【摘要】 目的了解实施综合配套改革前后基层医疗卫生机构运行情况,总结目前实施基本医疗卫生机构综合配套改革的成功经验和主要做法,深入剖析改革中的热点、难点问题和存在的不足,为实施基本医疗卫生机构综合配套改革建立科学长效机制提出政策建议。方法问卷调查实施"绩效考核、药品零差率、一般诊疗费"前后渝中区12家社区卫生服务中心运行情况,深入访谈卫生局、药品配送企业、基层医疗卫生机构负责人与药剂科科长等,获取定量与定性资料。结果 2011年财政投入占机构总收入的56.70%,比2009年增长6.09%。2011年全区社区卫生服务中心业务收入比2009年增长15.69%,比2010年增长48.57%,其中医保收入占业务收入的比例从2009年的18.95%增至2010年的22.91%和2011年的37.69%;在岗职工人均工作量年增加30%左右,年平均收入2011年(3.86万元/人)较2009年(2.82万元/人)增加36.88%。辖区内连续3年次均处方费用无增长。结论基层医疗卫生机构服务效率明显提高、服务能力明显加强,新的筹资方式保障基层医疗卫生服务公益性质。针对全科医师不足、基本医疗效率较低,基本药品供销不及时等问题,建议从改革人事制度、拓宽社区卫生筹资渠道、完善基本药物制度等入手,创新管理机制,促进基层医疗卫生机构可持续健康发展。更多还原

【Abstract】 Objective To analyze the operational aspects of primary health care institutions before and after the implementation of comprehensive reform,to summarize the successful experiences and practice and drive deep into hot and difficult problems and shortcomings,and to make policy recommendations for establishment of a scientific long-term mechanism for implementation of comprehensive reform of primary health care institutions.Methods A questionnaire survey was conducted on the running situation of 12 community health service centers(CHSCs) of Yuzhong District before and after the implementation of " performance appraisal,zero-profit drug management,and general clinic fee",and deep interviews were performed with the principals of health bureau,drug delivery companies,and institutions,as well as the heads of departments of pharmacy to obtain quantitative and qualitative data.Results The financial investment accounted for 56.70% of total income of CHSCs in 2011,being 6.90% higher than that in 2009.The business income in 2011 was higher by 15.69% than that in 2009,and by 48.57% than that in 2010;of which the total medicare revenue rose from 18.95% of 2009 to 22.91% of 2010 and 37.69% of 2011.The per capita average workload of employees increased by 30%,the average annual salary was 38 600 Yuan per capita in 2011,being higher by 36.88% than that in 2009.The average prescription cost in the CHSCs had had no increase for three successive years.Conclusion The service efficiency in primary health care institutions has significantly improved,and the service capacity remarkably enhanced.New financing ways guarantee the commonweal character for CHSCs.Nevertheless,there are still some problems such as shortage of general practitioners,less efficiency of basic medical care,and untimely supply of essential medical drugs.So it is necessary to start with reforming personnel system,widen the financing channels,and improve basic drug system,and then to establish a new management system so as to promote sustainable and healthy development of primary health care institutions.更多还原