Calculation Strategy and Empirical Study on Labor Cost for Delivering Community-based Integrated Pension Service and Medical Service

doi:10.12114/j.issn.1007-9572.2019.00.205

Abstract

Abstract: Background　China's aging population becomes a very challenging problem.One major way for addressing this problem is to construct elderly care institutions delivering integrated pension service and medical service care with both medical and elderly care resources.Clarifying the labor cost for delivering integrated pension service and medical service can determine the division of labor between medical and elderly care institutions，and can provide evidence for the development of subsidy mechanism for institutions offering such services.Objective　To measure the labor cost for delivering integrated pension service and medical service in Nanxiang Community Health Center，providing a basis for calculating labor cost in offering such care in other institutions and for developing subsidy mechanism for the delivery team for incentivizing them，as well as for constructing the codelivery patterns between community health centers and community elderly care institutions.Methods　From July 2016 to January 2017，the self-made Collection Table of Integrated Pension Service and Medical Service in Community was used to collect the integrated pension service and medical service provided by Nanxiang Community Health Center.From July 2017 to January 2018，two rounds of Delphi expert consultation were adopted.We calculated the standardized value of each integrated pension service and medical service programe implemented by Nanxiang Community Health Center，and measured the labor cost during the procedure，based on basic labor cost and time consumption，difficulties and risks in implementing per program，and individual salary parameters（level of hospital，technical type，professional and technical title and so on）with reference to the National Medical Service Price Project Specification（2012 edition）．Results　The center can provide a total of 75 integrated pension service and medical service programes，some of which can be delivered independently，but to deliver the rest services，the center needs help from other institutions.Regardless of the cost of outsourcing，the average labor cost for delivering each integrated pension service and medical service is（77.41±58.50）yuan（range，8.52-283.69 yuan）．The labor cost for delivering rapid blood sugar test is lowest，while that for delivering an emergency ward round with great difficulties and risks is highest（8.52 yuan vs 283.69 yuan）．Conclusion　We developed a set of methods for calculating the labor cost of the community health center in implementing the standardized workload，which were tested to be effective in calculating the labor cost of each of the 75 integrated pension service and medical service programes delivered by Nanxiang Community Health Center.The methods can be used as an assistant tool to manage the budget and expenditure for delivering community-based integrated pension service and medical service，and to develop a subsidy mechanism for offering such services.

Key words: Community health services, Health manpower, Integrated pension service and medical service, Standardized workload, Empirical research

摘要： 背景　当前中国的老龄化形势十分严峻，应对老龄化的主要途径就是构建医养结合的养老机构，将养老服务和医疗资源有效地结合起来，让老年人得到综合医疗保健和养老照顾。通过明确医养结合各项服务的人力成本，以确定医疗机构与养老机构的分工，进一步为补偿机制的构建提供依据。目的　测算南翔社区卫生服务中心各项医养结合服务的人力成本，并以此为基础进行医养结合服务的成本测算与补偿机制确定，从而提高医养结合服务团队医护人员的工作积极性，建立社区卫生服务中心与社区养老机构合作模式。方法　2016年7月—2017年1月，采用自制的《社区医养结合服务项目采集表》采集南翔镇社区卫生服务中心能够提供的医养结合服务项目。2017年7月—2018年1月，采用两轮德尔菲法专家咨询，基于《全国医疗服务价格项目规范工作手册（2012年版）》，以基本人力消耗和耗时、技术难度及风险程度为主要因素，结合各项薪酬参数（区分医院级别、技术类别、职称等），计算出医养结合项目技术劳务标化价值和各个项目所需的人力成本。结果　社区目前开展的服务可分为两大类，即社区卫生服务中心能够提供的服务和在外部资源辅助下能够提供的服务，共计75项。不考虑外包成本，各项人力成本为8.52~283.69元，平均人力成本为（77.41±58.50）元。人力成本最低的为快速血糖测试，为8.52元；人力成本最高的为突发情况临时查房（重度），为283.69元。结论　本研究构建了一套基于标化工作量的社区卫生服务中心人力成本测算方法，测算了南翔镇社区卫生服务中心75项医养结合服务项目的人力成本，可用于指导社区的医养结合服务的预算支出管理，同时为确立补偿机制提供依据。

关键词: 社区卫生服务, 卫生人力, 医养结合, 标化工作量, 实证研究

CHEN Hongzhu,QIU Yanqing,WANG Kang, et al. Calculation Strategy and Empirical Study on Labor Cost for Delivering Community-based Integrated Pension Service and Medical Service　[J]. Chinese General Practice, 2019, 22(16): 1915-1921. DOI: 10.12114/j.issn.1007-9572.2019.00.205.
陈洪珠,仇燕青,王康等. 社区卫生服务中心医养结合服务人力成本测算策略与实证研究[J]. 中国全科医学, 2019, 22(16): 1915-1921. DOI: 10.12114/j.issn.1007-9572.2019.00.205.

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