安徽省县级公立医院财政投入绩效评价研究

发布时间：2018-01-25 00:33

本文关键词： 县级公立医院财政投入绩效　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的摸清安徽省县级公立医院财政投入情况,探索不同财政投入水平、结构及各投入项目收支比对医院财政投入绩效的影响以及不同财政补助水平下医院产出指标的变化情况,从而找出财政投入存在的问题和薄弱环节,实例论证财政补助对医院运行的影响,以期为完善财政投入政策,提高县级医院运行效率提供参考依据。方法通过文献复习了解国内外公立医院财政投入及其绩效评价的实践经验,同时查阅文件资料了解相关部门对公立医院财政投入的政策规定,为课题研究方案的拟定和指标体系构建提供思路;召开专家讨论会,交流财政对县级医院的投入情况,并对初步研制的评价指标体系进行研讨、修正;运用德尔菲法确定各评价指标及权重;深度访谈相关人员,收集财政投入现状、问题及有关建议等资料;对样本医院进行问卷调查,内容涵盖三个部分:医院基本情况、医院收支情况和医院业务情况;利用Epi Data 3.1、Excel 2003和SPSS16.0分别对数据进行录入、处理和分析;运用一般描述性分析、t检验、方差分析、相关性分析、多元回归等统计方法深入了解样本医院财政投入现状和绩效得分情况,找出财政投入各因素与绩效间的相关关系,并实例论证财政补助水平对医院产出指标的影响。结果财政投入情况:(1)补助收入及比例:2013-2015年样本医院财政补助数额呈逐年增长的趋势,2015年财政补助收入同比增长率明显高于2014年,达到14.4%,但其占医院总收入的比例却有所下降,财政补助比例依旧不高。其中,2015年样本医院总体财政补助比例为9.4%,半数以上的县级医院财政补助比例低于7.8%,仅25%的医院该比例超过10%,且财政补助比例地域水平差别较大(最低为1.6%,最高为29.1%)。从医院类型看,县综合医院财政投入数额在不断增长,但2015年其财政投入增长率较2014年下降了近7个百分点;县中医院除了在2014年出现投入负增长外,其投入增长率亦与县综合医院差距较大。此外,县综合医院财政补助比例呈现逐年增长的趋势,而县中医院历年财政补助比例不仅没有上升,反而在逐年下降。与2013年比较,2015年降幅达到3.6%。(2)投入结构及分布:财政补助收入中,离退休人员经费各年占比均在22.7%-26.8%之间,2015年88.6%家样本医院得到了该项补助;在职人员经费占比各年均在15.2%以下,2015年45.5%家样本医院得到了该项补助,其中仅9家样本医院在职人员经费补助占实际在职人员支出比例在10%以上。(3)补助项目的收支情况:2015年在职人员经费、离退休人员经费、基本建设和设备购置四项补助均收不抵支。其中,在职人员经费补助和基本建设支出补助占其实际支出的比例分别为5.3%和68.1%。财政投入绩效得分情况:样本医院绩效总得分为825.6±72.0分。从各维度来看,医疗服务、社会服务、综合管理和社会评价四个维度的得分分别是209.7±20.9分、205.8±16.9分、203.5±18.1分和206.6±18.4分。无论从绩效总得分还是评价各维度得分来看,县中医院的得分水平均低于县综合医院,但两者仅在“社会服务”维度得分差异具有统计学意义(P0.05)。财政投入绩效得分的影响因素:就补助水平来说,绩效总得分与财政补助比例呈正相关;就投入结构而言,在职人员经费占比和基本建设补助占比影响医院财政投入的绩效总得分(P0.01),且在职人员经费和基本建设在补助收入中的占比越大,医院绩效得分越高;就投入项目收支比而言,财政补助总收支比、在职人员经费和基本建设的收支比三个因素影响医院财政投入的绩效总得分(P0.05),且财政补助力度越大,对人员经费和基本建设的实际支出补助份额越大,医院绩效得分就越高。财政补助水平对医院产出指标的影响:人员支出占比与财政补助水平呈正相关,而次均住院费用、次均门急诊费用、药占比及资产负债率与财政补助水平均呈负相关。不同财政补助水平下,各指标组间差异具有统计学意义(P0.05)。结论总体上,安徽省县级公立医院财政投入在不断增长,但投入水平依旧不高,且投入分布不均衡,县中医院补助水平相对较低;与此同时,财政投入结构也不尽合理,得到在职人员经费和基本建设补助的医院只在少数,且补助亦不到位,较大比例由医院自身发展予以解决。除此之外,财政补助比例、结构及各项目收支比不同,医院投入绩效也不同,且财政补助水平对人员支出占比、次均住院费用、次均门急诊费用、药占比及资产负债率亦有一定影响。因此,政府应对全省各县的财力情况和县级医院运营情况进行摸底,在此基础上建立长效投入保障机制,优化投入结构,全额保障离退休人员工资,加大在职人员经费补助,并逐步化解医院历史性债务。此外,还应加强对财政投入的绩效考核,将考核结果与财政投入相挂钩,从而切实提高财政资金的使用效率。
[Abstract]:Objective to find out the county public hospital of Anhui Province, the financial investment, explore the different level of financial investment, the investment structure and project budget on hospital performance of financial input and the effect of changes in output index hospitals of different level of financial assistance under the situation of financial investment so as to find out the existing problems and weak links, demonstration of financial assistance for the effect of hospital operation. In order to improve the financial investment policy, to provide reference on improving the efficiency of the hospital. Through the method of literature review about domestic and international financial investment and public hospital performance evaluation experience, and understanding of the relevant departments to provide access to documents on policy of financial investment in public hospitals, and to provide ideas for the construction of the index system of the research project; seminar, exchange of financial investment in county hospitals, and the preliminary development evaluation The evaluation index system is discussed, using the Delphy Fa correction; to determine the evaluation index and weight; in-depth interviews with relevant personnel, collect the financial investment situation, problems and suggestions of information; questionnaire survey of sample hospitals, covers three parts: the basic situation of the hospital situation, hospital and hospital business income; the use of Epi Data 3.1 Excel, 2003 and SPSS16.0 respectively for data entry, processing and analysis; using descriptive analysis, t test, variance analysis, correlation analysis, multiple regression and in-depth understanding of the hospital financial investment status and performance scores, to find out the relationship between the factors and related financial investment performance, influence and demonstration of finance the level of subsidy on hospital output index. Results: (1) financial investment subsidy income and the proportion of 2013-2015 in sample hospitals subsidy amount is increasing year by year The trend of 2015, financial subsidy income year-on-year growth rate was significantly higher than that in 2014, reached 14.4%, but the total hospital revenue ratio has declined, fiscal subsidy proportion is still not high. Among them, the 2015 sample hospital overall fiscal subsidy proportion is 9.4%, the proportion of financial subsidies in county hospitals more than half of less than 7.8%, only 25% of the hospital the proportion of more than 10%, and the difference of regional level greater fiscal subsidy proportion (minimum 1.6%, maximum 29.1%). From the type of hospital, county general hospital financial investment amount is growing, but in 2015 the financial investment growth rate fell by nearly 7 percentage points higher than in 2014; in addition to County Hospital of traditional Chinese medicine into negative growth in 2014 outside, the investment growth rate and a larger gap between the county general hospital. In addition, the county general hospital financial subsidy proportion increasing trend year by year, and the county hospital of traditional Chinese Medicine annual finance ratio did not help Rose, but declined year by year. Compared with 2013, 2015 by 3.6%. (2): investment structure and distribution of financial subsidy income, retirees funds each year accounted for between 22.7%-26.8%, 2015 88.6% sample hospitals received the subsidy; on-the-job personnel expenses accounted for the average below 15.2%. In 2015 45.5% sample hospitals received the subsidy, the on-the-job personnel funds only 9 sample hospitals accounted for the proportion of the actual expenditure subsidies for in-service personnel in more than 10%. (3) income subsidy project: 2015 in-service personnel expenses, retired personnel expenses, basic construction and equipment purchase subsidies are four items of income over expenditure. Among them, on-the-job personnel funding and basic construction expenditure subsidies accounted for the actual expenditure ratio were 5.3% and 68.1%. financial investment performance scores: the total score of performance of sample hospitals was 825.6 + 72 points from each dimension to. Look, medical services, social services, social management and comprehensive evaluation score of four dimensions were 209.7 + 20.9, 205.8 + 16.9, 203.5 + 18.1 and 206.6 + 18.4. Regardless of the total score or performance evaluation scores, the scores of county hospital were lower than the county general hospital. But both of them only in the "social service" scores the difference was statistically significant (P0.05). The financial investment performance score factors: the level of subsidy, positive performance total score and fiscal subsidy proportion; investment structure, service personnel funds accounted for and basic construction grants accounted the total score of hospital's financial investment performance (P0.01), and the staff in basic construction funds and subsidy income in the proportion of larger, higher scores on hospital performance; project investment budget ratio, financial subsidies total revenue ratio, on-the-job personnel funds and base The construction of the balance of payments than three factors affect the total score of hospital financial investment performance (P0.05), and financial assistance to the greater share of the actual expenditure of grant funds and personnel to the basic construction of the hospital performance, the higher the score. The level of financial assistance to the hospital output index: personnel expenditure accounting and finance the subsidy level was positively correlated, while the average hospitalization cost, average cost of outpatient and emergency medicine, accounting and asset liability ratio and financial subsidy levels were negatively correlated. Different level of financial assistance, with statistical significance of each index difference between the two groups (P0.05). Conclusion on the whole, Anhui Province, the county public hospital financial investment in the growing however, the input level is still not high, and the input distribution is not balanced, county hospital subsidy level is relatively low; at the same time, the financial investment structure is not reasonable, get on-the-job personnel funds and subsidies for the construction of Basic Medicine Hospital in only a few, and also subsidies are not in place, a large proportion of the development will be resolved by the hospital itself. In addition, the proportion of financial subsidies, project structure and the balance ratio is different, the hospital investment performance is different, and the level of financial assistance to the personnel expenditure ratio, average hospitalization expenses, average outpatient expenses, medicine accounting and asset liability ratio have a certain influence. Therefore, the government should thoroughly the financial situation of the province's counties and county-level hospital operations, on the basis of the establishment of long-term investment guarantee mechanism, optimize the investment structure, the full protection of retired personnel wages, increase on-the-job personnel funding, and gradually resolve the hospital historic debt. In addition, also we should strengthen the financial input of performance appraisal, the appraisal results and financial investment linked, so as to effectively improve the efficiency of fiscal funds.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

【参考文献】