User fees at a public hospital in Cambodia: effects on hospital performance and provider attitudes
User fees at a public hospital in Cambodia: effects on hospital performance and provider attitudes
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DOI：
10.1016/s0277-9536(03)00240-5
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发表时间：
2004-02-01
影响因子：
5.4
通讯作者：
Sugimoto, T
中科院分区：
文献类型：
--
作者：
Akashi, H;Yamada, T;Sugimoto, T
许多发展中国家的卫生保健机构已引入使用者付费计划。然而，也遇到了困难，尤其是在公立医院。本报告通过审查医院数据、患者和提供者调查以及提供者焦点小组讨论，描述了柬埔寨国家妇幼保健中心（NMCHC）公立医院于1997年4月引入的使用费对患者利用、收入和支出、医院服务质量、提供者态度、低收入患者和政府的影响。在引入使用费之前，来自患者的收入直接被个别工作人员作为私人收入，以补偿他们的低收入。然而，引入使用费后，收入被医院保留，用于提高医院服务质量。结果，患者对用户付费系统的满意度达到92.7%，门诊量增加了一倍。月均分娩人数从实行前的319人大幅增加到实行使用费后第三年的585人，床位使用率也从同期的50.6%上升到69.7%。随着患者利用率的提高，医院收入也随之增加。所产生的收入用于进一步加速质量改进，为员工提供额外的费用奖励以补偿他们的低政府工资，并扩大医院服务。这样，使用费收入就为国家卫生健康中心的可持续发展创造了一个良性循环。通过这个过程，使用费收入对低收入用户提供了免缴费，通过使用费捐款为政府提供了财政支持，同时减少了捐助者的财政支持。虽然在使用费实施的第三年，由于工资补偿较低，员工满意度仍保持在41.2%，但员工的工作态度从以工资为导向转变为以病人为导向，更多地关注低收入用户。 (C) 2003 Elsevier Ltd. 保留所有权利。
User-fee programs have been introduced at health care facilities in many developing countries. Difficulties have been encountered, however, especially at public hospitals. This report describes the effects of user fees introduced in April 1997 at a public hospital, the National Maternal and Child Health Center (NMCHC) of Cambodia, on patient utilization, revenue and expenditure, quality of hospital services, provider attitudes, low-income patients, and the government, by reviewing hospital data, patient and provider surveys, and provider focus group discussions.Before the introduction of user fees, the revenue from patients was taken directly by individual staff as their private income to compensate their low income. After the introduction of user fees, however, revenue was retained by the hospital, and used to improve the quality of hospital services. Consequently, the patient satisfaction rate for the user-fee system showed 92.7%, and the number of outpatients doubled. The average monthly number of delivery of babies increased significantly from 319 before introduction of the system to 585 in the third year after the user-fee introduction, and the bed occupancy rate also increased from 50.6% to 69.7% during the same period. As patient utilization increased, hospital revenue increased. The generated revenue was used to accelerate quality improvement further, to provide staff with additional fee incentives that compensated their low government salaries, and to expand hospital services. Thus, the revenue obtained user fees created a benign cycle for sustainability at NMCHC.Through this process, the user-fee revenue offered payment exemption to low-income users, supported the government financially through user-fee contributions, and reduced financial support from donors.Although the staff satisfaction rate remained at 41.2% due to low salary compensation in the third year of user-fee implementation, staff's work attitude shifted from salary-oriented to patient-oriented-with more attention to low-income users. (C) 2003 Elsevier Ltd. All rights reserved.