基于机制设计理论的基本公共卫生服务均等化策略研究

Remarkable achievements have been seen in the equalization of basic public health services since the project was carried out. However, such new problems as unclear awareness, unspecified functions, weak co-ordination, have emerged in the course of further promoting the project, which led to a considerable gap in the availability and level of basic public health services among different regions and people. Therefore, it is of great significance to identify the main factors influencing the equalization of basic public health services so as to explore new strategies to enhance the further implementation of the project. The Mechanism Design Theory has shed light on the solution to the problems and the exploration of new strategies.. This study is designed to investigate the current situation of the implementation of basic public health services and figure out the key issues and influencing factors in the process of equalization by applying Macro Health Delivery System Model and Analytic Hierarchy. Based on Incentive Compatibility, Revelation Principle and Implementation Theory, three important parts of Mechanism Design Theory, we work to set objectives of equal basic public health services and analyze a series of implementation mechanisms, including access mechanism, input mechanism, cross cooperation mechanism, running mechanism, supervision and management mechanism, and design the optimal mechanism to achieve the equalization. This study is supposed to offer references for the relevant government sectors in achieving the equalization of basic public health services.

基本公共卫生服务项目推进成效显著，但其深入开展逐渐暴露出认识不清、职能不明、协调乏力等问题，导致不同地区和人群服务水平和可及性存在较大差异。明确影响基本公共卫生服务均等化的主要因素，探索新的推动策略具有非常重要的意义。而机制设计理论为解决问题、探索策略提供了新思路。. 本研究拟对我国基本公共卫生服务均等化实施现状进行调查，运用卫生系统宏观模型和层次分析法确认均等化过程中的关键问题及影响因素；借鉴机制设计理论中的激励相容、显示原理和实施理论，研究确定基本公共卫生服务均等化社会目标，分析实现均等化的准入机制、投入机制、交叉合作机制、运行机制、监督管理机制，设计实现均等化的最优机制，为全面实现基本公共卫生服务均等化提供参考。

项目背景：基本公共卫生服务均等化政策是实施健康中国战略的重要抓手。基本公共卫生服务项目实施10年成效显著，但也暴露诸多问题。如何使基本公共卫生服务均等化政策能够持续深入的推进是当前研究亟需解决的问题。. 研究内容：基本公共卫生服务均等化实施现状；工作人员职业倦怠、满意度、离职意愿影响因素；慢性病患者随访服务利用和满意度影响因素；老年人体检服务利用和满意度影响因素；不同人群健康信念指数得分分析；基本公共卫生服务均等化实施存在的问题；促进基本公共卫生服务均等化的策略。. 重要结果：1.东、中、西部地区间每万人口全科医生、每万农业人口乡镇卫生院人员、乡村医生和卫生员、村卫生室人员、人均补助标准、预防接种建证率、糖尿病患者血糖控制率有差异；24.7%居民了解基本公共卫生服务项目，预防接种和高血压患者健康管理知晓率为67.9%、49.1%，其它项目低于40%，居民对基层卫生机构环境/设备/服务流程/服务态度/技术水平满意的比例为60.6%-82.6%。2.公卫工作压力、与居民关系、公卫工作意愿及地区是工作人员职业倦怠、满意度及离职意愿的影响因素。3.有效性认知、地区是慢性病患者随访服务利用及满意度的影响因素。4.障碍性认知、收益性认知及地区是老年人体检服务利用及满意度的影响因素。5.健康信念5个维度指数得分，慢性病患者在0.42-0.84之间，老年人在0.37-0.82之间（满分为1分）。6.基本公共卫生服务均等化实施存在的问题，准入机制未建立、投入机制不到位、交叉合作机制不顺畅、运行机制不健全及监督管理机制不完善。7.促进基本公共卫生服务均等化的策略，建立准入机制，规范投入机制，畅通交叉合作机制，健全运行机制和完善监督管理机制。. 科学意义：研究对于提高基本公卫服务人才队伍稳定性，保证服务质量，改善居民健康信念认知并选择有利于健康的生活行为方式，积极寻求、利用基本公卫服务，进而提高服务利用率、满意度以及促进基本公共卫生服务均等化目标实现有重要意义。