社区卫生服务机构岗位绩效考核激励机制探讨

分析了社区卫生服务机构绩效考核激励机制的实施情况,探讨了社区卫生服务机构岗位绩效考核结果与激励措施的衔接问题,指出管理者应该综合运用物质激励、目标激励、知识激励、情感激励等各种激励措施,同时注意要尽量灵活、巧妙、多样、合理地运用激励手段;要根据机构不同的用人需要,分别选择适当的激励时机;要将正激励与负激励巧妙地结合起来,坚持以正激励为主.

Abstract：

An analysis of the existing incentives mechanism of performance appraisal for community health service centers, and insight into the challenges for linking the post performance appraisal in community health service centers with incentive measures. It is pointed out the administrators should take a variety of measures including material incentive, target incentive, knowledge incentive, and emotional incentive among others. In addition, such measures should be used sophistically, flexibly and reasonably, while timing of incentives should meet the human resource needs of the institution, notably a combination of positive incentive with negative ones,, mostly the former incentive.     

基于集团化的社区卫生服务管理模式研究

发展基于社区卫生服务的基本医疗卫生服务体系是新医改的重要目标之一,建立基层医疗机构管理服务新机制是浙江省新医改的创新和有益的探索.阐述了目前基层医疗机构管理服务现状,重点论述了杭州市某区卫生局从2007年底积极开展社区卫生服务集团化管理的"九‘化'模式"的具体策略和获得的主要成效,为探索区域内社区卫生服务机构的集团化管理,为完善以社区卫生服务为基础的新型城市基层医疗卫生服务体系,提供模式参考.

Abstract：

Full-speed development of the primary health care centering on community health service is key to the ongoing health reform in China. Building a new management mechanism for these grass-root health centers is an innovative approach of such a reform as carried out in Zhejiang province.The authors described the present management mechanism in the province, and focused on the specific measures and main outcomes of the "nine Group-scale model" as used by a district health bureau in Hanzhou since end of 2007. The paper aims at building an ideal model for group-scale management of community health centers, and improving the new city primary health care system centering on community health service.     

流动人口基本公共卫生服务均等化调查

目的 了解流动人口与当地常住人口基本公共卫生服务不均等的情况.方法 通过现场调研和访谈,抽样调查了浙江省某县的流动人口和常住人口各581人,了解两种人群的基本公共卫生服务在投入、机会.结果 上的不均等情况.结果 流动人口中享受过医疗救助的比例仅占7.8%,低于常住人口的13.4%;有40.9%的流动人口会因为较高的医药费用而不去就医,远远高于常住人口;流动人口妇科检查率为58.7%,低于常住人口(67.7%).结论 应增加公共卫生机构资源配置和财政投入,发展和完善社会医疗保障体系,促进不同人群间基本公共卫生服务的均等化.

Abstract：

Objective To probe into the inequality found in primary public health service available to the migrant population and permanent residents. Methods With on-site interviews, 581 migrant workers and 581 permanent residents in a county in Zhejiang province were surveyed, to learn the inequalities between the two in the expenditure, access and outcomes of the public health service accessible to each. Results only 7. 8% of the migrant population ever had access to medical aid, a ratio far below that of the permanent residents; 40. 9% of the migrant population may turn down medical service beyond their affordability, a ratio far higher; for the migrant population, their ratio of gynecological checkup is 58. 7%, lower than that of the permanent residents (67. 7%). Conclusion Resources and financial allocation to institutions of public health should be enhanced, and social medical and insurance system should be developed and improved, in an effort to encourage the equality of primary public health services accessible to various sectors of the population.     

农民工社区医疗卫生服务的现状及对策

随着我国城镇化进程的不断推进,解决好农民工"看病难"、"看病贵"的问题是深化医疗卫生体制改革的重要内容.文章介绍了农民工医疗卫生服务的现状,基于农民工对社区卫生服务机构的可及性较高,文章从政府、社会和农民工三个角度分析了社区卫生服务中心服务在农民工医疗卫生服务方面存在的问题,同时针对三个方面提出利用社区卫生服务中心完善农民工医疗卫生服务合理化建议.

Abstract：

As urbanization moves on in China, the ongoing health reform tums to focus on the problems of "Too difficult and too expensive to see doctors" for migrant workers. The paper covered the present medical and healthcare services available to migrant workers. From the aspects of government,community and migrant workers, the paper analyzed problems found in services offered by community healthcare centers. In the end, the author came up with recommendations to rationalize such services by means of community healthcare centers.     

Analysis of Developing Public Health Service Sector with Private Finance Initiative in Guangxi

In Guangxi Public Health Service Sector （GPHSS）, because lack of budget, it has caused a number of problems, such as weakened public health service in rural areas, poor professional quality of medical personnel in public health units at village and township levels, current urban public health service could not meet the health demand for urban residents. This paper is a secondary research. Through analysis of the financial problem and both of the advantages and disadvantages of using the Private Finance Initiative （PFI）, it intend to demonstrate that using the PFI could be considered as a good way for the Guangxi government.     

政府卫生投入的国际经验

通过对<2009年世界卫生统计>年鉴资料的整理分析,总结了世界卫生组织各成员国政府卫生支出的基本特点.通过回顾梳理国际社会财政卫生投入的相关政策与经验,得出国际社会政府卫生投入的主要特点是社会价值取向决定了政府财政卫生的投入,以立法方式建立财政卫生投入的稳定机制及优先权,地方政府承担财政卫生投入的主要责任,财政卫生支出政策目标具有动态性,其政策导向功能日益增强,通过拓展政府卫生筹资渠道,完善财政卫生支出方式,建立政府问责机制来加强卫生系统的治理,以及不断完善社会医疗保障制度.

Abstract：

A review of the yearbook World Health Statistics 2009 revealed the basic features of health spending of member states of the World Health Organization. A review of the policies and experiences of government health spending of the international community points the following findings:this health spending is characteristic of social values deciding government health spending, legislature determines the stable mechanism and priority of government health spending local government shoulders main duties of government health spending, policy objectives of government health spending may be dynamic with stronger function of guidance, greater health financing sources of the government can empower government health spending, a government accountability mechanism should be built for better governance of the health system and for a better social medical assurance system.     

深圳市公立医院法人治理改革探索

分析了目前公立医院体制机制方面存在的问题,按照"政事分开、管办分开、医药分开、营利性与非营利性分开"的改革原则,制定了公立医院法人治理改革实施路径.一是建立公立医院管理委员会,统筹政府办医保障职能;建立公立医院管理机构,提高举办医院的行政管理水平;转变卫生行政部门职能,形成多元化办医格局.二是建立分级决策机制、自主经营制度及多元监管制度,解决政事分开问题.三是研究制定公立医院章程,促进公立医院向法定机构转变,通过法制化巩固法人治理改革成果.

Abstract：

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of "Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals", the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.     

Social Expenditure on Health Service and Its Macro Estimation

By social expenditure on health service(SEHS)we refer to the sum total of money paid by thewhole society during a certain period of year for the sake of preventing and treating diseases andof protecting and improving the people's health.It reflects objectively the total level of SEHSduring a certain period;the levels of health service expenditures on the parts of the whole society,enterprises,and individuals;the ratio between SEHS and total social expenditure;and the ratiosof SEHS to gross national product and to national income.The article discussed and analysed     

世界卫生组织健康调查资料的结构方程模型

Objective Based on the 2002 WHO health survey data, to explore the latent relationship among self-reported health level, the actual level of health, the social demographic characteristics and the risk factors, and to analyze the influence of the various surveillence indicators on self-reported health and the degree that the self-reported health explained the actual level of health.Methods Field tests for various components of the World health survey were conducted in nine countries during 2002, including India, Brazil, Burkina, Hungary, Nepal, Russia, Spain, Tunisia, and Vietnam (29 971 ).The survey questionnaire included a self-assessment component and anchoring vignette component.The self-assessment component data was adjusted and eliminated the affect of "cut-point bias" by using the anchoring vignette component data,and then was used to build the structural equation model on the relationship among selfreported health level, actual health level, social demographic characteristics and the risk factors.Results In the final structural equation model, "the actual level of health" = 0.80 × "the self-reported health level" +( - 0.04) × "the social demographic characteristics" + ( - 0.08 ) × "the risk factors" ( R2 = 0.66 ), and"the self-reported health level" = ( -0.70) × "the social demographic characteristics" +0.10 × "the risk factors" (R2 = 0.55 ).The standardized total effect of self-reported health to the actual level of health was 0.80 ,and that of the social demographic characteristics to the self-reported health and the actual level of health were - 0.70 and - 0.60, respectively.And the 16 items of self-reported health consisted of8 dimensions; and sorted by the power of impact to the actual health level, they were mobility, pain and discomfort, sleep, cognition, feelings, self-care ability, visual capacity and interpersonal activities.Conclusion There were significant linear correlation relationship between the actual level of health and the self-reported health, as well as between the self-reported health and the social demographic characteristics.And the self-reported 16 items used by the 2002 WHO health survey played an important role in the health evaluation of population.