安徽省基层卫生综合改革实施效果

目的：分析安徽省基层卫生综合改革的实施效果。方法：按照社会经济状况，选择安徽省三个城市6个区县共88家基层医疗卫生机构作为研究对象，收集2009_2011年的相关数据，分析基层卫生综合改革的实施效果。结果：2011年社区卫生服务中心和乡镇卫生院药占比分别降至23．97％和30．73％，基层卫生机构的补偿结构发生明显改变；大专以上学历卫生技术人员所占比例明显增加，人力资源数量和结构逐步改善；人员收入有所增长但满意度仍然不高。门急诊服务数量和效率提高，住院服务数量和效率有所降低，医疗费用得到控制，服务质量有所改善。结论：政府的强力推动是安徽省基层卫生综合改革迅速推进的重要保障。初步实现了建立公益性运行新机制的目标，但人力资源仍然不足，绩效考核与预期实现的激励效果仍存在差距。理顺政府与基层卫生机构之间的治理关系仍需继续努力；应完善招聘机制，合理提高医务人员收入，改进绩效考核方案，关注改革措施的综合作用，巩固已有成果。

Effect on primary healthcare comprehensive reform in Anhui province

Objective： In this paper, we discuss the effects of implementing primary healthcare comprehensive reform in Anhui province. Methods： Data was collected for the years 2009 to 2011 from 88 primary healtheare institu- tes in six districts and counties, and the effects of the primary healthcare reform were analyzed using an input-process- output method. Results： In 2011 ,the drug revenues had declined to 23.97% and 30.73% respectively in community and township health centers. We found that the reimbursement structure of primary heahhcare institutes has funda- mentally changed. Human resources have been strengthened and the income of health care professionals has in- creased; however, satisfaction levels remain low. The service quantity and efficiency for outpatient service has im- proved, but that of the inpatient service has decreased. Quality and cost control for both outpatient and inpatient serv- ice has improved. Conclusion： Reforms in Anhui province have improved under the effective governance, but human resources are still not sufficient to cover the workload, and performance evaluation also needs to be improved. We suggest managers of primary heahhcare institutes should be given greater power, and employment packages should be more flexible. We suggest gradually increasing the salaries of heahhcare professionals and improving performance evaluation scheme. With regards to the behavior of stakeholders and effects of integrated policies, we suggest consoli- dating achievements of primary healthcare system reform.