【作者】 周航；

【导师】 佟光霁；

【作者基本信息】 东北林业大学 ， 农业经济管理， 2010， 博士

【摘要】 由于社会、经济、技术的发展,卫生保健事业已进入综合保健时代。综合保健是指从全人群多维健康切入,以人群的生命周期为服务对象,采取从健康促进、保健预防、合理正规治疗到康复的全面保健措施,组织并发动全社会支持并积极共同参与,以达到延长人群的健康寿命、提高并维护人群的良好生活质量的目标。综合保健这一目标的实现,必须要以发展社区卫生服务为基础,内容包括：基本医疗,预防保健和健康教育等。本文主要研究我国农村社区卫生服务体系和模式的相关问题。在分析目前我国农村卫生服务体系的现状及存在的问题的基础上,借鉴国外某些国家社区卫生服务体系的建设和实施方面的成功经验,对我国农村社区卫生服务功能进行定位,确定发展农村社区卫生服务的必要性和可行性,对期管理、运行、统筹、补偿等模式进行试探性的探讨,总结出一套适合农村社区卫生服务良好发展的配套政策。本文分析了我国农村社区卫生服务体系目前存在的问题,并提出了相关对策,进而提出了适合我国国情的农村社区卫生服务模式。本研究以整体分析为重点,以案例分析为补充,将案例分析与整体分析相结合。以经济发达地区和欠发达地区的农村社区卫生服务为例,对其发展的阶段性进行分析,对研究建立与城市社区卫生服务相同又有乡土特色的卫生服务模式的可行性进行验证。进入21世纪后,我国社区卫生机构基础设施状况大大改善,卫生服务人员的培训也取得了较好成效,其服务方式和服务内容方面基本实现了从传统医疗模式向社区卫生服务方式的转变,预防保健等各项服务的开展也取得了较大突破,这使得社区卫生服务机构的业务量有了显著提高,经济运营状况大大好转,并逐步进入了良性发展轨道,取得了良好的经济效益和社会效益。同时研究中发现了我国在建立农村社区卫生服务体系中的诸多不足之处,例如,科室设置方面还存在一定差距；还没有按照社区卫生服务“六位一体”的服务功能真正理顺社区卫生服务队伍,目前从事社区卫生服务工作人员的素质状况还不能真正满足社区卫生服务工作的要求；社区卫生服务中某些预防保健服务功能的开展还不是很理想；社区卫生服务机构的收入结构存在严重的不合理性,缺乏长效稳固的投入机制做保障等。在新形势下改善农村卫生服务体系,政策选择应当倾向于强化政府健康责任的体现、优化农村卫生服务体系、保障农村公共卫生产品提供等几方面,以切实维护农村居民的健康权益和卫生服务的利用。政府的协调功能、建立于不同计划之间的平衡机制、公平性在不同计划之间,在计划内外成员的医疗保障方面得到的体现和发展,就显得尤为重要。中国农村医疗服务的质量、效率和公平性在现阶段都处在一个较低水平。中国原有的农村医疗卫生制度正在逐步衰退,这其中经济体制改革对其有着重要影响,但其制度在设计方面本身也欠缺可持续性,已不能适应当今社会的需要,只能在特定的历史时期发挥作用。所以,一旦它所依赖的经济、社会等体制背景发生变化,必将暴露其在设计方面的所有缺陷。作为我国农村卫生服务体系建设的重要组成部分,新型农村合作医疗在制度设计和管理方面还存在许多问题,参保模式、筹资水平、补偿模式、支付模式都亟待改善。综上,农村社区卫生服务具有现实层面的可操作性,其成功经验值得在今后的社区卫生服务实践中运用和推广；应加大对社区卫生服务的宣传力度；应当抓紧实现乡镇卫生院从队伍和功能上真正向社区卫生服务中心转变；应当加强全科医学知识培训,提高现有社区卫生服务人员的素质,为社区卫生服务某些服务功能的开展奠定队伍基础。更多还原

【Abstract】 Because of the development of the society, economy, technology, the public health work of the hygiene has already entered comprehensive health care ear.It must develop community’s hygiene service to reach the goal of snythesizing sanitarily.community’s hygiene is served with basic medical treatment, such public health as prevention and health care and health education, etc, which are served for the main content.This text discussed the relevant problems of serving development of rural community’s hygiene of our country mainly. On the basis of analysing our country’s current rural hygiene service system current situation and question, it stated briefly the service function of the rural community’s hygiene of our country. Then, It found out some community’s hygiene experience of foreign countries where developed the community well. The article pointed out that structuring the rural community’s hygiene service network should be based on the national conditions, and suited measures to the local conditions. It analysed that develops feasibility and meaning of the rural community’s hygiene service. The paper also put forward the suggestion on the rural community’s hygiene service, such as the mode of running, managing, compensating, operating etc. Finally, it analysed the supporting policy that influences the development of the rural community’s hygiene service.The text analysed of China’s rural community health service system, the existing problems and put forward countermeasures, and then made suitable to rural community health service model. This study will focus on the overall analysis; to case analysis will be complemented by case studies combined with the overall analysis. In economically developed regions and less developed areas of rural community health services, for example, the analysis stage of its development, to study the establishment of urban community health services have the same local characteristics of the health service delivery model to verify the feasibility.Studies have shown that infrastructure construction condition improved consumedly in China from the 21st century. The training to the community health service personnel has got good effect. The service mode and content of the community health service has successfully changed. The work load of the community health service centers and stations has increased greatly. The mean income and the profit and payout balance of the community health service centers and stations has increased greatly. However, several defects are detected in the study. The installation of the division is not ideal.Not sorting out the community health service troops according to the demand of the community health service. And the capability of the community health service troops is not ideal.Some public health services have not been carried out enough. The income structure of the community health service centers and stations lack of long-term and lasting reimbursement mechanism is unreasonable.To improve rural health service system at the new situation of market economic development, the policy options should put priorities to fllowing areas:to sterngthen government responsibility for people’s health, to optimize rural health system, and to ensure the adequate public health provision, so as to protect rural people’s rights in health and health service utilization. Governmental coordination of establishing a balancing mechanism between different plans is important to enhance equity between different plans and members within and outside the mechanism. The quality,efficiency and equity of China’s rural medical service are not satisfactory. It could be attributed to insufficient input of medical resources to the rural sector, lack of medical security system in rural areas,and to the absence of government and market function on the medical service sector due to undeveloped medical management system. Although the disintegration of original rural community medical scheme was heavily influence by the economic reform, its technical design was also unsustainable, limiting its survival and development under certain historical environment. Once its dependent institutional context changed, its design defects were completely exposed, such as the participatory model, the average contribution level, the compensatory model and the payment method.From above of all, rural community health service has the feasibility of carrying out. The experience is worth applying and spreading; to spread the propaganda of community health service; expedite the transformation of health center in villages and towns to the community health service center in deed; strengthen the whole medical knowledge training to enhance the capability of the community health service troops that can lay a personnel foundation to the community health service.更多还原