我国基层卫生综合改革实施效果

目的：分析我国基层卫生综合改革进展和效果，为进一步深化医改提供参考和借鉴。方法：选取北京、安徽、河南和重庆作为样本地区，共调查171家社区卫生服务中心和161家乡镇卫生院，借鉴WHO系统模块框架构建分析框架。结果：改革以后，基层卫生人员数量增加，但结构仍不合理，护士缺口依然较大，学历和职称水平较低；机构收入中政府补助占比显著增加，药占比明显下降；门诊服务数量整体呈增加趋势，住院服务有所削弱，乡镇卫生院的趋势更为明显；合理用药问题仍然突出，高血压和糖尿病有效控制率整体呈上升趋势，且处于较高水平；服务费用快速增长得到缓解；医务人员对收入满意度较低，患者对人员技术、设施设备和就医费用的满意度有较大提升空间。结论：基层卫生体系建设得到加强，但持续性的运行机制仍需进一步推进，建议完善长效稳定的基层财政卫生投入以及人才引进与培养机制，加强岗位管理与绩效考核，促进服务模式转变。

Effect on primary healthcare comprehensive reform in China

Objective： In this paper, we analyzed the progress and effect of primary heahhcare comprehensive reform in China in order to provide a reference for further reform. Methods： We used an empirical approach to study 171 community health centers and 161 township health centers in Beijing, Henan, Anhui, and Chongqing. The World Health Organization＇s Building Blocks was used to construct the analysis framework for this study. Results：Af- ter reform, the number of health personnel increased but the structure was not optimal. There were still an insufficient number of nurses ; the educational levels were still low ; the proportion of government investment increased ; and drug revenues declined. Outpatient services increased, and inpatient services decreased, the trend was more obvious for township health centers. There were also problems with the rational use of drugs. Hypertension and diabetes manage- ment significantly improved; rapidly increasing medical expenditure was slowed; and health personnel remained unsatisfied with incentives mechanisms and income. There was much room for improvement in terms of patient satisfac- tion with the technical level of health personnel, facilities, equipment, and the costs of medical service. Conclu- sions： The primary heahhcare system has been strengthened, but operational mechanisms need to be improved. We suggest perfecting stable, long-term investment and health personnel introduction and training, improving performance management and assessment, and promoting integrated health services.