中国全科医学Issue(32)：4004-4010,7.DOI:10.3969/j.issn.1007-9572.2015.32.027
海口市社区卫生服务体系发展状况调查及优势、潜力和困境探讨
Development Status,Advantages,Potential and Predicaments of Haikou Community Health Service System
摘要
Abstract
Objective To investigate the development status,advantages,potential and predicaments of Haikou community health service( CHS)system. Methods We enrolled all CHS centers and CHS stations in the four districts of Haikou,We investigated the general scale,health human resources,financial revenue and expenditure and the delivery of health services from 2007 to 2010 of the CHS settings in Haikou using the Conventional Monitoring Questionnaire for CHS stations and the Conventional Monitoring Questionnaire for CHS Centers issued by the Women and Social Division of the Ministry of Health. We selected prescriptions from some CHS settings in Haikou,and used the CHS Conventional Monitoring Questionnaire of Reasonable Drug Administration and Prescription Expense to investigate the number of medications,the use of antibiotics and hormone and expenses from 2008 to 2010 of the selected CHS settings. We also enrolled community residents from some of the CHS settings and investigated their awareness,utilization and satisfaction degree about CHS from 2009 to 2010. Results In 2010,11 CHS centers were established and put into operation,accounting for 55. 0% of the planned amount,and 74 CHS stations were established,reaching the planned amount. By the end of 2010,the average fixed asset of the CHS centers in Haikou was 300 510 000 yuan,and that of the CHS stations was 446 600 yuan. By the end of 2010,the number of health workers,clinicians and nurses were 1 180,403 and 548,with a doctor - to - nurse ratio of 1∶ 1. 36. The CHS stations and centers first achieved approximate balance between revenue and expenditure and made profit slightly;in the aspect of revenue, operating revenue was the major resource of the revenue of CHS settings,accounting for 70% of the total revenue;in the aspect of expenditure,operating expenditure and manpower expenditure were the major part of the expenditure of the CHS settings;the medicine expenditure took up more than 60% of the operating expenditure of the CHS centers,and that proportion for the CHS stations was 78% ;in the aspect of manpower expense,the wages of staff took up the majority. In 2010,the total number of outpatients was 1 633 913 in the CHS settings in Haikou,accounting for 26. 6% of the total number of outpatients in all medical settings in Haikou which was 6 151 781;the number of outpatients in CHS settings was 36 041 in 2007,and that was 257 282 in 2010,7. 1 times that of 2007;the two - way referral system showed an nonequivalent state in which upward referrals were more than downward referrals. From 2008 to 2010,antibiotics were used in 2 / 3 of the prescriptions,and the number of prescriptions that included duplex antibiotics and hormone took up more than 20% . In 2010,35 634 hypertensive patients and 10 550 diabetic patients were registered and treated in the CHS settings in Haikou. The selected community residents held the highest satisfaction rate toward the service attitude of medical staff of the CHS setting,and the items with the secondary and third highest satisfaction rates were waiting time and the interpretation and communication of medical staff,and the lowest item was the facility and equipment of the CHS settings. Conclusion The CHS system of Haikou with social forces as the main body has several advantages including the wide range of financing,flexible operation and the realization of regional accessibility of medical services by setting layout in a short period of time. Its primary potential is that the cost control is relatively easier,which provides space for the down regulation of medicine price;what's more,the relevant documents of hypertension,diabetes mellitus and other chronic disease management filed by CHS settings lay a foundation for the prevention and treatment of cardiovascular and cerebrovascular diseases. The predicaments facing CHS settings are mainly the difficulty to get technological support from general hospitals and the query of its public welfare due to its private ownership.关键词
社区卫生服务/社会力量/海口市Key words
Community health services/Social forces/Haikou分类
医药卫生引用本文复制引用
陈淑芬,魏桃枝,饶利亚,王小虹,郑金丹,张卫,张云波,姚伟,严瑜..海口市社区卫生服务体系发展状况调查及优势、潜力和困境探讨[J].中国全科医学,2015,(32):4004-4010,7.基金项目
卫生部项目（卫妇社社卫便函［2008］126号［2010］11号）---社区卫生服务体系建设重点联系城市常规监测；海南省卫生厅项目（琼卫科教［2006］16号）---全科医学培训需求调查 （）
