郑永均

[摘要] 目的 以中山市三乡医院（以下简称“我院”）手术科室绩效分配实践为研究对象，采用实例法提出绩效分配中存在的问题，为搭建科学合理术科系统绩效分配方案提供现实依据。 方法 回顾性分析我院关节外科、脊柱外科、普通外科、泌尿外科、妇科、眼耳鼻喉科等6个手术科室2015年1月～2016年12月的绩效分配结果。以现行绩效分配方案作为模型1，以医保分值绩效分配方案建立模型2；以现行绩效结果作为因变量，业务收入、医保分值、平均住院天数、模型2结果作为自变量，采用t检验，采用Pearson相关性分析进行统计学分析。 结果 业务收入、医保分值对模型1均有显著影响（r = 0.655、0.656，P < 0.05）。 结论 以医保分值为基础加入医疗差错与事故等若干质控指标搭建绩效分配模型，能够在保证医疗质量的基础上有效回归医务人员技术价值。其具有操作简单、工作量小、耗费时间短的特点，能够以较低成本达到科学的手术绩效评价效果，具有较高的应用价值。

[关键词] 病种分值；医疗绩效；分配模型；手术科室

[中图分类号] R197.32 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0173-04

[Abstract] Objective To provide realistic basis for the establishment of a scientific and reasonable system performance allocation scheme， adapt to pose a question in the performance distribution， through the Surgery Department of Sanxiang Hospital of Zhongshan City as the object of the study. Methods A retrospective analysis was conducted on the results of the performance distribution of the six surgical departments， including Joint Surgery， Spine Surgery， General Surgery， Urology， Gynecology， and Otolaryngology， from January 2015 to December 2016. The current performance allocation scheme was as model 1， and model 2 was established based on the performance distribution scheme set up by health insurance； Current performance results were as dependent variables， income， health insurance score， average hospital stay， model 2 results as independent variables， t test was used for the analysis of metering data， Pearson correlation analysis was adopted for multifactor analysis. Results Income and disease score had significant influence on model 1 （r = 0.655， 0.656， P < 0.05）. Conclusion The performance distribution model based on the disease score combined with medical errors and other quality indicators can effectively reflect the technical value of medical personnel on the basis of guaranteeing medical quality. It is characterized by simple operation， less amount of work and short time， which can achieve scientific operation performance evaluation result with lower cost and had great application value.

[Key words] Disease score； Medical performance； Allocation model； Operation departments

目前，我國医疗机构的绩效分配大多数依旧执行20世纪 90年代的国家政策，建立了以“（收入-支出）×提取系数”为基础的绩效工资分配模型。这种绩效分配模型通过控制成本、减少损耗、增加效益、调节劳动收益等方法，曾经在医疗机构发展中发挥了积极作用。然而，从体现医务人员技术价值这个角度考虑，这种分配模型在合理性方面还有所欠缺[1]。目前普遍应用的以成本核算为导向的绩效分配模型，已不能够适应新医改形势下发展的需要。目前，大多数医疗机构普遍通过手术费、手术量以及手术等级等作为手术绩效的核算依据。绩效评价和分配体系的导向功能呈现出明显减弱的趋势，手术绩效分配的导向功能在根本上导致手术绩效的分配不适应新医改的导向需要[2-6]。……