【作者】 黎欣；

【导师】 黎尔平；

【作者基本信息】 汕头大学 ， 行政管理， 2011， 硕士

【摘要】 社区卫生服务在我国的产生和发展是医疗卫生体制改革不断深入的结果,是充分考虑我国医疗卫生事业的发展现状,并借鉴国外经验基础上实施的。社区卫生服务资源是卫生服务资源中重要的和基础的部分。卫生资源配置越来越成为政治与经济的焦点,关注点在于如何把资源分配到医疗与卫生领域,以及如何更有效更公平地满足群众的需要。一方面,社区卫生服务资源配置受到整个卫生服务体系资源配置的影响,而另一方面,社区卫生服务的发展正是为了促进卫生服务资源的合理配置。本文把社区卫生服务资源配置的问题放到我国卫生政策与卫生资源配置的框架下进行分析,认为社区卫生服务资源配置合理化的实现受到经济发展和政府作用的影响,而合理化的表现是满足了人群的不同层次需要。首先,本文回顾了我国社区卫生服务在政策的引导下产生的背景与过程,通过对卫生服务资源配置计划方式与市场方式的分析,得出政府主导卫生资源配置可以有效实现公平,而市场方式主导卫生资源配置可以实现效率。当前社区卫生服务资源配置的问题是总体投入不足与局部浪费并存、重规模轻质量、需求过剩与有效需求不足,这是政府失灵与市场失灵共同作用下的结果。第二,英美两国社区卫生服务资源配置的方式、结果以及改革的趋势,可以看出政府与市场在促进社区卫生服务资源配置合理化及保证群众公平获得卫生服务所起的作用。其借鉴意义在于政府在社区卫生服务资源配置中应发挥主导作用,并根据社区卫生服务的公共物品属性确立优先发展公共卫生服务及选择合适的资源配给方式。第三,社区卫生服务资源合理配置的实现受到经济发展的影响,发达城市社区卫生服务资源配置应根据其经济、社会、文化的特点来实行。通过对东莞案例,分析东莞转换社区卫生服务模式的过程,得出政府主导社区卫生服务资源配置的优缺点及其优化配置所需要的条件。最后结合发达城市社区卫生服务的特点,以公共物品供给理论为基础,从政府的职责与发挥市场的作用两个角度出发,针对当前发达城市社区卫生服务资源配置中需要解决的关键问题,提出重构的思路是在发挥政府主导作用和市场作用下,满足不同层次的需要。更多还原

【Abstract】 Considering the present situation of Health Care Industry in China, the Community Health Service, resulted from the continuous reform of Medical and Health Care System, has been implemented adopted many overseas empirical data. The resource of Community Health Service is the key and basic part of Health Service. The allocation of Health Service Resource has been a political and economic focus, pays attention to how to allocate the resources to Medical and Health fields respectively, and how to meet peoples’needs publicly and effectively. The resource allocation of Community Health Service has been effected by resource allocation of the whole Health Service System and has been promoted effectively by the development of the Community Health Service. This paper analysis the resource allocation problem of Community Health Service in frame of Health Care policy and the resource allocation of Health Care in China and present that the rational resource allocation of the Community Health Service, which performance is meeting peoples’needs in different level, is influenced by the economic development and the government intervention.Firstly, this article reviews that how does the Community Health Service arise and how is it going instructed by the related policy and shows that government-sponsored resource allocation guarantee equity while market-dominated realize efficiency after comparing the planning allocation and marketing allocation. The coexisting of overall investment insufficiency and partial wasting, focusing on large scale but ignoring the quality, demand surplus while the effective demand is insufficient, these are the problems under government malfunction combined with market malfunction at present.Secondly, after comparing the resource allocation planning, performance and the reform tendency in the UK and the USA, we can see that the government and market do work on promoting the resource rationalization of Community Health Service and realizing the Public Community Health Service fairly. The government should lead the resource allocation of Community Health Service and develop the Public Health Service in priority and adopt the optimal allocation method.Thirdly, the implementation of the rational resource allocation has been influenced by the economic development. The resource allocation of Community Health Service in developed city should adapt to its specific economics, society, and culture. Take Dong-guan for instance, we analyze the transformation of its Community Health Service and achieve that the relative merits of the government-sponsored resource allocation of Community Health Service and the conditions needed when optimizing the resource allocation.Finally, based on the Public Good’s Theory and the feature of the Community Health Service in developed city, we suggest the restructure of government-sponsored and market-dominated to solve the key problems of the resource allocation from both the government responsibility aspects and marketing oriented aspects and to meet people’s needs in different level.更多还原