基层卫生服务均衡供给与社群治理嵌入策略研究

Analysis on the Strategy of Balanced Supply and Imbedding Community Governance of Primary Health Services

目的:分析我国基层医疗卫生服务供给现状,提出社群治理嵌入策略。方法:采用多阶段随机分层整群抽样对6省36县区基层机构展开调查和典型案例研究。结果:基层机构公共卫生服务项目开展率显著高于医疗服务项目开展率;外科、精神卫生、安宁疗护等结构性短板和服务供给城乡、区域差异显著。单一行政机制或者市场机制降低了部分服务项目开展的可能性,社群治理机制一定程度上弥补了此局限性。结论:基层卫生服务供需结构失衡和区域差异显著;社群治理嵌入有助于促进政府、市场与社会多主体的互动协同。

Objective:To analyze the current situation of the supply of primary care services in China,and propose the embedding strategy of community governance.Methods:A multi-stage stratified random cluster sampling was used to investigate the primary care facilities in 36 counties and districts of 6 provinces and case studies were conducted.Results:The development rate of public health service in primary care facilities was significantly greater than that of medical services.There were significant structural weaknesses in surgery,mental health,hospice care,and other services;significant differences between urban and rural areas and regions were also observed.The single administrative mechanism or market mechanism reduced the provision of some service,and the community governance mechanism made up for this limitation to some extent.Conclusion:The imbalance of supply and need of primary health services and regional differences are significant.The embedding of community governance helps to promote the interaction and coordination among the government,market and society.