国家基本公共卫生服务项目实施进展及公平性

目的：分析国家基本公共卫生服务项目实施进展与公平性，为项目持续发展提供参考。方法：在安徽、河南和重庆调查15个区县的所有社区卫生服务中心和乡镇卫生院，分析基本公共卫生筹资、人员配置和服务提供进展，并以基尼系数分析公平性改善情况。结果：基本公共卫生服务经费逐年提高，2011年人均筹资标准已超过25元／刖年；基层公共卫生人员数量有所增加，但人员配置相对不足且公平性有待提高；服务提供公平性有所改善，妇幼保健服务相对较好，高血压和糖尿病规范化管理明显改善。结论：基本公共卫生筹资可能存在“隐性不公平”，基层公卫人员配置相对不足，服务提供实效性有待提升。建议重视项目成本测算，加强基层人才队伍建设，合理确定服务项目，建立以质量为导向的绩效考核机制，创新基层公共卫生服务模式等。

Pay for performance in primary healthcare institutions: A policy analysis

Objectives: In this paper, we discuss the development and equity of national essential public health services, and provide references for the sustainable development of these services. Methods: We analyzed financing, staffing, and service delivery at community and township health centers in 15 counties in Anhui, Henan, and Chongqing. We calculated the Gini coefficient to evaluate equity. Results: We found that financing for essential public health services has gradually increased and that subsidies were more than RMB 25 per capita in 2011. The quantity of personnel in primary health care institutions had increased, but personnel needed to be distributed more equitably. Primary health care services, in particular, child and maternal health services, were being more equitably provided. Management of hypertension and diabetes had also been standardized to a much greater extent. Conclusions: Some imbalances still remain in the financing of essential public health care, and there is still a shortage of trained public health care staff. Service delivery also needs to be continually improved. We recommend paying more attention to cost estimates of essential public health services, training and developing health care staff, and making well considered decisions about which services to focus on. We also recommend establishing a quality oriented performance evaluation mechanism and innovating on the service delivery model.