本文關(guān)鍵詞： 縣級(jí)公立醫(yī)院 財(cái)政投入 績(jī)效　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的摸清安徽省縣級(jí)公立醫(yī)院財(cái)政投入情況,探索不同財(cái)政投入水平、結(jié)構(gòu)及各投入項(xiàng)目收支比對(duì)醫(yī)院財(cái)政投入績(jī)效的影響以及不同財(cái)政補(bǔ)助水平下醫(yī)院產(chǎn)出指標(biāo)的變化情況,從而找出財(cái)政投入存在的問題和薄弱環(huán)節(jié),實(shí)例論證財(cái)政補(bǔ)助對(duì)醫(yī)院運(yùn)行的影響,以期為完善財(cái)政投入政策,提高縣級(jí)醫(yī)院運(yùn)行效率提供參考依據(jù)。方法通過文獻(xiàn)復(fù)習(xí)了解國(guó)內(nèi)外公立醫(yī)院財(cái)政投入及其績(jī)效評(píng)價(jià)的實(shí)踐經(jīng)驗(yàn),同時(shí)查閱文件資料了解相關(guān)部門對(duì)公立醫(yī)院財(cái)政投入的政策規(guī)定,為課題研究方案的擬定和指標(biāo)體系構(gòu)建提供思路;召開專家討論會(huì),交流財(cái)政對(duì)縣級(jí)醫(yī)院的投入情況,并對(duì)初步研制的評(píng)價(jià)指標(biāo)體系進(jìn)行研討、修正;運(yùn)用德爾菲法確定各評(píng)價(jià)指標(biāo)及權(quán)重;深度訪談相關(guān)人員,收集財(cái)政投入現(xiàn)狀、問題及有關(guān)建議等資料;對(duì)樣本醫(yī)院進(jìn)行問卷調(diào)查,內(nèi)容涵蓋三個(gè)部分:醫(yī)院基本情況、醫(yī)院收支情況和醫(yī)院業(yè)務(wù)情況;利用Epi Data 3.1、Excel 2003和SPSS16.0分別對(duì)數(shù)據(jù)進(jìn)行錄入、處理和分析;運(yùn)用一般描述性分析、t檢驗(yàn)、方差分析、相關(guān)性分析、多元回歸等統(tǒng)計(jì)方法深入了解樣本醫(yī)院財(cái)政投入現(xiàn)狀和績(jī)效得分情況,找出財(cái)政投入各因素與績(jī)效間的相關(guān)關(guān)系,并實(shí)例論證財(cái)政補(bǔ)助水平對(duì)醫(yī)院產(chǎn)出指標(biāo)的影響。結(jié)果財(cái)政投入情況:(1)補(bǔ)助收入及比例:2013-2015年樣本醫(yī)院財(cái)政補(bǔ)助數(shù)額呈逐年增長(zhǎng)的趨勢(shì),2015年財(cái)政補(bǔ)助收入同比增長(zhǎng)率明顯高于2014年,達(dá)到14.4%,但其占醫(yī)院總收入的比例卻有所下降,財(cái)政補(bǔ)助比例依舊不高。其中,2015年樣本醫(yī)院總體財(cái)政補(bǔ)助比例為9.4%,半數(shù)以上的縣級(jí)醫(yī)院財(cái)政補(bǔ)助比例低于7.8%,僅25%的醫(yī)院該比例超過10%,且財(cái)政補(bǔ)助比例地域水平差別較大(最低為1.6%,最高為29.1%)。從醫(yī)院類型看,縣綜合醫(yī)院財(cái)政投入數(shù)額在不斷增長(zhǎng),但2015年其財(cái)政投入增長(zhǎng)率較2014年下降了近7個(gè)百分點(diǎn);縣中醫(yī)院除了在2014年出現(xiàn)投入負(fù)增長(zhǎng)外,其投入增長(zhǎng)率亦與縣綜合醫(yī)院差距較大。此外,縣綜合醫(yī)院財(cái)政補(bǔ)助比例呈現(xiàn)逐年增長(zhǎng)的趨勢(shì),而縣中醫(yī)院歷年財(cái)政補(bǔ)助比例不僅沒有上升,反而在逐年下降。與2013年比較,2015年降幅達(dá)到3.6%。(2)投入結(jié)構(gòu)及分布:財(cái)政補(bǔ)助收入中,離退休人員經(jīng)費(fèi)各年占比均在22.7%-26.8%之間,2015年88.6%家樣本醫(yī)院得到了該項(xiàng)補(bǔ)助;在職人員經(jīng)費(fèi)占比各年均在15.2%以下,2015年45.5%家樣本醫(yī)院得到了該項(xiàng)補(bǔ)助,其中僅9家樣本醫(yī)院在職人員經(jīng)費(fèi)補(bǔ)助占實(shí)際在職人員支出比例在10%以上。(3)補(bǔ)助項(xiàng)目的收支情況:2015年在職人員經(jīng)費(fèi)、離退休人員經(jīng)費(fèi)、基本建設(shè)和設(shè)備購(gòu)置四項(xiàng)補(bǔ)助均收不抵支。其中,在職人員經(jīng)費(fèi)補(bǔ)助和基本建設(shè)支出補(bǔ)助占其實(shí)際支出的比例分別為5.3%和68.1%。財(cái)政投入績(jī)效得分情況:樣本醫(yī)院績(jī)效總得分為825.6±72.0分。從各維度來看,醫(yī)療服務(wù)、社會(huì)服務(wù)、綜合管理和社會(huì)評(píng)價(jià)四個(gè)維度的得分分別是209.7±20.9分、205.8±16.9分、203.5±18.1分和206.6±18.4分。無論從績(jī)效總得分還是評(píng)價(jià)各維度得分來看,縣中醫(yī)院的得分水平均低于縣綜合醫(yī)院,但兩者僅在“社會(huì)服務(wù)”維度得分差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。財(cái)政投入績(jī)效得分的影響因素:就補(bǔ)助水平來說,績(jī)效總得分與財(cái)政補(bǔ)助比例呈正相關(guān);就投入結(jié)構(gòu)而言,在職人員經(jīng)費(fèi)占比和基本建設(shè)補(bǔ)助占比影響醫(yī)院財(cái)政投入的績(jī)效總得分(P0.01),且在職人員經(jīng)費(fèi)和基本建設(shè)在補(bǔ)助收入中的占比越大,醫(yī)院績(jī)效得分越高;就投入項(xiàng)目收支比而言,財(cái)政補(bǔ)助總收支比、在職人員經(jīng)費(fèi)和基本建設(shè)的收支比三個(gè)因素影響醫(yī)院財(cái)政投入的績(jī)效總得分(P0.05),且財(cái)政補(bǔ)助力度越大,對(duì)人員經(jīng)費(fèi)和基本建設(shè)的實(shí)際支出補(bǔ)助份額越大,醫(yī)院績(jī)效得分就越高。財(cái)政補(bǔ)助水平對(duì)醫(yī)院產(chǎn)出指標(biāo)的影響:人員支出占比與財(cái)政補(bǔ)助水平呈正相關(guān),而次均住院費(fèi)用、次均門急診費(fèi)用、藥占比及資產(chǎn)負(fù)債率與財(cái)政補(bǔ)助水平均呈負(fù)相關(guān)。不同財(cái)政補(bǔ)助水平下,各指標(biāo)組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論總體上,安徽省縣級(jí)公立醫(yī)院財(cái)政投入在不斷增長(zhǎng),但投入水平依舊不高,且投入分布不均衡,縣中醫(yī)院補(bǔ)助水平相對(duì)較低;與此同時(shí),財(cái)政投入結(jié)構(gòu)也不盡合理,得到在職人員經(jīng)費(fèi)和基本建設(shè)補(bǔ)助的醫(yī)院只在少數(shù),且補(bǔ)助亦不到位,較大比例由醫(yī)院自身發(fā)展予以解決。除此之外,財(cái)政補(bǔ)助比例、結(jié)構(gòu)及各項(xiàng)目收支比不同,醫(yī)院投入績(jī)效也不同,且財(cái)政補(bǔ)助水平對(duì)人員支出占比、次均住院費(fèi)用、次均門急診費(fèi)用、藥占比及資產(chǎn)負(fù)債率亦有一定影響。因此,政府應(yīng)對(duì)全省各縣的財(cái)力情況和縣級(jí)醫(yī)院運(yùn)營(yíng)情況進(jìn)行摸底,在此基礎(chǔ)上建立長(zhǎng)效投入保障機(jī)制,優(yōu)化投入結(jié)構(gòu),全額保障離退休人員工資,加大在職人員經(jīng)費(fèi)補(bǔ)助,并逐步化解醫(yī)院歷史性債務(wù)。此外,還應(yīng)加強(qiáng)對(duì)財(cái)政投入的績(jī)效考核,將考核結(jié)果與財(cái)政投入相掛鉤,從而切實(shí)提高財(cái)政資金的使用效率。
[Abstract]:Objective to find out the county public hospital of Anhui Province, the financial investment, explore the different level of financial investment, the investment structure and project budget on hospital performance of financial input and the effect of changes in output index hospitals of different level of financial assistance under the situation of financial investment so as to find out the existing problems and weak links, demonstration of financial assistance for the effect of hospital operation. In order to improve the financial investment policy, to provide reference on improving the efficiency of the hospital. Through the method of literature review about domestic and international financial investment and public hospital performance evaluation experience, and understanding of the relevant departments to provide access to documents on policy of financial investment in public hospitals, and to provide ideas for the construction of the index system of the research project; seminar, exchange of financial investment in county hospitals, and the preliminary development evaluation The evaluation index system is discussed, using the Delphy Fa correction; to determine the evaluation index and weight; in-depth interviews with relevant personnel, collect the financial investment situation, problems and suggestions of information; questionnaire survey of sample hospitals, covers three parts: the basic situation of the hospital situation, hospital and hospital business income; the use of Epi Data 3.1 Excel, 2003 and SPSS16.0 respectively for data entry, processing and analysis; using descriptive analysis, t test, variance analysis, correlation analysis, multiple regression and in-depth understanding of the hospital financial investment status and performance scores, to find out the relationship between the factors and related financial investment performance, influence and demonstration of finance the level of subsidy on hospital output index. Results: (1) financial investment subsidy income and the proportion of 2013-2015 in sample hospitals subsidy amount is increasing year by year The trend of 2015, financial subsidy income year-on-year growth rate was significantly higher than that in 2014, reached 14.4%, but the total hospital revenue ratio has declined, fiscal subsidy proportion is still not high. Among them, the 2015 sample hospital overall fiscal subsidy proportion is 9.4%, the proportion of financial subsidies in county hospitals more than half of less than 7.8%, only 25% of the hospital the proportion of more than 10%, and the difference of regional level greater fiscal subsidy proportion (minimum 1.6%, maximum 29.1%). From the type of hospital, county general hospital financial investment amount is growing, but in 2015 the financial investment growth rate fell by nearly 7 percentage points higher than in 2014; in addition to County Hospital of traditional Chinese medicine into negative growth in 2014 outside, the investment growth rate and a larger gap between the county general hospital. In addition, the county general hospital financial subsidy proportion increasing trend year by year, and the county hospital of traditional Chinese Medicine annual finance ratio did not help Rose, but declined year by year. Compared with 2013, 2015 by 3.6%. (2): investment structure and distribution of financial subsidy income, retirees funds each year accounted for between 22.7%-26.8%, 2015 88.6% sample hospitals received the subsidy; on-the-job personnel expenses accounted for the average below 15.2%. In 2015 45.5% sample hospitals received the subsidy, the on-the-job personnel funds only 9 sample hospitals accounted for the proportion of the actual expenditure subsidies for in-service personnel in more than 10%. (3) income subsidy project: 2015 in-service personnel expenses, retired personnel expenses, basic construction and equipment purchase subsidies are four items of income over expenditure. Among them, on-the-job personnel funding and basic construction expenditure subsidies accounted for the actual expenditure ratio were 5.3% and 68.1%. financial investment performance scores: the total score of performance of sample hospitals was 825.6 + 72 points from each dimension to. Look, medical services, social services, social management and comprehensive evaluation score of four dimensions were 209.7 + 20.9, 205.8 + 16.9, 203.5 + 18.1 and 206.6 + 18.4. Regardless of the total score or performance evaluation scores, the scores of county hospital were lower than the county general hospital. But both of them only in the "social service" scores the difference was statistically significant (P0.05). The financial investment performance score factors: the level of subsidy, positive performance total score and fiscal subsidy proportion; investment structure, service personnel funds accounted for and basic construction grants accounted the total score of hospital's financial investment performance (P0.01), and the staff in basic construction funds and subsidy income in the proportion of larger, higher scores on hospital performance; project investment budget ratio, financial subsidies total revenue ratio, on-the-job personnel funds and base The construction of the balance of payments than three factors affect the total score of hospital financial investment performance (P0.05), and financial assistance to the greater share of the actual expenditure of grant funds and personnel to the basic construction of the hospital performance, the higher the score. The level of financial assistance to the hospital output index: personnel expenditure accounting and finance the subsidy level was positively correlated, while the average hospitalization cost, average cost of outpatient and emergency medicine, accounting and asset liability ratio and financial subsidy levels were negatively correlated. Different level of financial assistance, with statistical significance of each index difference between the two groups (P0.05). Conclusion on the whole, Anhui Province, the county public hospital financial investment in the growing however, the input level is still not high, and the input distribution is not balanced, county hospital subsidy level is relatively low; at the same time, the financial investment structure is not reasonable, get on-the-job personnel funds and subsidies for the construction of Basic Medicine Hospital in only a few, and also subsidies are not in place, a large proportion of the development will be resolved by the hospital itself. In addition, the proportion of financial subsidies, project structure and the balance ratio is different, the hospital investment performance is different, and the level of financial assistance to the personnel expenditure ratio, average hospitalization expenses, average outpatient expenses, medicine accounting and asset liability ratio have a certain influence. Therefore, the government should thoroughly the financial situation of the province's counties and county-level hospital operations, on the basis of the establishment of long-term investment guarantee mechanism, optimize the investment structure, the full protection of retired personnel wages, increase on-the-job personnel funding, and gradually resolve the hospital historic debt. In addition, also we should strengthen the financial input of performance appraisal, the appraisal results and financial investment linked, so as to effectively improve the efficiency of fiscal funds.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1

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