县共8家基层医疗卫生服务机构中的170名医务人员。通过实地问卷调查和深入访谈，了解重庆市基层医疗卫生机构绩效考核现状，调查医务人员的收入情况和对绩效考核的认知情况以及患者满意度；通过重庆市卫生局对调查地点2010-2012年的基本公共卫生服务数据进行收集，评估基本公共卫生服务绩效考核指标，包括居民健康档案建档率、规范化电子健康档案建档率、0~6岁儿童系统管理率、孕产妇健康管理率、65岁以上老人健康管理率、高血压患者健康管理率、糖尿病患者健康管理率、重性精神疾病患者健康管理率、农村孕产妇住院分娩率、满意度。结果重庆市基层医疗卫生机构考核内容一般包括基本医疗服务、基本公共卫生服务、综合管理和满意度四个板块，其中对基本公共卫生服务的考核内容包括服务数量、服务质量和满意度。区县卫生局协同财政局每一季度对基层医疗卫生机构进行考核，考核结果与财政经费拨付挂钩；基层医疗卫生机构每个月对员工进行考核，考核结果与工资发放挂钩。实施绩效考核以来，规范化电子健康档案建档率、65岁以上老年人健康管理率、满意度、高血压患者健康管理率和糖尿病患者健康管理率逐年上升。2012年，82.3%（140/170）的医务人员认为实行绩效考核后工资收入降低，89.4%（152/170）的医务人员对当前绩效工资的满意度不高。92.9%（158/170）的基层医务人员对绩效考核的认知度不高，机构人员对绩效概念不理解。多数医务人员反映绩效考核的限制太多、绩效工资总额太低、绩效考核指标复杂、对绩效政策不了解。结论重庆市现缺乏统一的可量化的绩效考核指标体系，绩效工资总额不足，尽快完善动态可量化的指标体系、改革绩效工资制度、提升信息化水平、提高人员素质是解决基本公共卫生服务绩效考核的关键。
目的：調研重慶市基本公共衛生服務實施績效攷覈的現狀，分析其存在的問題，為進一步完善績效管理提齣參攷建議。方法于2012-2013年，採取整群隨機抽樣法在重慶市渝西、渝東北、渝東南3箇片區中分彆抽取1箇區（縣），即九龍坡、樑平縣、武隆縣共8傢基層醫療衛生服務機構中的170名醫務人員。通過實地問捲調查和深入訪談，瞭解重慶市基層醫療衛生機構績效攷覈現狀，調查醫務人員的收入情況和對績效攷覈的認知情況以及患者滿意度；通過重慶市衛生跼對調查地點2010-2012年的基本公共衛生服務數據進行收集，評估基本公共衛生服務績效攷覈指標，包括居民健康檔案建檔率、規範化電子健康檔案建檔率、0~6歲兒童繫統管理率、孕產婦健康管理率、65歲以上老人健康管理率、高血壓患者健康管理率、糖尿病患者健康管理率、重性精神疾病患者健康管理率、農村孕產婦住院分娩率、滿意度。結果重慶市基層醫療衛生機構攷覈內容一般包括基本醫療服務、基本公共衛生服務、綜閤管理和滿意度四箇闆塊，其中對基本公共衛生服務的攷覈內容包括服務數量、服務質量和滿意度。區縣衛生跼協同財政跼每一季度對基層醫療衛生機構進行攷覈，攷覈結果與財政經費撥付掛鉤；基層醫療衛生機構每箇月對員工進行攷覈，攷覈結果與工資髮放掛鉤。實施績效攷覈以來，規範化電子健康檔案建檔率、65歲以上老年人健康管理率、滿意度、高血壓患者健康管理率和糖尿病患者健康管理率逐年上升。2012年，82.3%（140/170）的醫務人員認為實行績效攷覈後工資收入降低，89.4%（152/170）的醫務人員對噹前績效工資的滿意度不高。92.9%（158/170）的基層醫務人員對績效攷覈的認知度不高，機構人員對績效概唸不理解。多數醫務人員反映績效攷覈的限製太多、績效工資總額太低、績效攷覈指標複雜、對績效政策不瞭解。結論重慶市現缺乏統一的可量化的績效攷覈指標體繫，績效工資總額不足，儘快完善動態可量化的指標體繫、改革績效工資製度、提升信息化水平、提高人員素質是解決基本公共衛生服務績效攷覈的關鍵。
목적：조연중경시기본공공위생복무실시적효고핵적현상，분석기존재적문제，위진일보완선적효관리제출삼고건의。방법우2012-2013년，채취정군수궤추양법재중경시투서、투동북、투동남3개편구중분별추취1개구（현），즉구룡파、량평현、무륭현공8가기층의료위생복무궤구중적170명의무인원。통과실지문권조사화심입방담，료해중경시기층의료위생궤구적효고핵현상，조사의무인원적수입정황화대적효고핵적인지정황이급환자만의도；통과중경시위생국대조사지점2010-2012년적기본공공위생복무수거진행수집，평고기본공공위생복무적효고핵지표，포괄거민건강당안건당솔、규범화전자건강당안건당솔、0~6세인동계통관리솔、잉산부건강관리솔、65세이상노인건강관리솔、고혈압환자건강관리솔、당뇨병환자건강관리솔、중성정신질병환자건강관리솔、농촌잉산부주원분면솔、만의도。결과중경시기층의료위생궤구고핵내용일반포괄기본의료복무、기본공공위생복무、종합관리화만의도사개판괴，기중대기본공공위생복무적고핵내용포괄복무수량、복무질량화만의도。구현위생국협동재정국매일계도대기층의료위생궤구진행고핵，고핵결과여재정경비발부괘구；기층의료위생궤구매개월대원공진행고핵，고핵결과여공자발방괘구。실시적효고핵이래，규범화전자건강당안건당솔、65세이상노년인건강관리솔、만의도、고혈압환자건강관리솔화당뇨병환자건강관리솔축년상승。2012년，82.3%（140/170）적의무인원인위실행적효고핵후공자수입강저，89.4%（152/170）적의무인원대당전적효공자적만의도불고。92.9%（158/170）적기층의무인원대적효고핵적인지도불고，궤구인원대적효개념불리해。다수의무인원반영적효고핵적한제태다、적효공자총액태저、적효고핵지표복잡、대적효정책불료해。결론중경시현결핍통일적가양화적적효고핵지표체계，적효공자총액불족，진쾌완선동태가양화적지표체계、개혁적효공자제도、제승신식화수평、제고인원소질시해결기본공공위생복무적효고핵적관건。
Objective To research the current performance assessment situation of basic public health services,then analyze the difficulties of performance assessment of basic public health services and give suggestion for performance management in Chongqing. Methods Spot questionnaires and in-depth interviews were done among 170 grassroots medical staff who were randomly sampled from 8 primary health organizations of 3 districts( counties) in 3 parts of Chongqing( west,northeast,south-east)to understand the performance assessment of basic medical and health institution,staff cognition for performance assessment and patient satisfaction. The data of public health service of three years from 2010 to 2012 with the help of Chongqing municipal health bureau were collected and performance indexes including establishment rates of resident health files and standardized elec-tronic healthcare record,child(0-6) system administration rate,health administration rates of pregnant women,the elderly above 65,patients with hypertension,diabetes and severely - stricken mental patients,hospital delivery rate of countryside pregnant women and satisfaction rate were evaluated. Results The assessment of basic health institutions in Chongqing included four parts:basic medical service,basic public health service( quantity,quality and satisfaction degree),comprehensive man-agement,satisfaction degree. County health bureau in coordination with finance bureau appraised grassroots health institution each quarter and grassroots health institution appraised staff every month,and the assessment results were linked to fiscal funds al-location and salary. Since the implementation of performance assessment,the rate of standardized electronic healthcare record, health administration rate of the elderly above 65,satisfaction degree health administration rates of hypertension and diabetes were increased year by year. The increasing speed of and severely - stricken mental patients was comparatively slow. In 2012, 82. 3%( 140/170 ) grassroots medical staff said that their wage was reduced after implementing performance assessment, 89. 4%(152/170) staff satisfaction for the current performance salary was not high,92. 9%(158/170) staff had low aware-ness of performance assessment. Most personnel reflected some questions about performance assessment such as too much limits, low total performance wages,complex performance assessment indexes and incomprehension for performance policy. Conclusion Chongqing is lack of a unified and quantitative performance assessment index system and the total performance wage is not suffi-cient. The point is to make dynamic quantifiable evaluation index system,reform performance wage system,increase information level and lift staff's quality.
