【作者】 朱吉鸽；

【导师】 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2007， 硕士

【摘要】 无论是发达国家还是发展中国家,政府在公共卫生支出中,都不同程度地存在着资金短缺、公共卫生服务效率低等问题。政府在强调加强公共卫生资金投入的同时,更重要的是提高政府公共卫生资金投入的效益。传统公共卫生服务提供模式下,政府承担多重角色,效率低下,呈现失灵状态;卫生投入方式落后,以人员经费和工作经费的形式定额补助给卫生机构,缺乏激励和制约机制,公共卫生经费使用效益低下。传统服务模式已不适合当前社会发展的需要,迫切需要高效益服务模式的出现。因此,本课题希望通过对重庆市黔江区“公共卫生服务券”模式的研究,为公共卫生服务提供模式的创新提供一个参考。目的本课题通过对黔江“公共卫生服务券”模式进行初步评价,分析其对当地公共卫生系统的影响,探讨其在实施过程中所遇到的问题;并通过和传统的公共卫生服务模式以及政府购买模式进行比较,分析黔江区“公共卫生服务券”模式的性质和特点,为公共卫生服务模式的创新提供一个参考。方法1.文献研究法查阅大量国内外关于政府购买公共卫生服务理论和公共卫生服务券理论等方面的相关文献。2.深入访谈法通过对卫生行政人员、防保人员、居民等进行深入访谈,定性了解实际操作过程中公共卫生服务券制度对当地公共卫生系统的影响及运行中出现的问题。3.现场调查法从已选择的乡镇中,选取获得“公共卫生服务券”的农户进行问卷调查,探讨农民对公共卫生服务券的态度及利用情况,评价其对农民预防保健的态度和可及性的影响。4.统计分析方法采用SPSS11.5录用处理所有调查问卷数据。根据资料的性质运用卡方检验、多选题分析等统计学方法进行处理分析。结果1.黔江区服务券模式提高了当地预防保健服务的效率和质量。服务券制度实施以来,黔江区五苗计划免疫接种率由04年的97.56%上升为06年的99.85%,不合格接种率由04年的7.07%下降为06年的4.15%,孕产妇系统保健率由04年的90.88%上升为06年的92.52%,儿童体检率由04年的67.82%上升为06年的88.45%。2.黔江区服务券模式增强了政府部门的公共卫生管理职能。3.黔江区服务券模式促进了乡镇卫生院防保工作的落实。4.黔江区服务券模式增强了农民对公共卫生服务的可及性。结论1.黔江区“公共卫生服务券”模式只是一种投入方式的转变,并非真正意义上的政府购买服务。与传统公共卫生服务模式比较,黔江区服务券模式只是转变了经费投入方式:从供方投入转变为需方投入,从按人员工资支付转变为按服务产出支付;在提供主体和经费测算上,仍保留原来的运行方式。与政府购买服务模式相比,它缺乏政府购买服务按成本核算的意识以及在市场机制作用下的多元主体提供服务的机制。2.“服务券”并非是引起当地公共卫生状况变化的唯一因素。当地公共卫生状况的改善是多种因素综合作用的结果,“服务券”并非是引起当地公共卫生状况变化的唯一因素。乡镇卫生院整体功能的提高,院长聘用制、乡镇卫生院全员聘用制等管理体制的改革,政府对公共卫生重视程度的加强,农民自我保健意识的提高等都是引起公共卫生状况改善的原因。3.黔江区“公共卫生服务券”模式的推广是有理论和现实可行性的。更多还原

【Abstract】 Shortage of capital and low utilization efficiency on the public health disbursement all exist whether the developing countries or developed countries. When the governments emphasize to strengthen the investment of the public health fund , the more important is to raise the utilization efficiency. Considerd the low efficiency and bad service mode in the traditional public health system, new and efficient public service systems are necessary. Research on the“The public health voucher”mode of Qianjiang District in Chongqing city was presented in this paper.ObjectiveBy analyzing the characteristics of“the public health voucher”mode of Qianjiang District in Chongqing city, the influence of“the public health voucher”on local public health service system and the potential problem would be discussed, which provides a good reference to the innovation of the new public health service mode.Methods1. Document study Make a comprehensive study on the theories of purchasing public health service and the public health voucher made by the government.2. In-depth interview Analyze the influence of“the public health voucher”on local public health service system and the potential problem by undertaking the in-depth interviews to the health administrators, doctors and inhabitants.3. Questionnaire Survey Explore the implementation of“the public health vouchers”and the influence on the farmers’attitudes and accessibility to their health care by investigating the farmers who get the public health vouchers.4. Statistical Analyses Present statistical methods such as Descriptive analysis, X test and Multiple Category using the investigation data processed with SPSS11.5 software.Resualts1. The efficiency and quality of the health care and prevention service was improved.Since the enforcement of the“voucher”system, the planning immunity inoculation rate raised from 97.56% of the year of 2004 to 99.85% of the year of 2006 ; disqualification inoculation rate descended from 7.07%to 4.15%; puerperant race hygiene rate raised from 90.88% to 92.52%; children medical examination rate raised from 67.82% to 88% .2 .The government department’s public health management function was strengthened3 .The township health centers are encouraged to fulfil the public health service.4. The farmers’enthusiasm to the public health service was enhanced.Conclusions1.“The public health voucher”mode of Qianjiang District in Chongqing City was only a transformation as to the funds investment way, not really service purchased by the governmentCompared with the traditional public health service mode, Qianjiang voucher mode only transformed the funds investment way: from imputing to the institutions to the farmers, personnel wages payment style to output payment style; However, it still retained the original way on the main providing bodies and the budget method. And little consciousness was made given that cost accounting and the multielement providing system.2.“The voucher”is not the only factor that leads to the changes of the local public health states.The improvement of the local public health states attribute to the combination of multiple factors,“the voucher”is not the only one. The promotion of the functions of the township health centers, the reforms of the management systems such as the appointment system of the superintendents and staffs and the enforcement of awareness of the government and the farmers to the public health are all the important factors.3. The theoretical and realistic feasibility on the generalization of“the public health voucher”mode of Qianjiang District was testified.更多还原