【作者】 许帅；

【导师】 王亮亮；

【作者基本信息】 东南大学 ， 会计（专业学位）， 2022， 硕士

【摘要】 经济社会不断发展,高速运转的城市节奏给人们带来巨大的压力,精神疾病、心理疾病的患病率逐年攀升。随着物质条件的改善和传统思想的转变,人们逐渐开始重视精神健康、心理健康。由此,精神专科医院得到了飞速发展,政府投入逐年增加。经费投入、产出、效益关乎着政府的工作效率、财政资源的配置和社会经济的稳定,绩效管理因此成为精神专科医院考核的重要环节。对项目支出绩效评价的研究工作,已逐渐由萌芽向成熟、由表层应用向深层应用推进。近年来,政府不仅在共性指标框架上深入研究,也要求各部门、各行业形成各具特色的个性指标。但由于公立医院项目支出范围广、内容多,精神专科医院又具有其服务的特殊性,尚未形成较为权威公认的项目支出绩效评价指标体系。构建科学的项目支出绩效评价体系,一方面,可以客观评价精神专科医院项目支出的投入产出情况,为医院间横向对比提供可行性;另一方面,在财政补助的投入、分配方面,可以为政府有关部门提供决策支持。正是基于以上背景,探索精神专科医院项目支出绩效评价指标体系具有重要的理论价值和实践意义。本研究主要围绕四个部分展开。第一部分,通过文献研究法和专家访谈法初步筛选指标,形成了精神专科医院项目支出绩效评价初始指标集,共包括四个支出项目154个三级指标。第二部分,通过德尔菲专家咨询法对15名专家进行两轮问卷调查,请专家们按重要性对指标评分,并调查专家对问卷内容的熟悉程度和判断依据,通过计算各指标的算数平均数、满分频率、变异系数及专家的积极系数、权威系数,应用界值法筛选评价指标,构建出精神专科医院项目支出绩效评价指标框架。第三部分,采用层次分析法确定体系中各指标的权重系数。请权威系数较高的5名专家对指标进行两两对比,使用9分标度法对判断矩阵中的指标评分,运用yaahp10.1软件计算层次单排序结果并进行一致性检验,进一步计算层次总排序结果并进行一致性检验,最终确定指标体系中各层次、各指标的权重。第四部分,根据2020年财政拨款情况选取江苏省三所城市精神专科医院进行指标体系的应用,运用SPSS软件对样本数据进行归一化处理,再结合各指标的权重系数得出2020年三所精神专科医院的综合得分和排名。并根据应用结果对完善精神专科医院项目支出绩效评价工作提出建议。本研究首先构建了精神专科医院公共卫生服务任务类、重点学科发展类、基本建设类、设备购置类项目支出绩效评价指标框架。德尔菲专家咨询的专家积极系数100%,四个支出项目的平均权威系数0.75,各项目的权威系数均大于0.70,说明此次评估专家积极性较高,权威性较好,结果具有可信性。其次,根据层次分析结果,本研究形成了各指标的权重系数,四个一级指标的重要性排序依次为产出、效益、过程、决策。在四类项目的共性指标中,较为重要的指标是项目管理制度执行有效性、预算执行率,在四类指标中均具有较高的权重占比。在四类项目的个性指标中,较为重要的指标有在册严重精神障碍患者规范管理率、精神学科住院医师规范化培训合格率、工程验收合格率、大型医用设备检查阳性率。层次单排序及总排序一致性检验的结果表明,所有判断矩阵的一致性检验结果均小于0.1,具有满意的一致性。最后,通过对指标体系的应用情况分析,本研究构建的精神专科医院项目支出绩效评价指标体系在城市精神专科医院中具有适用性,在对比分析中可以提供一定参考价值。本文聚焦精神专科医院,从项目拨款类型出发,就公共卫生服务任务类、重点学科发展类、基本建设类、设备购置类项目支出分别构建绩效评价指标体系,不仅对精神专科医院项目支出绩效评价工作有现实指导意义,而且对政府有关部门相关政策决策提供参考建议。更多还原

【Abstract】 With the constant development of economy and society,high-speed rhythm of city life brings more and more pressure and worries.People not only pursue physical health,but also begin to pay attention to mental health and psychological health.Along with that,psychiatric hospitals have been developing rapidly,government investment has been increasing year by year.The funding input,output and efficiency are related to the efficiency of the government,the allocation of financial resources and the stability of the society.Performance management has become an important part of the assessment of psychiatric hospitals.The research on project expenditure performance evaluation has gradually advanced from the budding to the mature,from the surface application to the deep application.In recent years,the government has not only conducted in-depth research on the framework of common indicators,but also requested each department and industry to form individual indicators with their own characteristics.However,due to the wide scope and content of project expenditures in public hospitals and the special characteristics of psychiatric hospitals,an authoritative and recognized project expenditure performance evaluation index system has not yet been formed.The construction of a scientific project expenditure performance evaluation system can,on the one hand,objectively evaluate the input and output of project expenditure of psychiatric hospitals and provide feasibility for horizontal comparison among hospitals;on the other hand,it can provide decision-making support for relevant government departments in terms of input and distribution of financial subsidies.Based on the above background,it is of great theoretical value and practical significance to explore the performance evaluation index system of project expenditures of psychiatric hospitals.This study focuses on four parts.In the first part,the initial index set of project expenditure performance evaluation of psychiatric hospitals was formed by literature research method and expert interview method,which included 154 tertiary indexes of four expenditure items.In the second part,two rounds of questionnaire survey were conducted for 15 experts through Delphi expert consultation method,and experts were asked to rate the indexes according to their importance.Besides,experts’ familiarity with the contents and basis of judgment were investigated.The indicators were screened by applying the boundary value method through calculating the arithmetic mean,full score frequency,coefficient of variation for each indicator,so as to construct a psychiatric hospital project expenditure Performance evaluation index framework.In the third part,the hierarchical analysis method was used to determine the weight coefficients of each index in the system.Five experts with higher authority coefficients were invited to compare the indicators two by two,and the indicators in the judgment matrix were scored using the 9-point scale method,and the results of the hierarchical single ranking were calculated and tested for consistency using the yaahp10.1,and the results of the hierarchical total ranking were further calculated and tested for consistency to finally determine the weights of each level and each indicator in the index system.In the fourth part,three urban psychiatric hospitals in Jiangsu province were selected for the application of the index system according to the financial allocation in 2020.The SPSS was used to normalize the sample data.Then the weight coefficients of each index were combined to derive the comprehensive scores and rankings of the three psychiatric hospitals.Based on the application results,suggestions were made to improve the performance evaluation of project expenditures of psychiatric hospitals.This study firstly constructed a performance evaluation index framework for the expenditure items of public health service task category,key discipline development category,capital construction category,and equipment acquisition category in psychiatric hospitals.The positive coefficient of experts consulted by Delphi experts was 100%,the average authority coefficient of the four expenditure items was 0.75 and each item was greater than0.70,which indicated that the experts of this evaluation were positive and authoritative,and the results were credible.Secondly,based on the results of hierarchical analysis,this study formed the weight coefficients of each indicator,and the importance ranking of first-level indicators was output,benefit,process,and decision in order.Among the common indicators of the four types of projects,the more important indicators were the effectiveness of project management system implementation and budget execution rate,which had a high weight share in all four types of indicators.Among the individual indicators of the four types of projects,the more important indicators were the standardized management rate of registered patients with severe mental disorders,the qualified rate of standardized training of psychiatric residents,the qualified rate of engineering acceptance,and the positive rate of large medical equipment inspection.The results of the hierarchical single-ranking and total-ranking consistency tests showed that the consistency test results of all judgment matrices were less than 0.1,which had satisfactory consistency.Finally,through the analysis of the application of the index system,the psychiatric hospital project expenditure performance evaluation index system constructed in this study has applicability in the local and municipal psychiatric hospitals and can provide reference value in the comparative analysis.Focusing on psychiatric hospitals,this paper constructs performance evaluation index systems for public health service task,key discipline development,capital construction,and equipment acquisition project expenditures,which not only provides realistic guidance for psychiatric hospital project expenditure performance evaluation,but also provides reference suggestions for relevant policy decisions of government departments.更多还原