西部农村区域公共卫生绩效现状评价与改进对策研究

通过对我国西部某省3个县的现场调查,从投入、产出、结果3个维度比较分析了样本地区的公共卫生绩效,计算得到了样本地区公共卫生绩效综合评价指数:公共卫生投入水平普遍偏低;不同公共卫生项目的产出绩效参差不齐;结果绩效整体水平较高.提出了健全农村公共卫生筹资机制、建立以绩效为基础的投入机制、均衡提供基本公共卫生服务项目、加强社会各界的支持等发展农村公共卫生的策略建议.     

和谐社会视角下公共卫生投入的内涵分析

和谐社会的大背景下,加大公共卫生的投入力度,促进公共卫生事业发展,提高公共卫生领域的公平正义成为社会共识.然而,公共卫生投入是一个宽泛的概念,它包括有形投入和无形投入两部分,二者共同构成了我国公共卫生投入的金字塔形结构.丰富我国公共卫生投入的内涵将有利于树立公共卫生的"大投入"现,确保公共卫生有形投入的稳定性,提高公共卫生资源的使用效率,最终提升公共卫生绩效.     

城市社区公共卫生服务财政补偿资金绩效：基于投入与产出问题探讨

目的:讨论公共卫生服务财政补偿资金绩效.数据:四川省12家社区卫生服务中心2006年公共卫生服务工作资料和财务数据.结果:(1)在投入人员数量、素质和工作时间方面体现了中心对公共卫生服务工作的重视;(2)导致12家中心整体收支结余亏损的主要原因是政府补偿不足;(3)采用作业标准量计量公共卫生服务产出,居民(万人)标准量为72 155.1;(4)公共卫生服务的服务时间投入产出比为15.85,经费投入产出比为0.86.建议:完善相关制度,保障公共卫生服务的人力投入和提高经费管理水平;探索与完善投入与产出指标,更加科学合理地评价公共卫生服务财经补偿资金绩效.     

公共卫生领域中的绩效预算管理

从绩效预算的含义入手,分析了在我国公共卫生领域实施绩效预算管理的重要意义,并根据绩效预算管理逻辑框架,提出了在公共卫生领域实施绩效预算的方法和困难,为改革政府对公共卫生投入的方式提供依据。     

公共卫生体系绩效评估的概念性框架

文章提出了一个评估公共卫生系统绩效的概念性框架,该框架将整个系统分为全国、地区两个层次,以Donabedian的理论为基础,将系统目标与持续性质量改善模式中的结构、过程、产出和结果及外部环境5个部分联系在一起.该评估框架可以用来监测公共卫生系统、具体的机构及项目的绩效.尽管目前测量公共卫生系统绩效还存在一定的困难,但相信随着评估技术的不断改进,公共卫生系统的绩效将会得以改善,最终改善人群的健康状况.     

公共卫生服务系统筹资行为研究

研究分析了公共卫生服务系统供方的组成机构及经费来源,揭示了在公共卫生服务系统投入不足的情况下,公共卫生机构的无偿服务职能弱化,主要通过有偿服务来筹措资金;而且政府补偿量未依据公共卫生提供的公共产品量,因此公共卫生服务机构在提供公共卫生服务产品数量方面激励不足.提出优化公共卫生服务系统筹资行为,需要加大政府投入总量和对无偿服务项目的 补偿,规范公共卫生有偿服务收费.     

财政视角下我国公共卫生政府投入的问题和成因分析

从财政视角分析,目前公共卫生政府投入的主要问题包括投入规模不足、地区间结构不合理和投入效率低下,主要原因是政府对公共卫生机构收费政策和预算管理制度转变、财政分权改革及公共卫生财政预算体制不完善,同时,宏观制度背景下带来的激励机制问题和公共卫生固有的绩效评估技术问题也是导致公共卫生政府投入存在问题的重要原因.     

关于召开全国公共卫生专题研讨会的征文通知

为了贯彻落实全国卫生工作会议精神,更好地总结公共卫生投入政策与管理的有益经验,为公共卫生领域的改革提出具有参考价值的政策建议,中国卫生经济学会公共卫生经济专业委员会拟于2006年第四季度在浙江召开公共卫生专题研讨会。现向全国征集研讨会论文,征文的参考选题如下:1.公共卫生的范畴、内涵、补偿机制与实践探索;2.政府购买公共卫生服务的机制和模式研究;3.公共卫生服务投入与补偿政策研究;4.公共卫生的财政投入政策研究;5.公共卫生系统服务规范研究;6.建立健全突发公共卫生事件应急机制的规划及措施研究;7.疾病预防控制系统绩效评价…     

疾病预防控制机构组织绩效评估实证研究

近年来,政府行政绩效以及公共财政支出绩效越来越受到关注,人们的探索也同样投入到公共卫生领域〔1〕。卫生政策制定者开始关注各自卫生系统的绩效,许多国家进行了旨在改善绩效的改革〔2-3〕。作为卫生系统重要的组成部分,疾病预防控制机构承担大量的公共卫生服务,其绩效评估越来     

我国政府公共卫生支出与医疗体系绩效关系的实证分析

文章分析了我国卫生总费用和政府公共卫生支出水平情况.通过国际比较认为我国卫生总费用GDP占比偏低,这表明我国国民的卫生服务消费水平低下.通过研究认为我国政府和社会的公共卫生支出不足是限制我国卫生服务消费水平的主要原因.本文还分析了我国医疗服务体系的绩效情况,认为我国医疗服务体系的绩效与政府公共卫生支出水平关联不大.政府公共卫生支出水平影响医疗体系的服务能力,而医疗体系的绩效水平主要取决于医疗资源的充分利用和合理配置.最后在研究的基础上提出了相应的政策建议.     

浅析公共卫生财政投入的现状与对策

以南平市疾病预防控制中心近三年来的有关数据，说明政府对公共卫生投入不足，出现了“缺位”、“错位”、“越位”现象，制约了公共卫生事业的发展。并从构建公共财政体制、完善公共卫生的财政投入机制、改变财政供给模式、建立多渠道的筹资机制和加强资金监管等方面提出对策和建议。     

Returns on Investment in California County Departments of Public Health

Objectives. To estimate the average return on investment for the overall activities of county departments of public health in California.Methods. I gathered the elements necessary to estimate the average return on investment for county departments of public health in California during the period 2001 to 2008–2009. These came from peer-reviewed journal articles published as part of a larger project to develop a method for determining return on investment for public health by using a health economics framework. I combined these elements by using the standard formula for computing return on investment, and performed a sensitivity analysis. Then I compared the return on investment for county departments of public health with the returns on investment generated for various aspects of medical care.Results. The estimated return on investment from $1 invested in county departments of public health in California ranges from $67.07 to $88.21.Conclusions. The very large estimated return on investment for California county departments of public health relative to the return on investment for selected aspects of medical care suggests that public health is a wise investment.Is the public health system a good investment? Information about the return on investment for public health systems is an essential input to sound health policy decision-making, but has been difficult to ascertain. Determining the return on investment for the public health system as a whole—at least from the point of view of county departments of public health—requires 4 types of information: (1) a complete set of health outcomes that can be causally attributed to the expenditures of county departments of public health, (2) the time paths of these expenditures and outcomes, (3) the level of expenditures used to produce the outcomes, and (4) monetary valuations of each outcome. With this information, one could determine the discounted present value of both public health outcomes and the level of expenditures used to produce them, the components of return on investment for the public health system.Each of these 4 types of information is now available via a series of research articles appearing in health economics journals and health services journals, which make it possible for the first time to estimate the return on investment for the public health system in California.1–3 This series of research articles was generated as part of a larger project to develop a method for determining return on investment for public health by using a health economics framework. In this study, I draw together each of the 4 types of information necessary to estimate return on investment, briefly explain the manner in which each of the 4 types of information was determined, and then combine these to estimate return on investment.     

公共卫生技术服务开展现状及影响因素研究

目的：对山东省地市级疾病预防控制机构的公共卫生技术服务工作开展现状及影响因素进行研究。方法：采用开放式问卷调查、个人深入访谈等定性研究方法。结果：公共卫生技术服务工作的开展状况受外部政策、卫生体制改革、公共卫生经费投入、卫生服务市场化的影响。结论：通过加强政府对公共卫生服务的政策引导和财政投入，理顺与卫生监督机构的工作关系，加大人员培训力度，提高人员素质，加强机构的内部管理等措施，促进公共卫生技术服务的健康发展。     

美国公共卫生绩效评价工具的研究进展及借鉴意义

评价工具是公共卫生绩效评价研究的重点内容。美国公共卫生学界在公共卫生绩效评价的理论框架和工具开发两个方面取得了较大的进展,形成了以公共卫生体系的概念模型、国家公共卫生绩效标准项目等为代表的重要成果。借鉴美国公共卫生绩效评价工具研究的经验,我国的公共卫生绩效评价研究应加强公共卫生体系研究的理论基础,并推动建立国家公共卫生绩效标准。     

China's public health-care system: facing the challenges

The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care.     

Public Health Performance

This review examines past, current, and future issues in developing and using public health performance data for improving the public health system. Issues are explored relating to public health performance data collection and analysis, and inferences made from those data, largely by examining public health performance data collected since the Year 2000. More research is needed to improve understanding of the context in which public health systems operate and how that context affects performance and its relationship to health outcomes. There are major areas of concern that must be addressed by the public health practice organizations, governmental public health entities, and the public health systems research communities, such as ensuring that data are collected on public health infrastructure, practice, and performance and that data from various sources are collected in a harmonious fashion. At issue also is the examination of the impact of new arrivals to the public health system, such as accreditation and credentialing of the public health workforce, on public health system performance.     

江西省公立医院经济运行现状分析

调查分析江西省12所不同等级、不同地区公立医院2000--2007年的经济运行数据。结果发现，江西省12所公立医院8年来经济运行状况明显改善，发展趋势良好，但是仍然存在政府投入不足、收支结构不合理、“以药养医”现象严重、营利能力不强等突出问题。建议加大政府对公立医院的监管和财政补助力度，优化卫生资源配置．改革以药养医的经济运行机制，调整医药价格体系，提高医疗服务水平和效率。     

新医改以来我国卫生筹资的进展、问题与面临的挑战

新医改四年来,我国各级政府大规模增加卫生事业的财政投入,卫生公共筹资体系建设成效显著,然而亦存在一些突出问题,卫生筹资的可持续性面临挑战。当前我国新医改进入“提质增效”的第二季,需要以转变政府管医办医职能为统领,协同配套推进体制机制改革,多渠道增加卫生资源,提高卫生投入绩效,实现卫生筹资的可持续发展。     

甘肃省卫生Ⅺ项目县基本公共卫生服务均等化现状分析——以甘谷县为例

目的:探讨在甘肃省卫XI项目县如何推行基本公共卫生服务的均等化,提高公共卫生的服务能力,为其他地区更好实施基本公共卫生服务均等化项目提供理论支持和实践经验。方法:采用统一设计的调查表进行调查,并结合知情者访谈。结果:样本地区基本公共卫生服务资源投入严重不足,主要的资源消耗在重点人群的公共卫生服务上;保证了较高的健康档案的建档率;采取多种方式进行健康教育;预防接种与传染病防治的工作体系健全;儿童与妇幼保健工作高效完成。结论:探索科学的基本公共卫生服务经费投入机制;合理配置公共卫生资源;加强绩效考核。     

社区卫生服务收支两条线改革认识误区的思考

厘清社区卫生服务公益性内涵和收支两条线制度作用机理是实现社区卫生服务改革目标的前提。当前社区服务收支两条线改革存在将公益性机制的建立简单地等同于切断趋利行为、加大政府投入、减免医疗费用的认识误区。在厘清收支两条线改革认识误区的基础上,进行社区卫生服务外在形态机制、内在运行机制和绩效考核机制"三位一体"的综合改革,是实现社区卫生服务公益性的有效路径。