【作者】 李俊萍；

【导师】 包士峰；

【作者基本信息】 河北医科大学 ， 社会医学与卫生事业管理， 2004， 硕士

【摘要】 目的：了解石家庄市企业医疗机构的现状、资源利用情况；探讨分离国有企业医院的模式、方法、难点及相关政策，配合国企改革，为卫生决策部门提供参考依据。方法：向石家庄市区内企事业单位的职工医院函发自制调查表进行现况调查，内容包括医院级别，人力资源状况，基础设施状况，业务工作情况，收支情况，现行医疗制度类型，医院及所属企业对企业医院与所属企业分离（以下简称医企分离）的态度，不同意分离的原因，愿意采取的分离方式等。为了进行比较，同时调查了10所石家庄地区的级别相当的县市级医院。重点对十几所大型企业医院进行实地考察。派专人亲自上门找医院领导了解详细情况，如医院当前面临的困难，对医企分离的看法，认为医企分离的难点与关键何在等。在Excel软件中进行数据输入和整理，使用SPSS11.5 for Windows统计软件进行分析。采用描述性统计方法，分别计算绝对数和相对数等指标进行分析。采用卡方检验进行构成比的比较和相关性分析。结果： 2002年末，40家企业医院的职工总人数为4 160人，其中卫技人员2 913人，管理人员273人；卫技人员的高、中、初职称结构比为1：4：6；卫技人员中本科、专科、中专学历结构百分比分别为20％、41％、37％；卫技人员的平均年龄38岁；卫技人员中有医生1 339人，护士1 077人，医护比为1：0.80。40家医院共开设病床2 715张；固<WP=4>定资产总金额为28 689.84万元；医疗设备总金额为11 578.45万元；拥有大型医疗设备（万元以上）951台，一般医疗设备（千元至万元）1 589台；医疗设备使用率普遍偏低；床位使用率平均为 57.26%；2002年门急诊人次为2 221 259，收治住院病人人次为42 916。2002年40家医院总收入为23 259.78万元，其中业务收入11 767.00万元，企业拨款8 663.12万元。业务收入占总收入的51％，企业拨款占总收入的37％；2002年总支出为22 057.01万元，其中工资5 136.16万元，购置医疗设备1 345.31万元，医药费10 228.94万元。02年结余为1 202.77万元。调查中发现75％的企业医院已开展了社区卫生服务；有14家医院已加入医疗保险，占35％；同意医企分离的医院有15家占38％；所属企业同意医企分离的有22家占55％。不同意医企分离的原因主要有：担心分离后自身难以生存；底子薄、基础差、技术水平低、难与地方医院竞争；担心分离后失去固定的服务人群。认为医企分离的难题主要有：产权如何处置；人员如何安置；今后医院经费来源问题。人们普遍认识到医企分离是大势所趋，多数医院对分离作了准备，但有的人不理解为什么要这样做。认为医保是个好政策，但目前还不成熟。企业医院既存在劣势、难处又有它自身的优势。劣势：医院经营管理机制先天不足，医院领导没有自主权；没有形成经营性的管理机制；只重服务，成本效益观念差，人、财、物的使（利）用率低下，浪费现象严重；技术力量薄弱，人才断档、人才外流现象严重；卫生资源得不到充分合理的利用；卫生资源配置不合理；没有激励机制，医院活力远不如<WP=5>地方医院。难处：许多企业医院位于家属区内，地理位置封闭，服务人群局限；自身的竞争力较差；而石家庄市区整个大环境是，医疗服务供大于求；多年来已形成了等、靠、要的作风，所以人们普遍不愿意分离,害怕承担风险和面临竞争。优势：企业医院中聚集了一大批医疗卫生专业人才；企业医院建设周期较长，有的已形成优势科室、优势专业；企业医院中有丰富的物质资源；企业医院接近生活区，职工群众就医方便，因长期服务于职工与家属已建立了良好的医患关系，有良好的声誉；企业医院的医生由于长期的习惯，非常重视职业道德，医德医风均较好；企业医院没有庞大的后勤系统负担；有的企业医院确实起到了为企业节约劳保医疗费用和创收的作用。将40家职工医院与级别相当的8家市县级医院相比后发现，在人力资源上，除了一级职工医院职工平均年龄稍大外（2岁左右），职工医院的医护比和职称结构比均不比县市级医院差，学历结构还优于县级医院；二级职工医院的固定资产和医疗设备金额也不比县市级医院差；二级职工医院的业务收入占总收入的77％，企业拨款只占18％，这说明二级职工医院不再依赖企业，分离后自身完全可以生存。职工医院的人均门诊人次明显高于县市级医院，一级职工医院的床位使用率和人均住院人次明显较少；9家无拨款医院中有三家的年终结余为正。通过以上比较分析可知：医企分离后，职工医院在短期内可能不适应，但经过一段时间磨炼后肯定能够生存。不过，职工医院内部首先应进行改革。对几种可行的出路进行了分析：1、政府收编，移交政府管理：将资产、人员成建制移交政府正常运转，所需经费<WP=6>由政府承担。这是比较理想的方式，但不太现实。因为我省企业医疗机构的太多，而政府财力有限。只有那些经营状况不错又符合区域卫生规划的较大的企业医院有可能。2、重新组建独立的事业法人，走民营医院的道路：可根据区域卫生规划规定的规模、布局，几个企业医院合并或单独划出，自主经营、自负盈亏。这是一条可行的出路，尤其适合一些大的企业医院。3、一级职工医院转向社区卫生服务：社区卫生服务是城市卫生改革与更多还原

【Abstract】 Objectives: In order to learn about actual conditions and resource utilization of enterprise hospitals in Shi jiazhuang. That models, methods, difficulties and related policies about public enterprise hospital’s separation is to be discussed. Aim to matching public enterprise’s reform, to making references for policy-make departments.Materials and methods: Self-made questionaires were mailed out to enterprises related hospitals in Shi jiazhuang. It contains: class of hospitals, human resources, basic facilities, service work, incomes and outcomes, types of medical system, hospital and its enterprise’s atitiudes to separation, reasons of disagreement, content ways of seperation etc. At the same time, 10 county class hospitals in same level were studied for a comparison. The focus had been put on tens of bigger enterprise hospitals. Professional people were sent to hospital leaders to find out details such as, difficulties of hospital at present, their opinions to seperation, what were key points and difficulties of seperation. The datas were input and sorted in Excel, analyzed use SPSS 11.5 for windows. Descriptive statistics use relative numbers and obsolutive numbers. Comparison of proportion and correlation analysis was evaluated by Chi-square test. <WP=10>Results: By the end of 2002, there were 4160 works altogether in 40 enterprise hospitals, of which hygines were 2913,managers were 273. Of those hygines: professional title ratio was 1:4:6, educational background proportion was 20%, 41%, 37%, average age was 38, doctors and nurses ratio was 1:0.80. Total cots were 2715, Steady properties was 286.90 million yuan, large medical facilities were 951,common medical facilities were 1589, utilization rate were low in common, mean cots utilization rate was 57.26%. In 2002, outpatients were 2221259, inpatients were 42916. Total income was 232.60 million yuan, of which service income 117.69, money come from enterprise 86.63, service income accounted a percentage of 51% of tatal income, the latter 37%, total income in 2002 was 220.57 million yuan, of which salary 51.36, buying medical facilities 13.45, fare for medicine 102.29, remain 12.03.In investigation, we found that 75% enterprise hospitals have joined in community heath service, 14 of them have joined in medical insurance (35%), 15 of them agree on seperation (38%), enterprises’s agree rate was 55%, The reasons of disagreement maily were: afraid they can’t survive after seperation, with worse basic facility and lower level technician, they thought they are difficult in competing with local hospitals, afraid of lost steaty service corhot. The difficulties of seperation they thought were: who would the hospital belong to, how to arrange the workers, where would financition come from after seperation etc. They all realized that seperation is a trend, most <WP=11>hospitals have prepared for it. But some people can’t understand why they must do so. Most people thought medical insurance a good policy, only that it is not matured at present. There are disadvantages, difficulties and advantages about enterprise hospitals. Disadvantages: Hospital’s manage mechanism are born insufficient; the leaders have no independent rights; haven’t form an operating manage mechanism; services is the only important thing, there are no cost-effect realization; utilization rate in human resources, properties and facilities are low, materials ares wasted seriously; technical level were worse, hygine talents lost seriously; hygine resouces couldn’t be used fully and suitablely; configuration of health resources is unsuitable; there are no inspiration ,hospital vigorous are far less than local hospitals. Difficulties: Many enterprise hospitals located in folk regions, it is closed in geography and limitied in sevice crowd; their competition are weak. However, the whole circumstance is that health sevice supplies are larger than demand in Shi jiazhuang. Enterprise hospitals have formed a custom of waiting, demanding and asking in past years. So it is commonly that they woul更多还原