【作者】 夏海晖；

【导师】 杜玉开；

【作者基本信息】 华中科技大学 ， 儿少卫生与妇幼保健学， 2009， 博士

【摘要】 研究目的以广州市开展的十一项社区公共卫生服务项目为成本测算对象，通过建立社区公共卫生成本测算模型，对每项公共卫生项目的人员成本、专用设备成本、房屋建筑成本和运营成本等四大类成本进行测算，明确各服务项目成本构成，为广州市社区公共卫生服务项目的政府补偿标准和补偿方式提供依据；同时结合广州市经济发展水平、物价变动水平和居民收入增长等因素，建立广州市社区公共卫生服务成本和财政补偿预测模型，预测服务成本和财政补偿标准，为政府履行公共卫生服务职能、完善社区基本公共卫生服务补偿机制、保障社区公共卫生服务的稳定发展提供科学客观的方法与依据。研究方法通过文献研究与专家小组讨论，根据广州市社区卫生服务实际情况，确定成本测算指标与方法。对广州市现有的128个社区卫生服务机构状况和社区卫生服务机构提供的公共卫生服务状况进行现场调查，了解其公共卫生服务内容、服务量、资源消耗等情况。然后选择机构设置和财务独立的65个社区卫生服务中心进行成本测算，最后对调查结果进行定量分析，建立成本和财政补偿预测模型，并对今后政府的补偿标准进行建议和可行性探讨。研究结果1．广州市社区卫生服务基本情况截至2008年，广州市共有社区卫生服务中心128个，拥有在职职工8192人；中心固定总值平均为493.3万元，平均房屋建筑面积为2145平方米；平均总收入为1090.7万元，财政补助收入为137.8万元，占总收入的12.6％，平均总支出为1065.5万元。2．社区公共卫生服务情况社区卫生服务机构卫生信息、健康教育、计划免疫、妇女保健和计生指导、儿童保健、传染病预防控制以及精神卫生等项目工作开展率均在90％以上，而慢性病预防控制、老年人保健、残疾康复和公共卫生事件应急处置等项工作开展率较低。3．社区公共卫生服务项目实际成本情况2007年十一项公共卫生服务项目实际成本为每常住人口人均为37.2元，其中慢性病预防控制项目成本最高，为8.2元，其他依次为免疫规划、卫生信息管理、健康教育等项目。4．社区公共卫生服务项目标准成本按广州市卫生行业人均工资5.7万元的水平，2007年人均标准成本为42.0元，其中人员成本占76.18％，运营成本12.61％，房屋建筑成本9.61％，专业设备成本占1.60％。5．社区公共卫生服务项目财政补偿预测结果结合广州市经济发展水平、物价变动水平和居民收入增长等因素，通过成本预测模型分析结果显示，2008～2010年，社区公共卫生服务项目人均财政补偿标准分别为46.8元、52.2元、58.3元，其中人力成本占75％左右。研究结论经过近10年的努力，广州市已初步形成以社区卫生服务中心为主体的社区卫生服务体系。但仍存在业务用房紧张、基础设施缺乏、服务队伍素质不高、服务供给能力有限、公共卫生服务项目财政补偿不足等因素，阻碍社区公共卫生服务的进一步发展。本课题确定了广州市社区公共卫生服务项目成本测算方法，对2007年广州市社区公共卫生服务项目实际成本和标准成本进行了测算，建立了广州市十一项社区公共卫生服务成本和财政补偿预测模型，并对今后的社区公共卫生服务成本和财政补偿标准进行了预测，对合理确定社区公共卫生服务财政补偿标准、方式以及建立长效机制具有重要参考价值。更多还原

【Abstract】 ObjectiveThis research took the 11 community public health services programs in Guangzhou as costestimation targets, through cost estimation on the four major types, such as personnel cost,special equipment cost, housing construction cost, operating cost, etc. to identify serviceitems and cost composition, so as to provide a basis to government for compensationstandards and compensation styles of community public health services in Guangzhou. Atthe same time, combined with the factors such as economic development level, pricefluctuation level and resident income growth, we want to establish financial compensationforecasting model of the 11 community public health services in Guangzhou, to enable amore objective and reasonable financial compensation standard, in order to provide ascientific and effective basis to the government for fulfilling functions of public healthservices, improving basic compensation mechanism and protecting stability anddevelopment of community public health services.MethodsThrough literature research and expert panel discussions, according to the actual situation of community health services in Guangzhou, the indicators and methods of cost estimationwere determined. The existing 128 community health service agencies in Guangzhou weresuveyed to understand their financial situation, personnel structure, public health servicescontents, public health services times, fund raising, and resource consumption and so on. Atlast, 65 community health service centers with independent agency installations andindependent financial affairs were selected for cost estimation. Quantitative analysis wasperformed on the existing resources status and public health service costs, to establish costforecasting model, and explore the feasibility of future government compensation standard.Results1. Basic situation of community health services in Guangzhou.By 2008, there were a total of 128 community health centers in Guangzhou, with 8192 staff,the average fixed value of which was 4.933 million yuan, with an average housing floorarea of 2145 square meters. The total revenue per center was 10.907 million yuan, and thefinancial assistance revenue was 1.378 million yuan, accounting for 12.6% of the total cost.The average total expenditure was 10.655 million yuan.2. Community public health services.Among the carried out projects, the rates of health education, women’s health, child health,prevention and control of communicable diseases, as well as planned immunity were allabove 90%, but the rates of prevention and control of chronic disease and health care ofolder persons were at a low level.3. Actual cost of community public health services.In 2007, the cost per capita of the 11 public health services projects was 37.2 yuan.The project of prevention and control to chronic disease had the highest cost per capita as8.2 yuan, followed by other projects ranked as immunization program, health informationmanagement, health education, etc.4. Standard cost of community public health services projects. According to income per capita of health industry in Guangzhou as 57,000 yuan, standardcost per capita of community public health services in 2007 was 42.0 yuan.5. Financial compensation predicted results of community public health services.Combined with the level of economic development, the level of price changes and incomegrowth and other factors, the cost forecasting model analysis showed that from 2008 to2010, financial compensation standards per capita of community public health services was46.8 yuan, 52.2 yuan, 58.3 yuan respectively, of which, the direct personnel cost accountedfor 75%.ConclusionsAfter 10 years of efforts, the community health service system with community healthservice centers as the mainstay has been intially established, yet there are still factors suchas insufficient business space, lack of infrastructure, low service quality, limited capacity ofservice supply, and insufficient financial compensation of public health services, to impedefurther development of community public health services. This research determined thecost estimation methods of community public health services projects in Guangzhou. Itestimated actual cost and standard cost of community public health services in Guangzhouin 2007, and established financial compensation prediction model of the 11 communitypublic health services of Guangzhou City, and forecast the future compensation standardper capita of the community public health services, which plays an important role inreasonably determining the financial compensation amount of public health services andformulating price standard of community public health services.更多还原