海口市社区卫生服务体系发展状况调查及优势、潜力和困境探讨

发布时间：2018-08-30 11:22

【摘要】：目的了解海口市社区卫生服务(CHS)体系发展状况,并探讨其优势、潜力和困境。方法以海口市4个区的所有CHS中心和CHS站为调查对象,采用卫生部妇社司下发的《社区卫生服务站常规监测调查表》和《社区卫生服务中心常规监测调查表》,对2007—2010年海口市CHS机构的总体规模、卫生人力资源、财务收支及卫生服务提供情况等进行调查。抽取部分CHS机构的处方,采用卫生部妇社司下发的《社区卫生服务机构合理用药及处方费用常规监测调查表》,对2008—2010年CHS机构处方的用药个数、抗生素和激素使用情况及费用进行调查。随机拦截部分就诊CHS机构的社区居民,采用卫生部妇社司下发的《社区卫生服务利用者满意度调查表》,对2009—2010年社区居民的CHS知晓、利用及满意情况进行调查。结果 2010年建成并投入运行的CHS中心已有11家,完成规划数的55.0%(11/20);CHS站74家,完成规划任务。到2010年底,全市CHS中心的平均固定资产额为300.51万元,CHS站为44.66万元。2010年底,CHS机构卫生技术人员总数已达到1 180人,医师403人,护士548人,医护比为1∶1.36。CHS站和CHS中心分别于2009年和2010年实现了收支基本持平,并略有盈余;在收入方面,业务收入是CHS机构收入的主要来源,占总收入的70%以上;在支出方面,业务支出和人力支出是CHS机构支出的主要部分,CHS中心药品支出占业务支出的60%以上,CHS站则高达78%以上,在人力支出方面,人员的工资支出占绝大部分。2010年,海口市CHS机构的门急诊总量为1 633 913人次,占当年全市所有各级医疗机构门急诊总量6 151 781人次的26.6%;2007年CHS机构的急诊量为36 041人次,到2010年达到257 282人次,为2007年的7.1倍;双向转诊始终表现为上转多于下转的不对等态势。2008—2010年,2/3的处方中使用了抗生素,而且使用二联抗生素和激素的处方数均占抽查总数的20%以上。2010年,全市CHS机构共登记管理高血压患者35 634人,糖尿病患者10 550人。满意度较高的是CHS机构医务人员的服务态度,其次为等候时间和医务人员的解释和交流,最低的是就诊机构的设施和设备。结论以社会力量为主体的海口市CHS体系的优势在于资金筹措范围广,运作灵活,较短的时间内在机构的布局上实现了地域上的医疗服务可及性。其潜力首先在于成本控制相对容易,从而使药品价格下调有很大的空间;其次在高血压、糖尿病等慢性病管理方面,CHS机构逐渐积累起来的资料,为心脑血管疾病的人群防控奠定基础。目前所面临的发展困境主要是难以获得综合医院的技术支持及其私有制属性而引发的对其公益性的质疑。
[Abstract]:Objective to understand the development of community health service (CHS) system in Haikou City and explore its advantages, potentials and difficulties. Methods all CHS centers and CHS stations in 4 districts of Haikou City were selected as the subjects. The general scale and health human resources of CHS institutions in Haikou City from 2007 to 2010 were analyzed by using the questionnaire for routine monitoring of community health service stations and the questionnaire for routine monitoring of community health service centers issued by the Department of Women and Social Welfare of the Ministry of Health. Financial income and expenditure and health service provision were investigated. The prescriptions of some CHS institutions were selected, and the number of prescriptions for CHS institutions from 2008 to 2010 was investigated by the questionnaire on the routine monitoring of rational use of drugs and prescription costs in community health service institutions issued by the Department of Women and Social Affairs of the Ministry of Health. The use and cost of antibiotics and hormones were investigated. Some community residents who visited CHS institutions were randomly intercepted. The questionnaire on satisfaction of users of community health services issued by the Department of Women and Social Affairs of Ministry of Health was used to investigate the CHS knowledge, utilization and satisfaction of community residents in 2009-2010. Results there were 11 CHS centers built and put into operation in 2010, and 74 CHS stations were completed in 55.0% (11 / 20) of the total. By the end of 2010, the average fixed assets of the city's CHS center was 446600 yuan at 3.0051 million yuan. By the end of 2010, the total number of health technicians, doctors and nurses had reached 1,180, 403 doctors and 548 nurses. The health care ratio for the 1:1.36.CHS station and the CHS centre was basically flat in 2009 and 2010, with a slight surplus; on the revenue side, operational income was the main source of revenue for CHS institutions, accounting for more than 70 per cent of total revenue; and in terms of expenditure, Operating expenditure and manpower expenditure are the main part of CHS agency expenditure. The CHS center's drug expenditure accounts for more than 60% of the operating expenditure. In terms of manpower expenditure, the personnel wage expenditure accounts for the vast majority of the total expenditure in 2010. In Haikou City, the total number of outpatient and emergency cases in CHS institutions was 1 633,913, accounting for 26.6 times of the total number of outpatient and emergency cases in all medical institutions at all levels in the city in that year, and in 2007, the number of emergency cases in CHS institutions was 36,041, reaching 257 282 in 2010, 7.1 times of that in 2007. Bidirectional referrals always show an unequal trend of upturn over downturns. In 2008-2010, two thirds of prescriptions used antibiotics, and the number of prescriptions using both antibiotics and hormones accounted for more than 20% of the total number of random checks in 2010. A total of 35,634 patients with hypertension and 10,550 patients with diabetes mellitus were registered by CHS institutions in the city. The higher satisfaction was the service attitude of the medical staff in CHS, the second was the waiting time and the explanation and communication of the medical staff, and the lowest was the facilities and equipment of the hospital. Conclusion the advantage of Haikou CHS system with social force as the main body lies in its wide range of financing, flexible operation and the geographical availability of medical services in a short period of time. The potential lies first in the relatively easy cost control, so that there is a lot of room for lowering drug prices; secondly, in the management of chronic diseases such as hypertension, diabetes, and other chronic diseases, the CHS institutions have gradually accumulated information. To lay a foundation for prevention and control of cardiovascular and cerebrovascular diseases. At present, it is difficult to obtain technical support and private ownership property of general hospitals.
【作者单位】：海南医学院附属医院临床中心实验室;华中科技大学同济医学院附属协和医院心内科;海南医学院附属医院信息科;三亚市人民医院心内科;海南医学院附属医院预防保健科;
【基金】：卫生部项目(卫妇社社卫便函[2008]126号[2010]11号)——社区卫生服务体系建设重点联系城市常规监测海南省卫生厅项目(琼卫科教[2006]16号)——全科医学培训需求调查
【分类号】：R197.1

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