发展社区卫生服务,振兴城市初级卫生保健

20世纪的50年代和60年代,中国的初级卫生保健工作处于世界领先地位。但是,自从80年代在卫生领域引入市场机制之后,中国初级卫生保健赖以生存的基础设施发生了戏剧性的变化。政府投入在卫生费用中所占的比重急速下滑,同时,卫生机构所承受的财务风险日益加大,卫生服务的重点越来越倾向于医院和技术,越来越多地依靠患者付费,就卫生服务可及性而言,公平性越来越差。在这种背景下,中国政府于1997年启动了城市社区卫生改革,试图重振初级卫生保健,扭转以医院为主导的卫生服务体系。发展以社区卫生服务中心和全科医生为特征的社区卫生服务体系成为中国城市卫生改革的政策重点之一。本文分析了中国城市社区卫生服务改革重点实现的目标,评价了该项改革所取得的成就和面临的问题与挑战。

Developing Community Health Services,Revitalizing Urban Primary Health Care

China played a leading role in primary health care in the 1950s and 1960s.However,since the introduction of a market oriented health care system in 1980s,the infrastructure on which the Chinese model of primary health care was built has been altered dramatically. Government funding as a proportion of health expenditure has decreased sharply with the health care organization carrying increasing financial risk. The Chinese health system has become more hospital and more technology oriented and increasingly reliant on out-of-pocket payment of the patients with widening inequities with respect to access to health care. This is the context in which the Chinese government initiated the urban community health reforms of 1997,aiming to reinstate a strong primary health care sector and to reverse the trend towards hospital-dominated health service delivery. The key features of the urban community health reforms have been the establishment of community health centres and the emergence of general practitioners. This paper reviews the driving factors behind the development of the urban community health services,and comments on the achievements of urban community health services and the problems and challenges with which they must deal. The paper also draws out some lessons from Chinese experiences for the international community.