提高农村基层卫生服务绩效管理水平——中国农村卫生发展项目40县绩效改革设计与效果

世行贷款/英国赠款中国农村卫生发展项目(简称"卫十一项目")于2008年开始在我国8个省40个项目县引入绩效管理的思想,开展以绩效计划、绩效沟通、绩效考核、绩效改进为主要内容的循环管理,以绩效持续改进为目标,建立基于卫生服务绩效的激励机制。经过5年的试点,40个项目县中建成了若干个具有示范意义的绩效管理先进县,在改善卫生服务质量、提高基层医疗卫生机构管理者和员工的积极性、提高卫生服务效率等方面,取得了较好的效果,积累了一定的经验。绩效考核始终以质量为核心;经济激励与非经济激励措施有机结合;全员参与以保证绩效改善的可持续性;系统化的绩效管理思想应得到充分运用,以有效提升农村基层卫生服务绩效管理水平。

Comprehensive reform to improve the performance management of primary health care service in rural China

With the support of World Bank (WB) and UK Department for International Development (DFID), China Rural Health Project (hereinafter referred as "Health XI Project") began to introduce the idea of performance management to 40 counties in 8 provinces in 2008. The project implemented cyclic performance management strategies, including performance planning, performance communication, performance evaluation and performance improvement. With the continuous improvement of performance as the goal, the project attempted to establish incentive mechanisms based on the performance of health care services. After five years of pilots in 40 counties, it has achieved good results in the aspects of improving the quality and efficiency of health care services, motivating the enthusiasm of health care managers and workers, etc. Moreover, it has successfully built several advanced counties with exemplary performance management and accumulated some experience, which provides reference and demonstration for implementing performance management in other areas. The key experiences of implementing performance management of rural primary health care include taking health care quality as the core of performance, appropriately combining economic and non-economic incentives, encouraging personnel participation in performance management in order to ensure the sustainability of performance improvement, and effectively applying the ideology of systematic performance management in order to effectively enhance the management level of hospitals. The paper also puts forward some policy suggestions based on emerging issues during implementation of performance management.