社区卫生服务机构收支两条线管理的运作模式分析

通过分析并评价目前全国各地社区卫生服务机构收支两条线管理的主要运作模式,总结实行社区卫生服务机构收支两条线管理所需的前提条件.提出各地应当在机制、体制基本理顺,各项制度环境基本建成,社区卫生服务整体发展良好的情况下开展试点,切忌盲目推行.     

社区卫生服务机构实施收支两条线管理的现状及对策

经过多年的探索,社区卫生服务机构实行收支两条线管理的成效显著。社区卫生服务机构的公共卫生服务得到有效落实,无论是社区医务人员还是社区居民满意度都有较大提高。然而,社区卫生服务机构实行收支两条线管理也遇到了许多问题。文章通过对社区卫生服务机构实施收支两条线管理的现状、困难进行分析,就存在的新问题提出合理性建议与对策,总结实施收支两条线管理的必要性,在新医改攻坚阶段从而更好地完善政府投入、收支运行、考核分配等管理体制与运行机制,进一步保障社区卫生服务机构的正常运行,充分发挥收支两条线管理在社区卫生综合改革中的核心作用。     

社区卫生服务机构“收支两条线”改革成效与思考

杭州市是全国开展社区卫生服务较早的城市之一,迄今大致经历了探索起步、功能转换、标准化建设、深化内涵建设和综合改革五个阶段.2007年,杭州市六城区社区卫生服务中心启动了"收支两条线"综合改革试点工作.本文总结了六城区社区卫生服务机构"收支两条线"综合改革的作用与成效,提出了改革中出现的问题及解决建议.     

社区卫生服务收支两条线管理可持续发展的政策建议

目的 总结社区卫生服务中心实行综合改革试点后在收支两条线管理方面取得的成效,进一步完善收支两条线管理评价方法.方法 对上海市首批试点某区进行社区卫生服务收支两条线管理动态评价和效果分析.结果 某区社区卫生服务机构年度总收入下降了2.24%,其中检查收入和手术收入下降最多.全科人员及预防保健人员收入增加较多,工作业绩也有较明显的增长.社区居民、卫生行政人员及卫生服务人员对到中心看病是否方便、就医环境、医务人员服务内容及解释和交流情况、服务技术水平等满意度调查结果,差异无统计学意义;但对医务人员服务态度方面,卫生行政人员不满意(χ2=9.340,P=0.009).结论 上海市某区社区卫生服务收支两条线管理已取得较好成绩.建议进一步完善效果评价体系和评价标准,保证其科学性和有效性.     

典型地区社区卫生服务机构收支两条线管理模式的比较分析

通过分析典型地区社区卫生服务机构收支两条线管理模式,其共同特点是实行全额预算管理,以区财政为主实行多级财政筹资,收支两条线管理实施过程中收入和支出的内容基本相同;不同点包括收支两条线管理的方式、社区卫生服务机构总收入中财政投入标准和支出管理等三个方面的差异。通过分析不同收支两条线管理模式的优缺点．提出社区卫生服务机构实施收支两条线管理并没有绝对的最优和最差做法,各地在实践中,既要分析不同模式的优缺点,也要结合本地实际,总结已有的经验和教训,以便顺利开展社区卫生服务机构收支两条线管理试点。     

北京市社区卫生服务实施效果及建议

收支两条线管理是我国针对社区卫生服务机构实行的一项新财务管理制度,北京市是较早推行收支两条线管理的试点城市之一.通过对北京市社区卫生服务工作现状、财政资金投入以及社区卫生服务绩效结果进行分析,了解北京市收支两条线管理政策的实施效果及其影响,并对北京市社区卫生服务机构的发展提供政策性建议,以期完善以社区卫生服务为基础的新型城市医疗卫生服务体系.     

社区卫生服务中心实行“收支两条线”管理的实践与思考

上海市徐汇区社区卫生服务中心实行"收支两条线"管理,历经五年实践,不断创新和完善,基本形成了"运行机制、补偿机制、激励机制、监督机制"四位一体的管理模式,体现了社区卫生服务公益性,初步实现社区卫生服务均等化等目标。社区卫生服务中心实行"收支两条线"管理,还存在一些问题,需要不断完善。     

浅谈社区卫生服务机构收支两条线管理

社区卫生服务机构收支两条线管理源自于但并非完全等同于传统的收支两条线管理,它本质上是一种资金管理方式,但却突破了单纯意义上财务管理的概念.而是一种综合性制度设计.在社区卫生服务机构实施收支两条线管理,是政府承担发展社区卫生服务的责任的体现,这一制度作用于社区卫生服务机构内部的利益链环节,进而根除以药养医问题,促使社区卫生服务机构体现公益性.各地应建立在正确认识这一制度,并在基本条件具备的前提下开展试点,以便这一制度能规范实施、顺利推广,并取得实效.     

北京社区卫生服务机构员工对收支两条线管理的认知评价

[目的]了解北京社区卫生服务机构员工对收支两条线管理的认知评价情况.[方法]采取问卷调查的方法,调查北京社区卫生服务机构员工对收支两条线管理的认知评价情况,进行相应的统计学分析.[结果]201名社区卫生服务工作人员中78.1%认为在社区卫生服务机构实施收支两条线可以提高员工的工作积极性,83.1%希望实行收支两条线;所在机构已实施收支两条线管理的人员对该改革措施的反馈结果不乐观.[结论]北京市社区卫生工作人员对收支两条线管理的实施表示支持,实施意愿较高,但是应对配套的绩效考核评价体系进行深入的研究和论证,从而有效地提高社区医务人员的工作积极性.     

农村社区卫生服务机构收支两条线管理实施效果调查分析

目的探讨农村社区卫生服务机构实施收支两条线管理后的运行效果。方法对某大型城市位于农村的8家社区卫生服务中心进行回顾性调查,对相关人员进行访谈,并对收集的相关数据进行统计学处理。结果不同区、县收支两条线管理的模式不尽相同,实施收支两条线后,农村社区卫生服务机构的出院人次和手术例数下降,门诊人次和公共卫生服务量(除孕产妇管理和计划生育咨询)增加。结论落实社区卫生服务机构支出的预算管理,加强绩效考核,将有助于发挥社区医务人员的积极性,提高社区卫生服务机构的服务量和服务质量。     

上海市社区卫生服务中心临床免疫检验的现状调查

目的:调查上海市社区卫生服务中心检验科和临床免疫检验服务的现状。方法:对上海市的社区卫生服务中心进行抽样问卷调查,整理分析相关信息。结果:被调查社区平均配备6名检验技术人员,调查前一年开展了6类(共31项)非快速免疫检验项目和8项快速免疫检测。非快速免疫检验的开展方式以外送检验为主。"缺乏相应能力"、"缺乏设备"、"缺乏政府资金投入"和"居民无需求"是社区未开展部分免疫检验项目的主要原因。结论:上海市社区卫生服务中心开展临床免疫检验服务已具备一定能力,但临床实验室人力资源配置和能力建设有待加强。政府的支持是提升社区临床免疫检验能力的关键。     

Characteristics of ambulatory care patients and services: a comparison of community health centers and physicians' offices

The overall aim was to determine whether health care delivery for vulnerable populations served by community health centers (CHCs) was comparable to care for mainstream Americans primarily seen in physicians' offices (POs). Data came from the 2006 National Ambulatory Medical Care Survey. Patient visits occurring in CHCs were largely from younger, uninsured or Medicaid-insured, minority populations, while POs catered mainly to older, Medicare- or privately-insured, White patients. Communities served by CHCs were more often in low-income, low-education, urban regions. A greater proportion of visits to CHCs were from diabetic, obese, and depressed patients; CHCs also offered more evening/weekend visits and provided more health education during visits, but spent less time per visit than POs and had more difficulty referring patients to specialists. Results affirmed the significant role of CHCs as safety-net providers for vulnerable populations, and indicated that CHCs provide adequate care compared with POs although there remains room for improvement.     

Willingness to use and satisfaction of primary care services among locals and migrants in Shenzhen,China

The Chinese government has been reforming the health care system by developing a primary care system. The objectives of this study were to compare the willingness to use and satisfaction with community health care centres (CHCs), a component within the Chinese primary care system, between locals and migrants living in Luohu, Shenzhen, China. A 2019 cross-sectional survey data that interviewed 1,205 adult residents living in Luohu district were used for secondary data analysis. Two identifications of migrants were used for analysis, Shenzhen hukou status and urban village status. Linear probability models were used to determine relationship between migrants' status and the outcome variable of willingness to use CHCs and order logistic regression were used to determine the association between migrants' status and the outcome variable of satisfaction with CHCs. Among participants, 37.6% of the participants had Shenzhen hukou. Using the classification of urban village status, 29.1% of participants were urban villagers. Urban villagers were less likely to know the location of nearest CHCs and less likely to select CHCs as their frequently used health care institutions. No statistically significant difference was found on willingness to use CHCs or satisfaction with CHCs between Shenzhen hukou and non-Shenzhen hukou. But urban villagers were more satisfied with attitude and medical skills of health care workers. Our findings indicated that policymakers and social professionals need to adjust the organization and functioning of primary care institutions in the community to increase awareness and utilization of primary care services.     

上海市社区定量免疫检验技术的试点利用状况分析

目的:分析试点期间相关免疫检验项目利用情况,为上海市在社区卫生服务中心推广定量免疫检验技术提供依据。方法:运用VIDAS全自动荧光免疫分析系统在社区卫生服务中心试点开展甲状腺激素、肿瘤标记物、肝炎、绒毛膜促性腺激素和心血管相关免疫检测项目。分析试点项目利用状况、检验结果和使用满意度。结果:试点共开展4 450次免疫检测,癌胚抗原和甲种胎儿球蛋白检测次数最多,甲状腺激素和其他肿瘤标记物的检测次数也较多。社区卫生技术人员对试点项目总体评价较好,临床医生的满意度高于检验科人员。结论:社区患者对肿瘤标记物免疫检测的需求较大,在社区开展甲状腺激素免疫检测有助于慢性病管理,部分检测项目在市郊社区中有潜在需求。试点免疫检验项目总体效果良好。     

Optimizing community and stakeholder engagement in a merger of community health centres

Community Health Centres (CHCs) are grounded in a model of care that includes engagement with the community and have a history of working with communities to respond to emerging needs. Although most CHCs consider themselves to be integrated, mergers in this sector are uncommon. In Ontario, the first voluntary merger of CHCs showed the importance of community engagement to realize the intended benefits of the integration and to effectively manage change.     

Consumer involvement in health care purchasing: the role and influence of the community health councils

Recent reforms in the National Health Service (NHS) place great emphasis on the importance of the ‘voice of the consumer’ in the provision of health care. Health purchasers are now required to adopt the role of ‘champion of the people’, traditionally that of the Community Health Councils (CHCs). In turn the CHCs have been encouraged to become more closely involved in the purchasing process. This paper draws on a national investigation of the operation of CHCs in order to examine the response of both the Councils and local purchasers to these developments. For many CHCs pressures for greater involvement may clash with their concern to retain an independent stance. This paper examines how closely CHCs are currently working with local purchasers and explores the central question of whether those prepared to work more collaboratively with their Health Authorities (HAs) are likely to have greater impact on purchasing decisions. The paper concludes that, while some CHCs are more closely involved than others, few perceive that they exert much real influence over the decision-making process. Councils share a general view that major purchasing decisions are increasingly being made without the opportunity for scrutiny by them or the wider public.     

The value of electronic health records in community health centers: policy implications

This paper analyzes the costs and benefits of electronic health records (EHRs) in six community health centers (CHCs) that serve disadvantaged patients. EHR-related benefits for most study CHCs did not pay for ongoing EHR costs, yet quality improvement (QI) was substantial. Compared to private practices, CHCs cannot use EHRs to increase visit coding levels and revenues, yet they likely use EHRs more aggressively for QI, which raises equity questions. The evidence suggests that policies are needed that help CHCs to afford EHRs and produce more EHR-related QI gains, including through grants and QI performance rewards.     

Access to specialty care and medical services in community health centers

Although community health centers (CHCs) provide primary health services to the medically underserved and poor, limited access to off-site specialty services may lead to poorer outcomes among underinsured CHC patients. This study evaluates access to specialty health services for patients receiving care in CHCs, using a survey of medical directors of all federally qualified CHCs in the United States in 2004. Respondents reported that uninsured patients had greater difficulty obtaining access to off-site specialty services, including referrals and diagnostic testing, than did patients with Medicaid, Medicare, or private insurance.     

Collaboration Challenges and Opportunities: A Survey of School Foodservice Directors and Community Health Coalition Members

BACKGROUND

The Healthy, Huger‐Free Kids Act (HHFKA) presents challenges for foodservice directors (FSDs) in sourcing and preparing foods that meet nutrition standards. Concurrently, community health coalition members (CHCs) are engaging schools through community and school nutrition initiatives. We hypothesized significant differences in perceptions between FSDs and CHCs related to implementation of HHFKA such that FSDs would perceive greater foodservice challenges, while CHCs would be more supportive of community nutrition initiatives.

METHODS

A perceptions survey was administered by email to 528 FSDs and 334 CHCs during summer 2016. Experience, education level, urban/rural differences, school demographics, and involvement between FSDs and CHCs were compared.

RESULTS

Overall, 132 FSDs and 80 CHCs responded (29.5% FSDs, 24.7% CHCs). Overall perception of HHFKA foodservice challenge ranged between neutral (eg, neither challenging nor unchallenging) to somewhat challenging, and did not differ between groups. CHCs were significantly more supportive of community nutrition initiatives, while FSDs responded neutrally.

CONCLUSIONS

FSDs awareness of CHCs desire for collaboration may increase FSDs support for broader school nutrition initiatives such as school gardens, farm to school, and student/community engagement. There is great potential for integrating student and community health programs through partnerships.

     

America's Health Centers: Reducing Racial and Ethnic Disparities in Perinatal Care and Birth Outcomes

Objective. To examine whether community health centers (CHCs) reduce racial/ethnic disparities in perinatal care and birth outcomes, and to identify CHC characteristics associated with better outcomes.
Background. Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on infant mortality and other birth outcomes, and with wide inequities by race/ethnicity. Disparities in primary care (including perinatal care) may contribute to disparities in birth outcomes, which may be addressed by CHCs that provide safety-net medical services to vulnerable populations.
Methods. Data are from annual Uniform Data System reports submitted to the Bureau of Primary Health Care over six years (1996–2001) by about 700 CHCs each year.
Results. Across all years, about 60% of CHC mothers received first-trimester prenatal care and more than 70% received postpartum and newborn care. In 2001, Asian mothers were the most likely to receive both postpartum and newborn care (81.7% and 80.3%), followed by Hispanics (75.0% and 76.3%), blacks (70.8% and 69.9%), and whites (70.7% and 66.7%). In 2001, blacks had higher rates of low birth weight (LBW) babies (10.4%), but the disparity in rates for blacks and whites was smaller in CHCs (3.3 percentage points) compared to national disparities for low-socioeconomic status mothers (5.8 percentage points) and the total population (6.2 percentage points). In CHCs, greater perinatal care capacity was associated with higher rates of first-trimester prenatal care, which was associated with a lower LBW rate.
Conclusion. Racial/ethnic disparities in certain prenatal services and birth outcomes may be lower in CHCs compared to the general population, despite serving higher-risk groups. Within CHCs, increasing first-trimester prenatal care use through perinatal care capacity may lead to further improvement in birth outcomes for the underserved.