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卫生系统的改革依赖于包括分配机制在内的适宜的内部管理运行机制的催化。作者在分析综合性医院政策限度和技术限度基础上,构想手术科室分配机制的技术框架。引入“综合系数”、“人时”单位、“收入弹性系数”等概念,建立定量考核指标体系,确定指标的期望值以及各类手术之间的换算比例。分配机制紧紧依托卫生系统现有的宏观环境,机制的诱导趋势与卫生政策的导向一致。由于最重要的指标——期望月均手术量的核定是建立在现有人员构成基础上,故可以避免按床位定编将产生的人员分流组合所带来的振荡,为医院重新调配资源创造灵活的空间,同时可确保各科相互之间的比较具有水平公平性。
The reform of the health system depends on the catalysis of appropriate internal management operational mechanisms including the distribution mechanism. Based on the analysis of policy limits and technical limits of comprehensive hospitals, the authors conceived a technical framework for the allocation mechanism of surgical departments. The concept of “comprehensive coefficient”, “personal time” unit, and “income elasticity coefficient” were introduced to establish a quantitative assessment index system, determine the expected value of the index and the conversion ratio between various types of surgery. The distribution mechanism closely relies on the existing macro-environment of the health system, and the induced trend of the mechanism is consistent with the orientation of the health policy. Since the most important indicator, the expected monthly average surgical volume, is based on the existing personnel structure, it can avoid the oscillations caused by the personnel diversion combination that will result from the establishment of the bed, and create flexible resources for the hospital to redeploy resources. Space, at the same time, ensures that each section has horizontal fairness to one another.