基于投入产出的基层医疗机构绩效管理评价研究

发布时间：2018-03-01 06:24

本文关键词： 基层医疗机构绩效管理增量成本效果投入产出分析　出处：《南京医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的：基层医疗机构是我国卫生服务提供体系的网底,是基本医疗服务和基本公共卫生服务的主要提供者,其服务质量与运行效率直接关系到城乡居民能否享有安全、有效、方便、价廉的基本医疗卫生服务以及整个卫生服务体系的运转效率。2009年新医改启动以来,政府在不断提高基层医疗机构财政投入的同时,积极试行机构绩效管理工作以合理引导,系统提升基层医疗机构的综合绩效水平。然而国内部分绩效管理实践却提示绩效管理工作管理成本高,给基层医疗机构造成工作压力,甚至影响机构正常业务工作开展。为此,本研究站在基层医疗机构的角度,测量参与绩效管理前后基层医疗机构相关成本投入以及综合绩效变动,利用增量成本效果分析衡量机构绩效管理投入产出效率,从而为推动绩效管理工作顺利开展,提升机构综合绩效水平以及保障基层医疗卫生机构的平稳运行发展提出建议。研究方法：以安徽省界首市18所基层医疗机构作为研究对象,开展了定性与定量研究。定性调查包括面向16位基层医疗机构负责人的绩效管理座谈会、面向4位中心卫生院院长的深入访谈,以此获得基层医疗机构参与绩效管理工作的内容。定量调查包括收集2013年和2014年机构卫生财务报表、基于课题组自行设计的关键绩效指标体系收集机构连续两年的绩效数据、利用课题组自行设计的成本调查表收集绩效管理前后机构增量成本支出数据。本研究借鉴作业成本法的理念调查并归集与机构绩效管理相关的成本耗费、利用模糊综合评价法量化绩效管理对基层医疗机构的隐性影响、基于综合指数法对机构绩效管理工作进行效果评价、采用增量成本效果分析评价基层医疗机构参与绩效管理工作的投入产出效率以及利用系统基模分析探索当前基层医疗机构综合绩效提升阻碍因素以及增量成本效果差异的原因。研究结果：(1)机构绩效管理下,平均每所基层医疗机构因参与绩效管理工作需多支出38.7万(显性成本13.8万,人力时间成本24.9万)。86%的人力时间成本耗费在绩效反馈与改进工作,91.3%的显性成本为机构院容院貌和科室设施设备支出。显性成本支出占2014年机构总支出2.56%。(2)虽然绩效管理工作增加了基层医疗机构工作压力,但提高了机构管理效率、工作积极性以及机构声誉等,量化分析表明隐性影响促进机构总收入平均增加68万,远高于显性成本与人力时间成本。(3)尽管界首当前并未规范地开展以绩效持续改进和提高机构综合绩效水平为目的绩效管理工作,但2014年18所基层医疗机构综合绩效水平平均增长了11,仅A06和C1两所机构综合绩效水平下跌(-9和-0.35)。相关分析结果表明机构2014年绩效指数与绩效排名变动呈正相关,提示18所机构存在较大绩效提升空间(Pearson相关P value=0.002,R=0.680; Spearman相关P value=0.005, R=0.626)。(4)增量成本效果分析表明18所机构提高单位绩效指数,需要增加投入3.6万元(1.3万显性成本和2.3万人力时间成本),一般卫生院、在职职工人人数较少、总收支结余水平较差的机构往往提高单位绩效需增加的成本高于其他机构。(5)基模分析表明基层医疗机构硬件与软件发展不协调限制了机构绩效产出增长上限；繁重的基本公共卫生服务任务、有限的卫技人员数以及薄弱的村室服务能力影响了机构工作效率；基层医疗机构薄弱的经济自我补偿能力导致绩效投入产出效率“强者越强”。政策建议：(1)不断优化机构绩效管理模式,创新绩效考核方式,推进基层卫生信息化建设等措施提高绩效管理效率；(2)完善对基层卫生人才的经济激励与非经济激励措施,提高基层卫生人员数量素质,降低人才流失率；(3)加强财政对基层医疗机构基础设施设备、物理环境建设等投入,创新财政投入方式,积极为绩效改进成本合理兜底；(4)卫生局积极利用绩效管理均衡基层医疗机构医疗服务和基本公共卫生服务,不断强化基层医疗机构服务功能建设。机构院长积极拓宽思路,不断提高医疗服务和基本公共卫生服务效率。
[Abstract]:Objective: To study the grassroots medical institutions is our country health service system network is the main provider of basic medical services and basic public health services, the service quality and operation efficiency is directly related to urban and rural residents can enjoy safe, effective, convenient and inexpensive, since the basic medical and health services and the health service system operation efficiency.2009 years of the start of new medical reform, the government in the continuous improvement of grassroots medical institutions of financial investment, actively work to guide a reasonable performance management mechanism, system to improve the comprehensive performance level of grassroots medical institutions. However, the domestic part of the performance management practice has indicated that performance management work of high cost, resulting in the work pressure to the grassroots medical institutions, and even affect the mechanism the normal business work. Therefore, this research station in the basic medical institutions involved in the perspective of performance management and measurement Changes in basic medical institutions related to cost and performance, using the incremental cost-effectiveness analysis to measure the input-output efficiency of performance management mechanism, so as to promote the performance management work smoothly, suggestions to enhance the comprehensive performance level of development and smooth operation mechanism and the protection of basic medical and health institutions. Methods: in Anhui Province Jieshou City 18 primary medical institutions as the research object, carry out qualitative and quantitative research. Quantitative survey for 16 grassroots medical institutions responsible for the performance management forum for the 4 center hospital hospital long in-depth interviews, in order to obtain the basic medical institutions involved in performance management work. The quantitative survey collected in 2013 and 2014 including health financial statements. The performance data of the key performance index system designed by research team for two consecutive years collecting mechanism based on the use of The research group designed the questionnaire to collect the cost of performance management mechanism before and after the incremental cost expenditure data. The concept of activity-based costing and performance management mechanism investigation and collection related costs from this research, using fuzzy comprehensive evaluation method to quantify the performance management of recessive effect of grass-roots medical institutions, comprehensive index method is used to evaluate the effect of performance management mechanism based on the exploration of basic medical institutions comprehensive performance reasons hindering factors and incremental cost effectiveness analysis of the differences in basic medical institutions to participate in the evaluation of the performance management of the input-output efficiency by using the incremental cost effectiveness analysis and the use of system model. Results: (1) performance management mechanism, the average of each basic medical institutions for participation in performance management work requires the expenditure of more than 387 thousand (the dominant cost 138 thousand manpower costs 249 thousand).86% human Between the cost in performance feedback and improvement work, 91.3% of the cost for the dominant institutions courtyard Rong Yuanmao and Department of facilities and equipment spending. The dominant cost spending in 2014 accounted for the total body 2.56%. (2) although the performance management work to increase the working pressure of the grassroots medical institutions, but improve the efficiency of management mechanism, working enthusiasm and reputation mechanism etc. the quantitative analysis shows that, the recessive influence promotion agencies total income increased by an average of 680 thousand, much higher than the explicit cost and human cost of time. (3) although not currently carried out by Jieshou standard performance continued to improve and enhance the comprehensive performance level of institutions for the purpose of performance management, but the comprehensive performance level in 2014 18 local medical institutions rose by an average of 11 the comprehensive performance level of only A06 and C1 two institutions (-9 and -0.35) fell. Correlation analysis showed that the 2014 performance index and performance ranking changes were positively correlated, That 18 mechanism has improved greatly the performance (Pearson P value=0.002, R=0.680 P value=0.005 R=0.626; Spearman,). (4) show that the incremental cost effectiveness analysis of 18 institutions to improve the performance index, the need to increase the investment of 36 thousand yuan (13 thousand to 23 thousand human dominant cost and time cost), general hospital, all staff small number of the total balance of lower level institutions tend to improve performance to increase the cost is higher than other institutions. (5) show that the development of grassroots medical institutions, hardware and software of uncoordinated limit mechanism performance growth limit analysis of fundamental mode; the heavy task of basic public health services, the number of health personnel is limited and weak the ability of village room service affects the efficiency of institutions; the weak economic self compensation ability of grassroots medical institutions lead to the input-output efficiency "performance strong stronger political." Policy recommendations: (1) to optimize the performance management mechanism innovation, performance evaluation, and promote grass-roots health informatization construction and other measures to improve the efficiency of performance management; (2) improve the economic incentive for primary health professionals and non economic incentive measures, improve the grass-roots health personnel quantity quality, reduce the wastage rate; (3) strengthen financial the basic medical institutions infrastructure equipment, physical environment construction investment, the innovation of financial investment, actively improve the cost of reasonable fallback for performance; (4) Health Bureau to actively use the performance management balanced grassroots medical institutions of medical services and basic public health services, continue to strengthen the grassroots medical service function construction. Institutions actively expand the idea of the president. Improving medical services and basic public health service efficiency.

【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.32

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