【作者】 李向辉；

【导师】 曲江斌；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 “看病难、看病贵”是我国现阶段卫生领域存在的一个主要的社会问题。而发展城市社区卫生服务体系,是缓解“看病贵、看病难”的一项非常有效的战略性措施之一,同时也是我国深化医疗服务体制改革的“突破口”,是发展城市卫生工作的重点。为此,我国自上世纪90年代初期开始了进行社区卫生服务的尝试,1997年,党中央、国务院在《关于卫生改革与发展的决定》中明确提出发展城市社区卫生服务的指示后,国家及有关部委相继出台了一系列的政策文件,我国的城市社区卫生服务进入了一个较快的发展阶段,期间也经历了许多的挑战和困难。至今,虽已经过10余年的发展,但是总体来看,我国城市社区卫生服务仍然处在发展的初级阶段,社区卫生服务的实际运行情况与国家社区卫生服务相关政策要求还有很大的差距。在理论探讨、基本建设、政策配套、实施效果等方面都与人民群众的实际需求差距很大,存在有诸多弊端,需要努力完善。基于此,本文主要对开展社区卫生服务的相关政策进行了回顾、分析与评价。主要研究目的:本研究主要是通过对不同时期政策的回顾,分析相关政策对城市社区卫生服务发展的影响作用,通过分析评价,总结成绩和发现问题,为今后进一步完善城市社区卫生服务政策,促进城市社区卫生服务健康发展提供理论依据。主要研究目标:1、回顾我国城市社区卫生服务开展的动因,不同时期政策的核心内容与特征;2、分析在政策引导下,我国城市社区卫生服务的发展情况;3、评价不同时期政策影响下,我国城市社区卫生服务取得的成绩和问题,分析影响因素;4、为今后进一步完善我国城市社区卫生服务政策提供对策建议。主要研究方法:通过运用文献分析法,系统收集城市社区卫生服务相关研究报告、书籍、政策文件以及研究文献。运用“比较评价”与“结构—过程—结果”思路,系统分析我国不同阶段城市社区卫生服务的相关政策,从多个方面予以综合分析评价,找出存在的问题和挑战,分析影响城市社区卫生服务功能的主要因素,从而提出对策建议。主要研究结果:1、通过对文献的复习和政策的研究,回顾城市社区卫生服务的进展历史,分析了我国开展城市社区卫生服务的动因;2、通过对政策的研究,将我国城市社区卫生服务政策系统归纳为三个发展阶段,即酝酿及试点阶段(1990年—1999年)、框架建设阶段(1999年—2005年)、完善建设阶段(2006年至今),总结出不同阶段的政策特征和城市社区卫生服务的特性;3、从城市社区卫生服务的功能与定位、筹资补偿机制、人员队伍建设、与医保政策的衔接、准入管理、运行管理等方面进行综合评价,提出了我国目前存在的问题和面临的挑战以及影响功能落实的主要因素;4、通过以上几个方面的研究,进一步提出了完善我国城市社区卫生服务政策的建议。完善我国城市社区卫生服务政策的建议:1、加强领导,完善政府行为,加大政策扶持力度;2、加快政策制定和立法进度,提供有效的政策和法律保障;3、加大资金投入,完善筹资和补偿机制;4、加强规范管理,健全网络建设,强调部门协调、共同参与;5、严格社区卫生服务机构和人员的准入制度,完善评价标准;6、全面推进“社区首诊制”和“双向转诊制”;7、大力加强社区卫生服务人才队伍建设;8、加强同基本医疗保险的结合;9、加强创新研究,探索新型城市社区卫生服务模式。更多还原

【Abstract】 Research Background: To see a doctor is difficult, and to see a doctor is expensive. This is an important problem which exists in health service of our current stage. As a very efficient strategic measure of relaxing this problem, also as a breakthrough of deepening the reform of medical treatment service system, developing urban community health service is the emphasis of urban health task. Since the beginning of 90’s of last century, our country began the attempt of urban community health service. In 1997, after the direction of developing urban community health service is brought forward clearly by central government and State Council in decisions on health reform and development, a serious of policy documents are issued by our country and related departments. Urban community health service of our country entered into a rather faster developing stage which is experienced many challenges and difficulties.The orientation and significance of this study: This study oriented to unfold the review, analyzation, and estimate of the Health Service Polices of Urban Community, to provide theoretical foundation for scientific decision-making, and to develop Urban Community Health Service even better. And there are very strong real and theoretical significances in this study as well, for relaxing the public problem that to see a doctor is difficult, and to see a doctor is expensive. Through reviewing on related polices systematically, completely hackling the track of developing Health Service System and policy framework of our country’s Urban Community, and comparing with typical countries abroad, this study aims to search and analyze the existing problems in community health service of our country, to provide related measures and suggestions, to provide references for perfecting the police framework and developing strategy of China’s community health service, and to relax the important problem that to see a doctor is difficult, and to see a doctor is expensive more efficiently.Contents: Firstly, it was to review the developing history of community health service system and policy framework, and to draw a clear outline of the developing process and regulation of community health service system and policy framework. Secondly, it was to review the policy and topic for discussion of organizing structure, compensation mechanism, operation mechanism, management pattern of community health service institution, and the junction of community health service and policies of medical insurance. Thirdly, it was to summarize and conclude the existing problems, obstacles and conflicts in community health service system and policy framework. Fourthly, it was to estimate policy framework and operational effect of community health service scientifically, to set a strong foundation for completing community health service system and policy framework, and to provide related policies and suggestions. And lastly, analyzing with subjective and objective circumstances of international mature community health service, and combined with civil realization, it was to provide the developing methods and policies and suggestions of community health in different regions of our country.Research Methods: literature analytical methods was taken used into systematically collect research results, books, political documents, and research literature which related with community health service. Comparative Estimate and Structure-Process-Results was taken used into operation effect of community health service and the analyzation and estimate of related policies and topics for discussion. During the process of research, typical research and demonstration were carried out on the development direction of future community health service and policy framework, ect.Results: Firstly, motivations of unfolding urban community health service of our county, which includes changes of medical pattern and health requirement, the aging expedite and changes of disease charts of population, the illogical collocation of health resource, the over-fast rising of medical health fee, the requirement of deepen health reform, and the requirement of establish basic medical insurance for urban employee, ect, were analyzed. Secondly, the related policies of urban community health service were reviewed. Three stages were brought forward: conceive and experimental stage (1990—1999) , framework construction stage( 1999—2005), and complete construction stage(2006 to now). And the policy characteristics of every stage were analyzed systematically. Thirdly, the connotation and character of urban community health service were analyzed. Ten characters of urban community health service of our country: integrity, generality, equity, non-benefit, publiurban and welfare, elementary healthy, sustainablity, programming, linkage systematically, and expend gradually, were provided. Fourthly, the community health service system and related policies and topics for discussion of our country were estimated systematically. This estimation mainly focused on investment and effects of compensation policies of community health service, community health service and medical insurance policies, strategies of community health service team construction, the host organization structure of community health service, the management of community health service, ect. Fifthly, situations of community health service of foreign typical countries were compared with China. Referenced methods were put forward. Lastly, the existing problems and the facing challenges of urban community health service operation of our country were analyzed systematically, and main factors of influencing fulfills of urban community health service function were analyzed as well.Measures and Suggestions: Firstly, to strengthen leadership, complete government behavior, and increase policy support. Secondly, to fasten policy-establishment and lawmaking progressing, and to provide efficient policy and law protection. Thirdly, to increase capital investment, to complete the mechanism of collecting capital and compensation. Fourthly, to strengthen standard management, to complete network construction, and to emphasis cooperation and participate together among departments. Fifthly, to take strict entrance system on community health service institution and personnel, and to complete evaluate standard. Sixthly, to push fully the priority of community and the two direction transfer examination. Seventhly, to strengthen the team construction of persons with ability in community health service. Eighthly, to strengthen the combination with basic medical insurance. Lastly, to strengthen the innovative research, and to explore new patterns of urban community health service.更多还原