基于标化价值模型的社区医养结合服务人力成本测算实践研究

doi:10.12114/j.issn.1007-9572.2018.00.238

摘要/Abstract

摘要： 目的　基于上海市嘉定区马陆镇社区卫生服务中心所能提供的医养结合服务，通过各种路径测算出各项医养结合服务的人力成本，为中心与居家及各类养老机构进行医养结合服务结算，以及中心内人员绩效分配提供依据。方法　于2018年1—2月，由马陆镇社区卫生服务中心医养结合服务所涉及的科室（即全科、中医、口腔、康复、护理、检验、放射和功能科）执行人代表，通过小组会议的形式，分别对各科室所提供的服务项目的人力成本的构成要素：人力消耗与耗时、技术难度和风险程度进行填写，同时由人事科对医养结合服务所涉及的医务人员2016年和2017年薪酬资料进行采集并审校，在中心项目组核心成员小组会议讨论确认不同科室间技术难度和风险程度相似或相同服务项目的基础上，引入标化价值模型，对医养结合服务的人力成本进行测算。结果　中心可提供的医养结合服务共572项，其中收费项目518项，纳入医保的项目511项。项目均可服务于各类养老场所的老年人，其中283项服务只能在中心内提供，其他289项可上门提供。经测算，人力成本最低的是挂号费服务，为2.13元；人力成本最高的为牙开窗助萌术（骨内）、阻生牙拔除术（未完全萌出）、阻生牙拔除术（骨性埋藏）、根尖切除术、胸腔闭式引流术，为506.27元；其中，可以向福利院、养老院、社区养老机构、居家的老年人上门提供的服务中，最低的为贴敷降温，为6.73元；最高的为血液疟原虫检查，为190.54元。结论　本研究测算出马陆镇社区卫生服务中心所能提供各项医养结合服务的人力成本具有一定的合理性，为中心与居家及各类养老机构进行医养结合服务结算，以及中心内人员绩效分配提供合理、可靠的依据。

关键词: 医养结合服务, 人力成本, 绩效分配, 薪酬

Abstract: Objective　To calculate the manpower cost of various medical care combined services through various paths based on the medical care service provided by Malu Town Community Health Service Center，Jiading District，Shanghai，so as to provide the basis for the settlement of medical care service in the center，home medical services and various types of nursing homes and the distribution of personnel performance in the center.Methods　The executive representatives of departments （Departments of General Medicine，Traditional Chinese Medicine，Stomatology，Rehabilitation，Nursing，Clinical Laboratory，Radiology and Function） involved in Malu Town Community Health Service Center filled forms of manpower cost of service items provided by different departments：manpower and time consumption，technical difficulty and risk level through panel discussion from January to February 2018.At the same time，remuneration data of medical personnel in 2016 and 2017 involved in medical care services were collected and reviewed by the Personnel Department.On the basis of confirmation of similar technical difficulties and risks or the same service items among different departments，the standardized value model was introduced to calculate the labor cost of integrated medical and nursing services.Results　The center can provide 572 medical care services，of which 518 items were charged and 511 items are included in the medical insurance project.All the projects can serve the elderly in all kinds of nursing homes.However，283 items can only be provided in the center，and the other 289 can be provided in door-to-door services.The item with lowest human cost was the registration fee service，which was 2.13 yuan；item of the highest human cost was dental fenestration （in bone），extraction of impacted third molar（incomplete eruption），extraction of impacted third molar （bone burial），tooth apiectomy and the closed thoracic drainage，which were 506.27 yuan.Among items which can serve at welfare homes，nursing homes，community nursing homes and elderly people at home，application of cooling had the lowest human cost （6.73 yuan），and blood malaria parasite test had the highest （190.54 yuan）．Conclusion　This study concludes that Malu Town Community Health Service Center had a rational manpower cost of various medical and health services.This provides a reliable basis for the settlement of medical and health services combined with home medical services and various centers for the elderly，as well as personnel performance distribution in the center.

Key words: Integrated health and social care, Manpower cost, Performance distribution, Payment

高波,赵珊珊,严海风,等. 基于标化价值模型的社区医养结合服务人力成本测算实践研究[J]. 中国全科医学, 2018, 21(32): 3981-3985. DOI: 10.12114/j.issn.1007-9572.2018.00.238.
GAO Bo,ZHAO Shanshan,YAN Haifeng, et al. Calculation of Manpower Cost in Community Integrated Health and Social Care Based on Standardized Value Model[J]. Chinese General Practice, 2018, 21(32): 3981-3985. DOI: 10.12114/j.issn.1007-9572.2018.00.238.

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