摘要
目的:比较镇村卫生一体化管理对村卫生室服务效率、质量和费用控制的影响。方法:选择重庆市九龙坡区、黔江区和武隆县作为典型地区,调查所有村卫生室2009—2011年的服务数量、质量以及诊疗费用,采用倍差法比较不同类型的效果差异。结果:镇村一体化管理可分为完全型、紧密型和松散型三类。实施一体化管理组各项指标的变化好于未实施组。与2009年相比,完全型和紧密型组2011年日均门诊人次数增加幅度较大,且完全型一体化管理的作用更加明显;完全型组慢性病规范管理率上升幅度和门诊次均费用下降幅度较大,其他两种类型慢性病规范管理率上升幅度较小,且门诊次均费用呈现增加趋势。结论:实施镇村一体化管理对村卫生室服务效率和质量改善以及就医费用的控制产生积极影响,以完全型作用最为明显,建议将实施实体整合、注重非经济激励因素、避免村医补偿机制的不同而带来的问题作为镇村卫生一体化未来发展方向和重点。
Objective： In this paper, we analyzed the effect of different integrated management mechanisms for township health centers and village clinics. We analyzed these mechanisms in terms of service efficiency, quality, and expense. Methods： A questionnaire was used to investigate village clinics in Jiulongpo, Qianjiang and Wulong counties. A difference-in-difference method was used to analyze the difference of effects. Results ： We found that in- tegrated management can be complete, compact or loose. The change of all the indicators for integration group was better than that of non-integration group. Compared with that of 2009, the increase in the average daily number of outpatient for the complete and compact group in 2011 was greater, and the complete group was more apparent. The increase of standardized management of chronic diseases and the decrease of average expenses at complete implemen- tation group was greater. However, for other two categories, the increase of standardized management rate of chronic diseases was less, and average expenses increased. Conclusion：Integrated township and village management has im- proved efficiency and quality of services and has reduced costs. These trends are most obvious for the complete cate- gory. Implementing complete integration, paying attention to non-economic incentives, and avoiding potential prob- lems from various compensation mechanisms could be prioritized for the development of integrated management of township health center and village clinic.
出处
《中国卫生政策研究》
CSCD
2013年第5期27-31,共5页
Chinese Journal of Health Policy
基金
中澳卫生与艾滋病项目"医药卫生体制改革评价研究"
中央级公益性科研院所基本科研业务费"深化医药卫生体制改革监测与评价研究"
关键词
农村卫生
镇村一体化
村医
整合
Rural health
Township and village integration
Rural doctor
Integration
