Robra B P, Felder S, Scholz N
Institut für Sozialmedizin und Gesundheitsökonomie, Otto-von-Guericke-Universität Magdeburg.
Gesundheitswesen. 2001 May;63(5):289-96. doi: 10.1055/s-2001-14216.
In the state of Saxony-Anhalt, a new Public Health Service law came into force in 1998. Our study investigated whether this new legislation has led to an extension of duties performed by regional health departments and to a subsequent increase in expenditure.
Guided interviews at all administrative levels of the public health system were conducted. The catalogue of duties was systematized and a questionnaire was developed and distributed to all regional health departments (response rate: 17 out of 24). Data concerning revenues and expenditures of the regional health departments were analysed on the basis of the administrative districts' budget data.
Regional health departments stated that there had been practically no change in their activities over the last few years. When questioned about the coverage of 58 specific duties, a considerable disparity was evident between departments. A core group of "classical" duties comprising environmental health and hygiene, child health protection, individual health appraisal, and public health supervision are carried out on an established basis. Some duties were handled by external institutions, others, mostly community health duties, were not performed on an extensive scale. When asked about the desired model for their health department, most departments preferred the model of being an executor of sovereign duties, however a corporate model was deemed to be almost as acceptable. The following fields will gain increasing significance in the future: environmental medicine, health reporting, preventive medicine, co-ordination of regional health care, and health promotion. Since 1995, staff has been reduced in all regional health departments (-10.4%; 1999: 2.92 employees per 10,000 inhabitants). In 1999, expenditures amounted to an average of 24.64 German Marks per capita (range 14.20-44.58 DM). The number of inhabitants and the revenue of the regional districts were determinants of their health budgets.
Our results showed that no uncompensated additional expenditure by regional authorities resulted from this law. So far, most districts have not perceived regional health as a community affair offering possible competitive advantages. The federal state lost considerable influence at the regional level. Recommended are regional health priorities, conjoint staff development, and state guidance by a head agency providing leadership and support, while leaving responsibility with the districts.
在萨克森 - 安哈尔特州，一项新的公共卫生服务法于1998年生效。我们的研究调查了这项新立法是否导致地区卫生部门的职责范围扩大以及随后支出的增加。
在公共卫生系统的所有行政层面进行了引导式访谈。职责目录被系统化，并且编制了一份问卷并分发给所有地区卫生部门（回复率：24个部门中有17个回复）。基于行政区的预算数据对地区卫生部门的收入和支出数据进行了分析。
地区卫生部门表示，在过去几年中其活动实际上没有变化。当被问及58项具体职责的覆盖情况时，各部门之间存在明显差异。一组核心的“传统”职责，包括环境卫生与卫生学、儿童健康保护、个人健康评估和公共卫生监督，在既定基础上开展。一些职责由外部机构处理，其他职责，主要是社区卫生职责，没有广泛开展。当被问及他们希望的卫生部门模式时，大多数部门倾向于作为主权职责执行者的模式，然而企业模式也被认为几乎同样可以接受。以下领域在未来将变得越来越重要：环境医学、健康报告、预防医学、地区医疗保健协调和健康促进。自1995年以来，所有地区卫生部门的工作人员都有所减少（-10.4%；1999年：每10000名居民中有2.92名员工）。1999年，支出平均每人24.64德国马克（范围为14.20 - 44.58德国马克）。居民数量和地区的收入是其卫生预算的决定因素。
我们的结果表明，这项法律没有导致地区当局产生无补偿的额外支出。到目前为止，大多数地区没有将地区卫生视为具有潜在竞争优势的社区事务。联邦州在地区层面失去了相当大的影响力。建议确定地区卫生优先事项、联合开展人员发展以及由一个提供领导和支持的总部机构进行国家指导，同时由各地区承担责任。
