北京市1992-2013年乙型肝炎免疫规划成本的研究
|
摘要
目的分析北京市1992-2013年疾病预防控制机构、医院、社区卫生服务中心(站)(以下简称社区)在乙型肝炎(以下简称乙肝)免疫规划工作的成本及变化规律,为北京市乙肝免疫规划政策的制定、乙肝投入-产出评价提供数据支撑。方法采用文献复习、问卷调查等方法,结合北京市免疫规划信息管理系统、乙肝疫苗接种产科年度报表与乙肝疫苗接种财务报表等资料获得相关研究数据,利用ACCESS建立数据库并进行两次数据录入,应用Excel 2016对北京市疾病预防控制机构、医院、社区的乙肝免疫规划成本数据进行分析。结果北京市乙肝免疫规划总成本由1992年542.13万元增长至2013年1 328.22万元,年均增长率为4.36%。医院和社区的总成本变化幅度较大,疾病预防控制机构的变化幅度最小。单位成本方面,疾病预防控制机构单位成本由15.43元降低为8.93元,年均下降幅度为2.57%;医院、社区单位成本则均有不同程度的增长,年均增长率分别为9.56%和2.58%。结论北京市乙肝免疫规划总成本呈上升趋势,从成本在疾病预防控制机构、医院、社区的分布情况来看,疾病预防控制机构的总成本占三类机构总成本的比例为22.55%～61.11%,医院和社区的总成本占比分别为7.56%～32.83%及28.30%～48.30%,但医院和社区在人力方面的成本远大于疾病预防控制机构,由此显示,疾病预防控制机构在乙肝免疫规划中的成本在3类机构中最高,因此,政府在对乙肝免疫规划相关机构进行投入时,应对疾病预防控制机构有所侧重,而各类机构在对本机构成本进行补偿时,则应充分考虑成本构成及增长特点进行补偿。
Objective To understand the overall cost of national immunization programme of hepatitis B vaccine in Beijing from 1992 to 2013, and its dynamic change, in order to provide supports for policy-making and input-output assessment of hepatitis B vaccination program. Methods Data related to hepatitis B vaccination were collected by literature review, questionnaire survey, and also retrieved from Beijing immunization information system, hepatitis B vaccination annual report from obstetrics department of hospitals and vaccination associated financial reports, and were entered twice into a database established using ACCESS.Excel 2016 was used to analyze the cost of hepatitis B vaccination in CDC, hospitals and primary healthcare centers(PHCs). Results The overall cost of hepatitis B vaccination in Beijing increased from 5.42 million in 1992 to 13.28 million RMB, with the annual increase of 4.36%.The change of the cost was more dramatic in hospitals and PHCs than in CDC.The unit cost decreased from 15.43 to 8.93 RMB in CDC with an annual decrease of 2.57%, while increased in hospitals and PHCs with an annual increase of 9.56% and 2.58%, respectively during the study period. Conclusions The total cost of hepatitis B immunization in Beijing is on the rise.The cost in CDC, hospitals and PHCs accounts for 22.55% to 61.11%, 7.56% to 32.83% and 28.30% to 48.30% of the total, respectively, and the human resource cost in hospitals and PHCs is much higher than that in CDC.Therefore,government should invest more to CDC and should take cost structure and its changing pattern into consideration,to make more reasonable and scientific decisions.
Objective To understand the overall cost of national immunization programme of hepatitis B vaccine in Beijing from 1992 to 2013, and its dynamic change, in order to provide supports for policy-making and input-output assessment of hepatitis B vaccination program. Methods Data related to hepatitis B vaccination were collected by literature review, questionnaire survey, and also retrieved from Beijing immunization information system, hepatitis B vaccination annual report from obstetrics department of hospitals and vaccination associated financial reports, and were entered twice into a database established using ACCESS.Excel 2016 was used to analyze the cost of hepatitis B vaccination in CDC, hospitals and primary healthcare centers(PHCs). Results The overall cost of hepatitis B vaccination in Beijing increased from 5.42 million in 1992 to 13.28 million RMB, with the annual increase of 4.36%.The change of the cost was more dramatic in hospitals and PHCs than in CDC.The unit cost decreased from 15.43 to 8.93 RMB in CDC with an annual decrease of 2.57%, while increased in hospitals and PHCs with an annual increase of 9.56% and 2.58%, respectively during the study period. Conclusions The total cost of hepatitis B immunization in Beijing is on the rise.The cost in CDC, hospitals and PHCs accounts for 22.55% to 61.11%, 7.56% to 32.83% and 28.30% to 48.30% of the total, respectively, and the human resource cost in hospitals and PHCs is much higher than that in CDC.Therefore,government should invest more to CDC and should take cost structure and its changing pattern into consideration,to make more reasonable and scientific decisions.
引文
[1] 王鸣.实用免疫接种培训教程[M].北京:中国中医药出版社,2007:160.
[2] 丁胜月,李洁琼,申昆玲.国家免疫规划疫苗接种现状分析[J].标记免疫分析与临床,2016,23(6):707-712.
[3] 姜颖颖.北京市社区卫生服务项目成本测算模型研究[D].北京:北京中医药大学,2012.
[4] Alastair M.Gray,Philip M.Clarke.Applied Methods of Cost-effectiveness Analysis in Health Care[M].Oxford University,2011.
[5] 胡善联.卫生经济学[M].上海:复旦大学出版社,2003.
[6] 杨丽,唐艳丽.防治防疫机构开展不完全二级成本核算的尝试[J].中国公共卫生管理,2002,18(2):108-109.
[7] 王雪涛,王颖,姜庆五,等.成本核算在公共卫生领域应用的研究进展[J].中国初级卫生保健,2010,24(1):11-14.
[8] 郑重.社区基本公共卫生服务成本测算研究[J].中国公共卫生,2015,31(4):494-496.
[9] 张慧铭.疾控中心会计与企业会计财务处理的比照[J].企业改革与管理,2017(5):129-130.
[10] 边国林,马瑞,周绍英,等.新生儿乙型肝炎疫苗低/无应答者再免疫抗体应答研究[J].中国疫苗和免疫,2012,18(4):333-336.
[11] 郑贤义,吉兆华,闫永平,邵中军.乙型肝炎疫苗的应用及研究[J].重庆医学,2016,45(26):3719-3721.
[12] 陈雪霞,姚云清.乙型肝炎疫苗的应用进展[J].临床合理用药杂志,2017,10(15):177-179.
[13] 卓家同.乙肝疫苗大规模应用效果与预防效益研究进展[J].应用预防医学,2016,22(5):471-473.
[14] 杨思嘉.宁波市新生儿乙型肝炎疫苗卫生经济学评价[D].宁波大学,2013.
[15] 张岚,郭文博,郑小华,等.公立医院公共卫生服务补偿存在的问题及建议[J].卫生经济研究,2015 (9):50-52.
[16] 秦江梅,张丽芳,林春梅,张艳春.我国基层卫生综合改革进展[J].中国全科医学,2017,20(22):2683-2690.
[17] 应亚珍,戈昕,徐明明,等.我国基层医疗卫生机构补偿机制研究报告[J].卫生经济研究,2016(9):3-8.
[2] 丁胜月,李洁琼,申昆玲.国家免疫规划疫苗接种现状分析[J].标记免疫分析与临床,2016,23(6):707-712.
[3] 姜颖颖.北京市社区卫生服务项目成本测算模型研究[D].北京:北京中医药大学,2012.
[4] Alastair M.Gray,Philip M.Clarke.Applied Methods of Cost-effectiveness Analysis in Health Care[M].Oxford University,2011.
[5] 胡善联.卫生经济学[M].上海:复旦大学出版社,2003.
[6] 杨丽,唐艳丽.防治防疫机构开展不完全二级成本核算的尝试[J].中国公共卫生管理,2002,18(2):108-109.
[7] 王雪涛,王颖,姜庆五,等.成本核算在公共卫生领域应用的研究进展[J].中国初级卫生保健,2010,24(1):11-14.
[8] 郑重.社区基本公共卫生服务成本测算研究[J].中国公共卫生,2015,31(4):494-496.
[9] 张慧铭.疾控中心会计与企业会计财务处理的比照[J].企业改革与管理,2017(5):129-130.
[10] 边国林,马瑞,周绍英,等.新生儿乙型肝炎疫苗低/无应答者再免疫抗体应答研究[J].中国疫苗和免疫,2012,18(4):333-336.
[11] 郑贤义,吉兆华,闫永平,邵中军.乙型肝炎疫苗的应用及研究[J].重庆医学,2016,45(26):3719-3721.
[12] 陈雪霞,姚云清.乙型肝炎疫苗的应用进展[J].临床合理用药杂志,2017,10(15):177-179.
[13] 卓家同.乙肝疫苗大规模应用效果与预防效益研究进展[J].应用预防医学,2016,22(5):471-473.
[14] 杨思嘉.宁波市新生儿乙型肝炎疫苗卫生经济学评价[D].宁波大学,2013.
[15] 张岚,郭文博,郑小华,等.公立医院公共卫生服务补偿存在的问题及建议[J].卫生经济研究,2015 (9):50-52.
[16] 秦江梅,张丽芳,林春梅,张艳春.我国基层卫生综合改革进展[J].中国全科医学,2017,20(22):2683-2690.
[17] 应亚珍,戈昕,徐明明,等.我国基层医疗卫生机构补偿机制研究报告[J].卫生经济研究,2016(9):3-8.