我国各省及直辖市卫生系统绩效评价的研究
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摘要
随着经济的快速发展,人民生活水平的提高,人们对医疗服务需求的也在不断增加,从而导致了医疗卫生费用的过快增长,医疗卫生问题已成为世界关注的焦点。卫生系统对改善人类的健康水平起着重要的作用,管理卫生系统的科学方法之一就是绩效评价。卫生绩效评价已渐渐受到重视,并在全世界范围内开始广泛使用,许多国家都在试图建立和发展其卫生系统绩效评价体系。
本文首先介绍了课题研究的背景、意义、国内外情况,概述了国外几种比较有影响力的卫生系统绩效评价理论框架。接着分析了我国1978年到2009年卫生总费用的变化情况,掌握我国卫生总费用的发展状况。然后在借鉴国内外研究成果的基础上,结合我国的实际情况,遵循指标选取的原则,从疾病控制、卫生保健、医疗服务、卫生设施与人员、成本与费用这五个方面选取了36个指标,构建了一套评价各地区卫生系统绩效的指标体系。然后,以我国大陆各省份、自治区及直辖市为研究对象,从《2010中国卫生统计年鉴》和《2010中国统计年鉴》中获得样本数据,利用SPSS软件对样本数据进行因子分析,得到各地区卫生系统绩效的得分和排名。紧接着又以综合得分为依据,利用聚类分析将这些地区按卫生系统绩效的高低划分了五大类,并对这五类城市分别进行了评价。最后就改善卫生系统绩效方面提出了建议。
With the rapid development of economy and the improvement of people's living standard, the demand of medical services are also increasing, which led to the rapid growth of health costs. Medical and health problem has already become the focus of global attention. Health system plays an important role in improving human health level, performance evaluation is one of the scientific method of management of health system. Health performance evaluation has come to be taken seriously, and is extensively used all over the world. Many countries are trying to establish and develop their health system performance evaluation system.
This paper first introduced the research background, the significance and domestic and international situation, then summarizes several influential international theory frame of health system performance evaluation. The paper analyzes the total health expenses, master the development situation of total health expenses. Based on the research achievements and in accordance with the actual situation in our country, following the principle of index selection the paper selects 36 indicators from five areas including disease control, health care, health services, sanitation and personnel, cost and expenses. The 36 indicators construct a new index system which is used to evaluate the regional health system performance. Then, the paper selects 31 provinces and Municipalities of Chinese mainland as the research object, and carries on factor analysis to the data of the samples obtained from "China Health Statistics Yearbook 2010" and "China Statistics Yearbook 2010" through SPSS software, it reaches the regional health system performance scores and rankings. Then based on the integrated scores, these regions are divided into five kinds through cluster analysis according to the level of health system performance, and carries on the synthetic evaluation to the five kinds of cities. Finally, the paper put forward some suggestions to improve health system performance.
本文首先介绍了课题研究的背景、意义、国内外情况,概述了国外几种比较有影响力的卫生系统绩效评价理论框架。接着分析了我国1978年到2009年卫生总费用的变化情况,掌握我国卫生总费用的发展状况。然后在借鉴国内外研究成果的基础上,结合我国的实际情况,遵循指标选取的原则,从疾病控制、卫生保健、医疗服务、卫生设施与人员、成本与费用这五个方面选取了36个指标,构建了一套评价各地区卫生系统绩效的指标体系。然后,以我国大陆各省份、自治区及直辖市为研究对象,从《2010中国卫生统计年鉴》和《2010中国统计年鉴》中获得样本数据,利用SPSS软件对样本数据进行因子分析,得到各地区卫生系统绩效的得分和排名。紧接着又以综合得分为依据,利用聚类分析将这些地区按卫生系统绩效的高低划分了五大类,并对这五类城市分别进行了评价。最后就改善卫生系统绩效方面提出了建议。
With the rapid development of economy and the improvement of people's living standard, the demand of medical services are also increasing, which led to the rapid growth of health costs. Medical and health problem has already become the focus of global attention. Health system plays an important role in improving human health level, performance evaluation is one of the scientific method of management of health system. Health performance evaluation has come to be taken seriously, and is extensively used all over the world. Many countries are trying to establish and develop their health system performance evaluation system.
This paper first introduced the research background, the significance and domestic and international situation, then summarizes several influential international theory frame of health system performance evaluation. The paper analyzes the total health expenses, master the development situation of total health expenses. Based on the research achievements and in accordance with the actual situation in our country, following the principle of index selection the paper selects 36 indicators from five areas including disease control, health care, health services, sanitation and personnel, cost and expenses. The 36 indicators construct a new index system which is used to evaluate the regional health system performance. Then, the paper selects 31 provinces and Municipalities of Chinese mainland as the research object, and carries on factor analysis to the data of the samples obtained from "China Health Statistics Yearbook 2010" and "China Statistics Yearbook 2010" through SPSS software, it reaches the regional health system performance scores and rankings. Then based on the integrated scores, these regions are divided into five kinds through cluster analysis according to the level of health system performance, and carries on the synthetic evaluation to the five kinds of cities. Finally, the paper put forward some suggestions to improve health system performance.
引文
[1]何平平.我国医疗支出增长因素研究[D]：[博士学位论文].北京：北京邮电大学,2007.
[2]任苒.卫生系统绩效评估及其思考—《2000年世界卫生报告》的启示与思索[J].医学与哲学,2001,22(40)：19-22.
[3]胡善联.评价卫生系统绩效的新框架一介绍2000年世界卫生报告[J].卫生经济研究.2000,(7)：5-7.
[4]Marc J. Roberts, Williams Hsiao, Peter Berman, et al. Getting Health Reform Right, Background Material for Flagship Course on Health Reform and Sustainable Financing, World Bank, Washington,2001.
[5]保宏翔.国家卫生系统绩效统计指标的评价与对比研究[D]：[硕士学位论文].西安：第四军医大学.2007.
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[7]BrundtlandGH, Frenk J, Murray CJL. WIIO assessment of health systems performance[J]. The Lancet,2003,361:2155.
[8]Rifat Atun. Advisory support to Primary Health care Evaluation Model: Estonia PHC Evaluation Project. World Heallh Organization Regional Office for Europe.2004.
[9]刘岳,张亮.卫生系统绩效评价理论框架的研究进展[J].医学与社会,2008,21(8)：29—31.
[10]王淑红,龙立荣.绩效管理综述[J].中外管理导报,2002,9：40-44.
[11]蔡志明,陈春涛,王光明.绩效、绩效评估与绩效管理—基于对建立医院绩效
评价体系有借鉴作用的述评[J].中国医院,2005,9(3)：67-72.
[12]张俊婕,赵琦,赵根明.绩效评价在公共卫生体系建设中的应用[J].中华流行病学杂志,2009,30(8)：865-866.
[13]杨芬,段纪俊.世界卫生系统绩效现状及其改进建议[J].国外医学.社会医学分册,2002,19(3)：108-113.
[14]世界卫生组织.2000年世界卫生报告[M].北京：人民卫生出版社,2000.
[15]田伟,张鹭鹭,欧崇阳等.我国公共卫生服务系统的历史沿革和存在的问题.中国全科医学[J].2006,(17)：1402-1404.
[16]Smylie J, Anderson I, Ratima M. Indigenous health performance measurement system in Canada. Australia, and New Zealand[J]. Lancet, 2006(367):2029-2032.
[17]沈林.社区公共卫生服务绩效评价研究[D]：[硕士学位论文].杭州：浙江大学,2009.
[18]江芹,胡善联.对WHO卫生系统绩效公平性评价的几点疑问[J].中国卫生事业管理,2002,3：132—134.
[19]裴丽昆.澳大利亚卫生系统绩效评价框架[J].中华医院管理杂志,2004,20(8)：510-512.
[20]傅鸿鹏.澳大利亚卫生系统绩效评价指标体系的特色及应用[J].卫生经济研究,2009,6：33—35.
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[29]李秋芬.世界主要国家卫生绩效对比分析[J].医学研究讯,2005,34(7)：77—78.
[30]徐勇勇,刘丹红等.国家卫生系统绩效测量与统计指标的概念框架[J].中国卫生统计,2006,23(5)：386—389.
[31]苏海军,姚岚.公共卫生服务体系绩效评价指标框架研究[J].中国卫生经济,2010,29(11)：74-75.
[32]于秀林,任雪松.多元统计分析[M].北京：中国统计出版社,1999.171184.
[33]郭玉莲.地方公共卫生支出项目绩效评价指标体系研究[D]：[硕士学位论
文].武汉：武汉理工大学,2008.
[34]韩梅.DEA方法在国外医疗卫生系统效益评价中的应用[J].中华医院管理杂志,2002.18(9)：546-548.
[35]黄良文.统计学原理[M].北京：中国统计出版社,2000.368-380.
[36]吴喜之.统计学：从数据到结论[M].北京：中国统计出版社,2006.10-28.
[37]何平,孟庆跃.卫生总费用和医疗费用影响因素研究现状[J].中国卫生事业管理,2005,9：519—520.
[38]李立秋,雷海潮.卫生筹资与卫生系统绩效之间的关系及对中国的启示研究[J].中国卫生经济,2009,28(5)：20—23.
[39]赵郁馨,陈瑛等.2004年中国卫生总费用测算结果与卫生筹资分析[J].中国卫生经济,2006,3(3)：5-9.
[40]世界卫生组织.2010年世界卫生统计.
[41]郝晓宁,薄涛等.卫生专项经费支出绩效评价研究[J].中国卫生经济,2010,29(7)：56-58.
[42]彭想.卫生监督绩效评价指标体系及信息系统的构建研究[D]：[硕士学位论文].武汉：华中科技大学,2008.
[43]翁永才’,张启华,严敏华.医院绩效评价指标体系及考核研究[J].卫生经济研究,2004(9)：44-46.
[44]陈羲.农村区域公共卫生绩效评价指标体系研究[D]：[硕士学位论文].武汉：华中科技大学,2009.
[45]中华人民共和国卫生部.2010中国卫生统计年鉴.
[46]保宏翔,徐勇勇.国家卫生系统绩效统计指标之比较[J].中国高等医学教育,2009,5：112—113.
[47]刘岳,王竞波.我国中、西部县域卫生系统绩效评价框架[J].中国卫生经济,2009,28(1)：64—66.
[48]张红兵,贾来喜,李潞.SPSS宝典[M].北京：电子工业出版社.2007.388-404.
[49]Oxman A D, Bjorndal A, Becerra-Posada F, et al. A framework for mandatory impact evaluation to ensure informed policy decisions[J]. The Lancet,2010,372(9720):42701.
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[2]任苒.卫生系统绩效评估及其思考—《2000年世界卫生报告》的启示与思索[J].医学与哲学,2001,22(40)：19-22.
[3]胡善联.评价卫生系统绩效的新框架一介绍2000年世界卫生报告[J].卫生经济研究.2000,(7)：5-7.
[4]Marc J. Roberts, Williams Hsiao, Peter Berman, et al. Getting Health Reform Right, Background Material for Flagship Course on Health Reform and Sustainable Financing, World Bank, Washington,2001.
[5]保宏翔.国家卫生系统绩效统计指标的评价与对比研究[D]：[硕士学位论文].西安：第四军医大学.2007.
[6]The Lancet. Evaluation:the top priority for global health [J]. The Lancet 2010,375(9714):526.
[7]BrundtlandGH, Frenk J, Murray CJL. WIIO assessment of health systems performance[J]. The Lancet,2003,361:2155.
[8]Rifat Atun. Advisory support to Primary Health care Evaluation Model: Estonia PHC Evaluation Project. World Heallh Organization Regional Office for Europe.2004.
[9]刘岳,张亮.卫生系统绩效评价理论框架的研究进展[J].医学与社会,2008,21(8)：29—31.
[10]王淑红,龙立荣.绩效管理综述[J].中外管理导报,2002,9：40-44.
[11]蔡志明,陈春涛,王光明.绩效、绩效评估与绩效管理—基于对建立医院绩效
评价体系有借鉴作用的述评[J].中国医院,2005,9(3)：67-72.
[12]张俊婕,赵琦,赵根明.绩效评价在公共卫生体系建设中的应用[J].中华流行病学杂志,2009,30(8)：865-866.
[13]杨芬,段纪俊.世界卫生系统绩效现状及其改进建议[J].国外医学.社会医学分册,2002,19(3)：108-113.
[14]世界卫生组织.2000年世界卫生报告[M].北京：人民卫生出版社,2000.
[15]田伟,张鹭鹭,欧崇阳等.我国公共卫生服务系统的历史沿革和存在的问题.中国全科医学[J].2006,(17)：1402-1404.
[16]Smylie J, Anderson I, Ratima M. Indigenous health performance measurement system in Canada. Australia, and New Zealand[J]. Lancet, 2006(367):2029-2032.
[17]沈林.社区公共卫生服务绩效评价研究[D]：[硕士学位论文].杭州：浙江大学,2009.
[18]江芹,胡善联.对WHO卫生系统绩效公平性评价的几点疑问[J].中国卫生事业管理,2002,3：132—134.
[19]裴丽昆.澳大利亚卫生系统绩效评价框架[J].中华医院管理杂志,2004,20(8)：510-512.
[20]傅鸿鹏.澳大利亚卫生系统绩效评价指标体系的特色及应用[J].卫生经济研究,2009,6：33—35.
[21]Institute of Medicine. Crossing the Quality Chasm. A new health system for the 21st century. Washington, DC:National Academy Press,2001.
[22]The National Health Performance Committee. National Health Performance Framework Report. Brisbane Queensland Health,2001.
[23]WHO. The World Health Report 2000. Geneva:World Health Organisation 2000.
[24]Erik Nord. Measures of goal attainment and performance in the World Health Report 2000:A brief, critical consumer guide. Health Policy, Volume 59, Issue 3, March 2002, Pages 183-191.
[25]Philip Musgrove. Judging health systems:reflections on WHO's methods. The Lancet, Volume 361, Issue 9371,24 May 2003, Pages 1817-1820
[26]Margaret Elizabeth Kruk, Lynn P. Freedman. Assessing health system performance in developing countries; A review of the literature. Health Policy, Volume 85, Issue 3, March2008, Pages 263-276.
[27]李国红,胡善联等.医院绩效评价的研究[J].中国医院,2002,6(8)：24—27.
[28]马进,孔巍,刘铭.我国卫生服务系统绩效分析[J].中国卫生经济,2003,22(12)：77—78.
[29]李秋芬.世界主要国家卫生绩效对比分析[J].医学研究讯,2005,34(7)：77—78.
[30]徐勇勇,刘丹红等.国家卫生系统绩效测量与统计指标的概念框架[J].中国卫生统计,2006,23(5)：386—389.
[31]苏海军,姚岚.公共卫生服务体系绩效评价指标框架研究[J].中国卫生经济,2010,29(11)：74-75.
[32]于秀林,任雪松.多元统计分析[M].北京：中国统计出版社,1999.171184.
[33]郭玉莲.地方公共卫生支出项目绩效评价指标体系研究[D]：[硕士学位论
文].武汉：武汉理工大学,2008.
[34]韩梅.DEA方法在国外医疗卫生系统效益评价中的应用[J].中华医院管理杂志,2002.18(9)：546-548.
[35]黄良文.统计学原理[M].北京：中国统计出版社,2000.368-380.
[36]吴喜之.统计学：从数据到结论[M].北京：中国统计出版社,2006.10-28.
[37]何平,孟庆跃.卫生总费用和医疗费用影响因素研究现状[J].中国卫生事业管理,2005,9：519—520.
[38]李立秋,雷海潮.卫生筹资与卫生系统绩效之间的关系及对中国的启示研究[J].中国卫生经济,2009,28(5)：20—23.
[39]赵郁馨,陈瑛等.2004年中国卫生总费用测算结果与卫生筹资分析[J].中国卫生经济,2006,3(3)：5-9.
[40]世界卫生组织.2010年世界卫生统计.
[41]郝晓宁,薄涛等.卫生专项经费支出绩效评价研究[J].中国卫生经济,2010,29(7)：56-58.
[42]彭想.卫生监督绩效评价指标体系及信息系统的构建研究[D]：[硕士学位论文].武汉：华中科技大学,2008.
[43]翁永才’,张启华,严敏华.医院绩效评价指标体系及考核研究[J].卫生经济研究,2004(9)：44-46.
[44]陈羲.农村区域公共卫生绩效评价指标体系研究[D]：[硕士学位论文].武汉：华中科技大学,2009.
[45]中华人民共和国卫生部.2010中国卫生统计年鉴.
[46]保宏翔,徐勇勇.国家卫生系统绩效统计指标之比较[J].中国高等医学教育,2009,5：112—113.
[47]刘岳,王竞波.我国中、西部县域卫生系统绩效评价框架[J].中国卫生经济,2009,28(1)：64—66.
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