Evaluation Of The Effect And Impact Of The Separation Of Revenue And Expenditure And Performance Appraisal In Public Medical Institutions Of Songjiang District, Shanghai

Objective To discuss the theoretical basis for evaluation of the effect and impact of separation of revenue and expenditure and performance appraisal. Making use of this theoretical basis and considering the survey results, policy operational status at district, township and village levels would be revealed, the effect and impact of the policy would be analyzed, and the policy recommendation for further improvement would be made.Methods Quantitative survey was carried out by designed questionnaire for sample institutions and personnel, while qualitative survey was completed through individual interviews and group discussions. The data was collected from the year of 2003 to 2007. Sample institutions include district hospitals, community health centers and community health stations and village clinics. Administrative staff, medical staff and ordinary citizens are all referred in the sample personnel. According to the theoretical frame, survey results were described and analyzed to evaluate the effect and impact of policy.Results Separation of revenue and expenditure of and performance appraisal among health facilities worked well and has gained supports from the staff in medical institutions. Achievement has been made, such as the medical institutions gradually meeting commonweal, the leading role of government in compensation mechanism to medical institutions, the improvement of medical service quality and efficiency, and the positive impact on service behavior of medical staff. However, problems still existed, for example, the lack of long-term financial investment guarantee mechanism, the rapid growth of expenditure in medical institutions, the deficiency of fairness and rationality in performance appraisal system, and the differences of satisfaction between staff at all levels of medical institutions.Policy recommendation To increase the amount of investment and set up a long-term compensation mechanism; to strengthen budget management and control cost and expenses to a reasonable level; to integrate providing medical staff with reasonable wages and regulating medical service behavior, to optimize performance appraisal index system and improve it into a better-designed program; to improve the policy arrangements to balance the benefits at district and township levels.