政府购买社区卫生服务研究

发布时间：2018-06-23 17:28

本文选题：社区 + 公共服务　；参考：《郑州大学》2017年硕士论文

【摘要】：二十世纪八十年代以来,长期因为“高成本、低效率”饱受诟病的西方发达国家纷纷开始了政府购买公共服务的实践。此举打破了传统行政管理模式下,政府在公共服务市场的垄断地位。早期政府购买的公共服务主要集中在道路养护、基本设施维修等方面。与此同时,购买卫生服务的改革紧随其后,从世界范围内来说,这一举动揭开了政府购买卫生服务的新篇章。后来在World Health Organization的倡导下,一大批国家先后开展了关于政府购买社区卫生服务的改革与试点。关于政府购买社区卫生服务的理念和实践在我国发展进程较为缓慢,相较于西方发达国家业已全面的社区卫生服务体系,我国无论是理论探索还是实践的稍显滞后。我国政府购买社区卫生服务的实践始于2002年,发展至今,在多数地区,政府购买社区卫生服务的实践已经初具规模。社区卫生服务不仅是我国社区建设的重要组成部分,也是今天我国医疗卫生改革推行分级诊疗和建立城镇职工医疗卫生保险的前提基础。建设六位一体的社区医疗体系,发挥社区医疗“健康守门人”的特点,是今后社区卫生服务发展的重点。与此同时,在提倡深化行政体制改革的今天,积极推进政府购买社区卫生服务是大势所趋,也是我国医疗卫生改革实现分级诊疗制度的基础。因此,研究政府购买社区卫生服务不仅具有理论意义,同样具有深刻的实践意义。政府购买社区卫生服务的过程具体划分为以下四个阶段:准备阶段;采购实施阶段;签订和履行合同阶段;绩效考评阶段和资金支付阶段。准备阶段包括社区卫生服务需求项目和购买服务资金的确立和审核;采购实施阶段主要是招标活动的具体组织和实施;签订和履行合同阶段指的是确立社区卫生服务购买的承接单位,以及协议履行期间具体问题的处理;绩效考评和资金支付阶段主要是政府依法对承接单位服务质量和水平进行绩效考评和监管并根据合同履行质量支付购买资金。本文将严格按照这些环节对政府购买社区卫生服务进行展开,针对已有问题,尝试从营造良好的购买环境、丰富购买内容、构建竞争机制和完善考评监督体系四个方面提出提升政府购买社区卫生服务的建议。
[Abstract]:Since the 1980s, the Western developed countries, which have long been criticized for "high cost and low efficiency", have started the practice of government purchasing public services. This has broken the traditional administration mode, the government in the public service market monopoly position. The public services purchased by the early government mainly focus on road maintenance, infrastructure maintenance and so on. At the same time, reforms to buy health services followed, opening a new chapter in government purchases of health services worldwide. Later, at the initiative of the World Health Organization, a large number of countries carried out reforms and trials of government purchases of community health services. The concept and practice of government purchasing community health service is relatively slow in our country. Compared with the comprehensive community health service system in western developed countries, our country is lagging behind in theory and practice. The practice of government purchasing community health service in our country began in 2002 and has been developed up to now. In most areas, the practice of government purchasing community health service has taken shape. Community health service is not only an important part of the community construction in our country, but also the premise of carrying out classified diagnosis and treatment and establishing medical and health insurance for urban workers in the medical and health reform of our country today. It is the key point of the development of community health service in the future to build a six-member community medical system and give play to the characteristics of "health gatekeepers" in community health care. At the same time, it is the trend of the times to actively promote the government to purchase community health services, which is also the basis of the medical and health reform in China to realize the classified diagnosis and treatment system. Therefore, the study of government purchase of community health services not only has theoretical significance, but also has profound practical significance. The process of government purchasing community health service is divided into the following four stages: preparation stage, procurement implementation stage, signing and performing contract stage, performance evaluation stage and fund payment stage. The preparation stage includes the establishment and audit of community health service demand project and purchase service fund, and the procurement implementation stage is mainly about the specific organization and implementation of bidding activities. The stage of signing and performing the contract refers to the establishment of the undertaking unit for the purchase of community health services, as well as the handling of specific problems during the implementation of the agreement; The stage of performance appraisal and fund payment is that the government carries on the performance appraisal and supervision to the service quality and level of the undertaking unit according to the law and pays the purchase funds according to the contract performance quality. This article will strictly follow these links to the government to purchase community health services to carry out, aiming at existing problems, try to create a good purchase environment, enrich the content of the purchase, Suggestions on how to improve government purchase of community health services are put forward in four aspects: constructing competition mechanism and perfecting evaluation and supervision system.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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