Standardization-based research on fiscal compensation measurement for communities in Shanghai

Abstract

Objective To determine the standardized workload first of all. Then based on such workload, to establish the government′s resource input and allocation mechanism, and build the post setup, a fiscal compensation system, and the salary distribution mechanism of community medical staff. Methods This study selected 65 community health centers in Shanghai′s downtown area, suburban area and outer suburbs as sample units to investigate with questionnaires such indicators as community medical and health expenditure, standardized workload among others.With the measured workload as basis, item costs of health services at Shanghai′s communities were calculated. Results That of downtown, suburban and suburban areas accounted for 71.60%, 72.13% and 73.14% respectively of the total expenditure on health care.The unit cost of standardized workload varies with areas, while that in suburban and suburban areas was significantly higher than that downtown.The actual fiscal compensation was 20% lower than the target compensation as designed in the reform. Conclusions The ideal investment of basic public health services based on standardized workload can effectively realize the equalization of services among areas and promote effective allocation of resources.At the same time, estimates of the total standardized workload from the perspective of the demand side, and determination of an ideal investment ceiling for the investment of areas′ services budgets, can effectively minimize the waste of resources. Key words: Community health; Cost accounting; Standardized workload; Fiscal input; Shanghai