医改后社区卫生服务面临的机遇和挑战

为了解医改对病人求医意向的影响，医改是否会提高社区卫生服务的利用率并成为社区卫生服务新的发展机遇，我们调查了四川大学华西医学中心附属第一医院的门诊病人203名，结果表明，医改后病人选择医院看病的意向发生了变化，医改前，无论是看大病，小病，患者主要选择定点医院看病，医改后对小病主要选择不看病，自己买药，自我医疗或到大医院看病药店取药（61%）；其次为在单位的职工医院看病（17%），看大病主要选择省级医院就医，表明医改后病人并未因费用负担形式的变化主动选择社区卫生服务中心就医，调查显示，社区卫生服务目前存在的主要问题是病人对其不了解，认为其技术水平低，不信任及费用问题等，针对存在的问题，文章分析了医改给社区卫生服务带来的机遇及挑战，并提出应该采取措施，抓抓住机遇，推进社区卫生服务的向前发展。

Chance and Challenges That Community Health Service Faces after the Reform of Medical Insurance System

To learn influences of the reform of medical insurance system on patient's intention of visiting doctor and whether the reform of medical insurance system improves utilization of community health service and brings new development chance for community health service, we surveyed 203 outpatients at Huaxi First Hospital, Sichuan University. The results show that the intention of visiting doctor is changing. Before the reform, patients mainly chose contract hospitals no matter of disease condition. After the reform, if the diseases are not severe, 61 percent of patients choose without any treatment, buying medicine by themselves, self-treatment or visiting doctors in general hospital but buying medicine at chemist's shop and 17 percent of patients go to worker hospitals. If the diseases are severe, they choose going to provincial level hospitals. These show patients do not actively choose community health service center for change of burden form of medical expense. Main reasons are patient knowing little about community health service, thinking community health service supplying lower medical technology, distrusting and expense. This paper analyzes chance and challenges the reform bringing to community health service and put forward some measures to push forward development of community health service.