中国公共卫生

目的对湖北省国家基本公共卫生服务项目管理情况及相关问题进行分析,为改善基本公共卫生服务政策提供参考依据。方法 2014年6月—2015年1月,以区(县)为单位,对湖北省8个地级市的54个区(县)隶属的相关卫生行政组织和城乡基层卫生组织(社区卫生服务中心和乡镇卫生院)的基本公共卫生服务关键知情人868人进行问卷调查。结果调查发现,70.1%的调查对象认为基本公共卫生经费不够用,且城市地区认为经费不够用的比例更高(P <0.05),85.2%的人认为经费拨付方式是合理的,74.5%的人认为经费拨付周期是合理的;43.9%的人认为将经费作为工资发放不合理,76.2%的人认为作为工作补助发放是合理的,73.2%的人认为经费使用存在不合理地方;80%以上的人认为绩效考核是合理的,有75.7%的人认为绩效考核与经费拨付挂钩是基本严格执行的;在13项项目中,老年人管理、慢性病管理、孕产妇管理和儿童健康管理等项目被认为花费经费较多且完成情况不太好。结论湖北省国家基本公共卫生服务项目经费补偿标准偏低,经费管理以及绩效考核等方面存在一定的问题,需要进一步改善基本公共卫生服务相关政策,科学测算服务项目补偿标准,并提高经费管理科学性,促进基层医务人员的工作积极性。

Objective To analyze the management on the national basic public health service(BPHS) projects and its related issues in Hubei province and to provide references for improving BPHS policies. Methods We conducted a survey among health administrative agencies and primary health institutions(community health service centers and township hospitals) in 54 districts(counties) of 8 prefecture-level cities in Hubei province. Totally 868 BPHS-related key informants(one or two from each of the selected agencies or institutions) were asked to complete a self-administered questionnaire between June 2014 and January 2015. Results Of all the participants, 70.1% considered that fund for BPHS was inadequate and the inadequateness was noticed by more participants form the urban institutions than from the rural institutions(P <0.05); 85.2% believed that the fund allocation was reasonable and 74.5% thought that the fund allocation period was appropriate; 43.9% regarded using BPHS fund to pay medical staff's wages as an unreasonable approach but 76.2% regarded using the fund to offer staff's subsidies as a reasonable practice. There were 73.2% of the participants believing that some of the fund was utilized improperly; there were 80% of the participants regarding performance assessment as a proper way of management and 75.7% judging the policy for linking performance appraisal to fund allocation having been implemented strictly on the whole. Among the 13 BPHS projects assessed by the participants, the projects for management of elderly population, patients with chronic disease, maternal care, and child health were considered as costing too much fund but without a good implementation. Conclusion For the national basic public health service projects implemented in Hubei province, the compensation fund was at a relatively low level and there were some deficiencies in fund management and performance appraisal. The results suggest that basic public health service related policies need to be amended and fund management should be improved.