Research On The Reform Of Financial Budget System Of Community Health Service Centers Based On Standardized Workload

In recent years,with the continuous implementation of a series of medical reform priorities such as "maintaining basics,strengthening grassroots,and building mechanisms",the development of community health services has been further strengthened,mainly in two aspects: first,the intensity of financial subsidies;The workload of community medical and health services has increased significantly.However,the mismatch between the original financial compensation mechanism and the actual development of community health service centers has become increasingly prominent.This is mainly due to the lack of incentives for community medical staff to provide effective community health services,resulting in inefficient use of financial funds.Does not meet the requirements of the new medical reform.For this reason,the budgetary management reforms of community health service centers have been actively explored throughout the country to alleviate the contradiction between the financial compensation mechanism and the development of community health service centers.Based on the experience of some pilot reform areas in Shanghai,this paper proposes a budget reform plan for community health service centers based on standardized workloads,and uses data from Shanghai's H district to conduct an empirical test.The following conclusions are obtained:(1)Guaranteed the relatively stable investment in the fiscal budget before and after the reform.Budget reform planIt is based on the workload budget reported by the community health service center,taking into account the government's guarantee function for basic medical and health services,and referring to the implementation of the budget of the community health service center in recent years,while fully considering the financial resources of districts and counties,and verifying community health services Total financial budget of the center.In this way,the smooth transition of fiscal budget investment funds before and after reform is guaranteed.(2)Ensure the normal operation and public welfare of the community health service center.By setting the proportion of year-end liquidation budgets,the year-end liquidation portion of each institution is not used for assessment.This approach reduces the differences between the financial budget funds of each institution before and after the reform,ensuring the normal operation of the institution and the use of public welfare.(3)Formed incentives for the staff of community health service centers.A certain percentage of the quarterly appropriation budget is used for performance evaluation.This method can effectively stimulate the enthusiasm of various agencies in the process of budget declaration and budget implementation.At the same time,after the payment of the total amount in the fourth quarter,the balance is settled as the yearend total amount,which can be used for special projects of public health services,as well as projects that exceed the standard workload and have excellent evaluation coefficients as incentives.When the actual appropriation amount resulting from the performance evaluation of the standardization workload is less than the budget appropriation amount,the reduced appropriation amount of each community health service center adjusts the financial budget in accordance with the proportion of operating expenses bearing 70% and labor costs bearing 30%.Based on the above conclusions,the following policy recommendations are proposed:(1)The development of the "Community Health Basic Services Project Dictionary" is the foundation and key.On the one hand,the dictionary table project should be comprehensive,covering all the work content currently involving the community health service center,and it must also have some forward-looking.On the other hand,the quantity of dictionary table items should be scientific and reasonable.It should reflect both the difficulty of the job and the technical content of the job.It must meet both the needs of the clients and the needs of the policy.(2)Re-evaluate the performance evaluation indicators of community health service centers.The content includes further subdividing the basic medical service items and public health service items from the two dimensions of quarterly assessment indicators and year-end total liquidation assessment indicators to form a corresponding assessment indicator system(including KPIs,weights,and budget goals,etc.).There are four levels of A,B,C,and D,and the level of A is the highest level of assessment.(3)Adjust the main body of budget preparation and division of responsibilities.Under the premise that the district health and health committee is fully responsible for the performance evaluation and financial allocation of the community health service center,the main body and duties of the budget preparation should be adjusted according to the needs of the reform.(4)Follow the principle of gradual and gradual unification.Taking into account the actual situation of different community health service centers with different foundations,different positioning,different regional population distributions,and government funding allocations over the years,in order to ensure a balanced transition,it is recommended that coefficient adjustments be made on the premise of uniform financial investment standards for the standardized workload of the units in the district.To balance the differences between different community health service centers(the coefficient of difference can be finally unified within 3 years).