广州市社区公共卫生服务成本测算与补偿机制研究
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摘要
研究目的
以广州市开展的十一项社区公共卫生服务项目为成本测算对象，通过建立社区公共卫生成本测算模型，对每项公共卫生项目的人员成本、专用设备成本、房屋建筑成本和运营成本等四大类成本进行测算，明确各服务项目成本构成，为广州市社区公共卫生服务项目的政府补偿标准和补偿方式提供依据；同时结合广州市经济发展水平、物价变动水平和居民收入增长等因素，建立广州市社区公共卫生服务成本和财政补偿预测模型，预测服务成本和财政补偿标准，为政府履行公共卫生服务职能、完善社区基本公共卫生服务补偿机制、保障社区公共卫生服务的稳定发展提供科学客观的方法与依据。
研究方法
通过文献研究与专家小组讨论，根据广州市社区卫生服务实际情况，确定成本测算指标与方法。对广州市现有的128个社区卫生服务机构状况和社区卫生服务机构提供的公共卫生服务状况进行现场调查，了解其公共卫生服务内容、服务量、资源消耗等情况。然后选择机构设置和财务独立的65个社区卫生服务中心进行成本测算，最后对调查结果进行定量分析，建立成本和财政补偿预测模型，并对今后政府的补偿标准进行建议和可行性探讨。
研究结果
1．广州市社区卫生服务基本情况截至2008年，广州市共有社区卫生服务中心128个，拥有在职职工8192人；中心固定总值平均为493.3万元，平均房屋建筑面积为2145平方米；平均总收入为1090.7万元，财政补助收入为137.8万元，占总收入的12.6％，平均总支出为1065.5万元。
2．社区公共卫生服务情况社区卫生服务机构卫生信息、健康教育、计划免疫、妇女保健和计生指导、儿童保健、传染病预防控制以及精神卫生等项目工作开展率均在90％以上，而慢性病预防控制、老年人保健、残疾康复和公共卫生事件应急处置等项工作开展率较低。
3．社区公共卫生服务项目实际成本情况2007年十一项公共卫生服务项目实际成本为每常住人口人均为37.2元，其中慢性病预防控制项目成本最高，为8.2元，其他依次为免疫规划、卫生信息管理、健康教育等项目。
4．社区公共卫生服务项目标准成本按广州市卫生行业人均工资5.7万元的水平，2007年人均标准成本为42.0元，其中人员成本占76.18％，运营成本12.61％，房屋建筑成本9.61％，专业设备成本占1.60％。
5．社区公共卫生服务项目财政补偿预测结果结合广州市经济发展水平、物价变动水平和居民收入增长等因素，通过成本预测模型分析结果显示，2008～2010年，社区公共卫生服务项目人均财政补偿标准分别为46.8元、52.2元、58.3元，其中人力成本占75％左右。
研究结论
经过近10年的努力，广州市已初步形成以社区卫生服务中心为主体的社区卫生服务体系。但仍存在业务用房紧张、基础设施缺乏、服务队伍素质不高、服务供给能力有限、公共卫生服务项目财政补偿不足等因素，阻碍社区公共卫生服务的进一步发展。本课题确定了广州市社区公共卫生服务项目成本测算方法，对2007年广州市社区公共卫生服务项目实际成本和标准成本进行了测算，建立了广州市十一项社区公共卫生服务成本和财政补偿预测模型，并对今后的社区公共卫生服务成本和财政补偿标准进行了预测，对合理确定社区公共卫生服务财政补偿标准、方式以及建立长效机制具有重要参考价值。
Objective
This research took the 11 community public health services programs in Guangzhou as costestimation targets, through cost estimation on the four major types, such as personnel cost,special equipment cost, housing construction cost, operating cost, etc. to identify serviceitems and cost composition, so as to provide a basis to government for compensationstandards and compensation styles of community public health services in Guangzhou. Atthe same time, combined with the factors such as economic development level, pricefluctuation level and resident income growth, we want to establish financial compensationforecasting model of the 11 community public health services in Guangzhou, to enable amore objective and reasonable financial compensation standard, in order to provide ascientific and effective basis to the government for fulfilling functions of public healthservices, improving basic compensation mechanism and protecting stability anddevelopment of community public health services.
Methods
Through literature research and expert panel discussions, according to the actual situation of community health services in Guangzhou, the indicators and methods of cost estimationwere determined. The existing 128 community health service agencies in Guangzhou weresuveyed to understand their financial situation, personnel structure, public health servicescontents, public health services times, fund raising, and resource consumption and so on. Atlast, 65 community health service centers with independent agency installations andindependent financial affairs were selected for cost estimation. Quantitative analysis wasperformed on the existing resources status and public health service costs, to establish costforecasting model, and explore the feasibility of future government compensation standard.
Results
1. Basic situation of community health services in Guangzhou.
By 2008, there were a total of 128 community health centers in Guangzhou, with 8192 staff,the average fixed value of which was 4.933 million yuan, with an average housing floorarea of 2145 square meters. The total revenue per center was 10.907 million yuan, and thefinancial assistance revenue was 1.378 million yuan, accounting for 12.6% of the total cost.The average total expenditure was 10.655 million yuan.
2. Community public health services.
Among the carried out projects, the rates of health education, women's health, child health,prevention and control of communicable diseases, as well as planned immunity were allabove 90%, but the rates of prevention and control of chronic disease and health care ofolder persons were at a low level.
3. Actual cost of community public health services.
In 2007, the cost per capita of the 11 public health services projects was 37.2 yuan.The project of prevention and control to chronic disease had the highest cost per capita as8.2 yuan, followed by other projects ranked as immunization program, health informationmanagement, health education, etc.
4. Standard cost of community public health services projects.
According to income per capita of health industry in Guangzhou as 57,000 yuan, standardcost per capita of community public health services in 2007 was 42.0 yuan.
5. Financial compensation predicted results of community public health services.Combined with the level of economic development, the level of price changes and incomegrowth and other factors, the cost forecasting model analysis showed that from 2008 to2010, financial compensation standards per capita of community public health services was46.8 yuan, 52.2 yuan, 58.3 yuan respectively, of which, the direct personnel cost accountedfor 75%.
Conclusions
After 10 years of efforts, the community health service system with community healthservice centers as the mainstay has been intially established, yet there are still factors suchas insufficient business space, lack of infrastructure, low service quality, limited capacity ofservice supply, and insufficient financial compensation of public health services, to impedefurther development of community public health services. This research determined thecost estimation methods of community public health services projects in Guangzhou. Itestimated actual cost and standard cost of community public health services in Guangzhouin 2007, and established financial compensation prediction model of the 11 communitypublic health services of Guangzhou City, and forecast the future compensation standardper capita of the community public health services, which plays an important role inreasonably determining the financial compensation amount of public health services andformulating price standard of community public health services.
以广州市开展的十一项社区公共卫生服务项目为成本测算对象，通过建立社区公共卫生成本测算模型，对每项公共卫生项目的人员成本、专用设备成本、房屋建筑成本和运营成本等四大类成本进行测算，明确各服务项目成本构成，为广州市社区公共卫生服务项目的政府补偿标准和补偿方式提供依据；同时结合广州市经济发展水平、物价变动水平和居民收入增长等因素，建立广州市社区公共卫生服务成本和财政补偿预测模型，预测服务成本和财政补偿标准，为政府履行公共卫生服务职能、完善社区基本公共卫生服务补偿机制、保障社区公共卫生服务的稳定发展提供科学客观的方法与依据。
研究方法
通过文献研究与专家小组讨论，根据广州市社区卫生服务实际情况，确定成本测算指标与方法。对广州市现有的128个社区卫生服务机构状况和社区卫生服务机构提供的公共卫生服务状况进行现场调查，了解其公共卫生服务内容、服务量、资源消耗等情况。然后选择机构设置和财务独立的65个社区卫生服务中心进行成本测算，最后对调查结果进行定量分析，建立成本和财政补偿预测模型，并对今后政府的补偿标准进行建议和可行性探讨。
研究结果
1．广州市社区卫生服务基本情况截至2008年，广州市共有社区卫生服务中心128个，拥有在职职工8192人；中心固定总值平均为493.3万元，平均房屋建筑面积为2145平方米；平均总收入为1090.7万元，财政补助收入为137.8万元，占总收入的12.6％，平均总支出为1065.5万元。
2．社区公共卫生服务情况社区卫生服务机构卫生信息、健康教育、计划免疫、妇女保健和计生指导、儿童保健、传染病预防控制以及精神卫生等项目工作开展率均在90％以上，而慢性病预防控制、老年人保健、残疾康复和公共卫生事件应急处置等项工作开展率较低。
3．社区公共卫生服务项目实际成本情况2007年十一项公共卫生服务项目实际成本为每常住人口人均为37.2元，其中慢性病预防控制项目成本最高，为8.2元，其他依次为免疫规划、卫生信息管理、健康教育等项目。
4．社区公共卫生服务项目标准成本按广州市卫生行业人均工资5.7万元的水平，2007年人均标准成本为42.0元，其中人员成本占76.18％，运营成本12.61％，房屋建筑成本9.61％，专业设备成本占1.60％。
5．社区公共卫生服务项目财政补偿预测结果结合广州市经济发展水平、物价变动水平和居民收入增长等因素，通过成本预测模型分析结果显示，2008～2010年，社区公共卫生服务项目人均财政补偿标准分别为46.8元、52.2元、58.3元，其中人力成本占75％左右。
研究结论
经过近10年的努力，广州市已初步形成以社区卫生服务中心为主体的社区卫生服务体系。但仍存在业务用房紧张、基础设施缺乏、服务队伍素质不高、服务供给能力有限、公共卫生服务项目财政补偿不足等因素，阻碍社区公共卫生服务的进一步发展。本课题确定了广州市社区公共卫生服务项目成本测算方法，对2007年广州市社区公共卫生服务项目实际成本和标准成本进行了测算，建立了广州市十一项社区公共卫生服务成本和财政补偿预测模型，并对今后的社区公共卫生服务成本和财政补偿标准进行了预测，对合理确定社区公共卫生服务财政补偿标准、方式以及建立长效机制具有重要参考价值。
Objective
This research took the 11 community public health services programs in Guangzhou as costestimation targets, through cost estimation on the four major types, such as personnel cost,special equipment cost, housing construction cost, operating cost, etc. to identify serviceitems and cost composition, so as to provide a basis to government for compensationstandards and compensation styles of community public health services in Guangzhou. Atthe same time, combined with the factors such as economic development level, pricefluctuation level and resident income growth, we want to establish financial compensationforecasting model of the 11 community public health services in Guangzhou, to enable amore objective and reasonable financial compensation standard, in order to provide ascientific and effective basis to the government for fulfilling functions of public healthservices, improving basic compensation mechanism and protecting stability anddevelopment of community public health services.
Methods
Through literature research and expert panel discussions, according to the actual situation of community health services in Guangzhou, the indicators and methods of cost estimationwere determined. The existing 128 community health service agencies in Guangzhou weresuveyed to understand their financial situation, personnel structure, public health servicescontents, public health services times, fund raising, and resource consumption and so on. Atlast, 65 community health service centers with independent agency installations andindependent financial affairs were selected for cost estimation. Quantitative analysis wasperformed on the existing resources status and public health service costs, to establish costforecasting model, and explore the feasibility of future government compensation standard.
Results
1. Basic situation of community health services in Guangzhou.
By 2008, there were a total of 128 community health centers in Guangzhou, with 8192 staff,the average fixed value of which was 4.933 million yuan, with an average housing floorarea of 2145 square meters. The total revenue per center was 10.907 million yuan, and thefinancial assistance revenue was 1.378 million yuan, accounting for 12.6% of the total cost.The average total expenditure was 10.655 million yuan.
2. Community public health services.
Among the carried out projects, the rates of health education, women's health, child health,prevention and control of communicable diseases, as well as planned immunity were allabove 90%, but the rates of prevention and control of chronic disease and health care ofolder persons were at a low level.
3. Actual cost of community public health services.
In 2007, the cost per capita of the 11 public health services projects was 37.2 yuan.The project of prevention and control to chronic disease had the highest cost per capita as8.2 yuan, followed by other projects ranked as immunization program, health informationmanagement, health education, etc.
4. Standard cost of community public health services projects.
According to income per capita of health industry in Guangzhou as 57,000 yuan, standardcost per capita of community public health services in 2007 was 42.0 yuan.
5. Financial compensation predicted results of community public health services.Combined with the level of economic development, the level of price changes and incomegrowth and other factors, the cost forecasting model analysis showed that from 2008 to2010, financial compensation standards per capita of community public health services was46.8 yuan, 52.2 yuan, 58.3 yuan respectively, of which, the direct personnel cost accountedfor 75%.
Conclusions
After 10 years of efforts, the community health service system with community healthservice centers as the mainstay has been intially established, yet there are still factors suchas insufficient business space, lack of infrastructure, low service quality, limited capacity ofservice supply, and insufficient financial compensation of public health services, to impedefurther development of community public health services. This research determined thecost estimation methods of community public health services projects in Guangzhou. Itestimated actual cost and standard cost of community public health services in Guangzhouin 2007, and established financial compensation prediction model of the 11 communitypublic health services of Guangzhou City, and forecast the future compensation standardper capita of the community public health services, which plays an important role inreasonably determining the financial compensation amount of public health services andformulating price standard of community public health services.
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48．徐林山，程晓明，朱坤，等．四城市社区公共卫生服务项目成本测算．中国卫生经济，2005，24(7)：37-39．
49．程晓明，于跃，盛锋，等．社区卫生服务项目成本测算方法．中国卫生经济，2004，23(10)：48-50．
50．江萍，肖峰．上海市长宁区社区公共卫生服务的补偿机制探索．中国全科医学，2008，11(13)：1216．
51．邹晓春，林衍超，邱星元，等．城市社区公共卫生服务人才发展困境与对策研究--以深圳市宝安区为例．中国初级卫生保健，2008，22(12)：29-30．
52．曲相艳，潘志峰，杨广伟．基本公共社区卫生服务项目界定原则的研究．中国卫生事业管理，2007，22(9)：569-570．
53. Moran JL, Peisach AR, Solomon PJ, et al. Cost calculation and prediction in adult intensive care: a ground-up utilization study. Anaesth Intensive Care,2004,32(6): 787-797.
54. Gulls G, Garrido-Herrero L, Katreniakova Z, et al. Public health research priorities in Europe seen by non-governmental organizations. Cent Eur J Public Health, 2008,16(4): 209-212.
55. Oida Y, Morozumi K, Nakamura N,et al. Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial. Nippon Koshu Eisei Zasshi, 2008,55(4):228-237.
56. Westin J.Patient-specific cost calculation--a good way to evaluate new therapeutic methods. Lakartidningen,2003,100(42):3304-3306.
57．王跃平，罗乐宣，周勇，等．深圳市福田区社区卫生服务成本构成分析．中国全科医学，2008，11(21)：2007-2008．
58. Peinkofer-Menath C, Hausner H, Spiessl H. The public health service in the community psychiatry association. Psychiatr Prax,2009,36(2):93-94.
59．梁鸿，郭有德，李佩珊．社区卫生服务发展评价指标体系研究．中国卫生经济，2004，23(2)：64-67．
60．何岚．发展全科医学教育为推进社区卫生服务提供人才保障．江苏卫生事业管理，2008，19(6)：40．
61．严慧杰，田晓洁，鲍勇．上海市社区公共卫生服务主要项目流程的研究．中国全科医学，2007，10(15)：1234-1236．
62．梁万年．论社区卫生服务的定位与发展．中国全科医学，2004，7(1)：4-10．
63. Moreno K, Sanchez E, Salvador-Carulla L. Methodological advances in unit cost calculation of psychiatric residential care in Spain. J Ment Health Policy Econ, 2008,11 (2): 79-88.
1．李林贵，刘春宏，韩春艳．国内外社区卫生服务评价研究进展．中国卫生经济，2008，27(12)：46-48．
2．吴仪．加强公共卫生建设，开创我国卫生事业新局面--在全国卫生工作会议上的讲话．中国卫生质量管理，2003，53(4)：5-11
3. Kalanda B, Mandala C, Maoni M. Costing of community health service packages--the Malawi Social Action Fund (MASAF) experience. Malawi Med J,2008, 20(1):7-14.
4．滕芬，尹爱田，朱荣．济南市社区卫生服务机构现状及服务提供研究．中国初级卫生保健，2009，23(2)：18-20．
5. Al-Qutob R, Nasir LS. Provider perceptions of reproductive health service quality in jordanian public community health centers. Health Care Women Int, 2008, 29(5):539-50.
6. Alford K. Reforming Victoria's primary health and community service sector: rural implications. Aust Health Rev,2000,23(3):58-67.
7. Candreva MA, Wilson RJ. Selecting a mode of practice: Public Health Service and community health centers. Optometry,2006,77(12):629-633.
8. Andrulis DP. Community, service, and policy strategies to improve health care access in the changing urban environment.Am J Public Health.,2000,90(6): 858-862.
9. Robra BP, Felder S, Scholz N. Evaluation of the public health service law of the Saxony-Anhalt region--community affairs, transfer of power and loss of control. Gesundheitswesen, 2001,63(5):289-296.
10．刘利群．社区卫生服务--公共卫生体系建设不可忽视的基础环节．中国初级卫生保健，2003，17(11)：9．
11．周亚东，黄绪凯．目前我国社区卫生服务发展的困境探析．卫生软科学，2007，21(2)：158．
12. Bronwyn Howell. Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets Australia and New Zealand Health Policy,2005,6(2):20.
13．路洁，陈伟伦．积极探索完善社区卫生服务体系．中国初级卫生保健，2005，19(1)：31-32．
14. Zhang X, Wang T. Quantitative analysis on economic contribution of community health service in Chinav. J Huazhong Univ Sci Technolog Med Sci, 2004, 24 (1):103-106.
15．范莉，冯泽永，张培林，等．三甲医院兴办社区卫生服务的思考．中国医院管理，2007，27(6)：38-40．
16．徐艳华，杜亚平．绍兴县社区卫生服务机构运营现状与成本结构分析．中国社会医学，2006，23(3)：165-168．
17．徐林山，程晓明，周召梅，等．城市社区公共卫生服务项目分类研究．中华医院管理杂志，2005，21(2)：86-88．
18．张媚，景琳，谢屏萍，等．用ABC法测算城市社区公共卫生服务项目成本的探讨．卫生经济研究，2008，5：48-50．
19．姚建红．我国社区卫生服务进展、问题和展望．中国初级卫生保健，2004，18(2)：1-2．
20. Yang J, Guo A, Wang Y, et al. Human resource staffing and service functions of community health services organizations in China. Ann Fam Meal,2008, 6(5): 421-427.
21．程晓明，陈兴宝，叶露，等．社区卫生服务成本、收费与补偿现况分析．中国全科医学，2004，7(15)：1031-1033．
22．徐林山，程晓明，朱坤，等．四城市社区公共卫生服务项目成本测算．中国卫生经济，2005，24(7)：37-39．
23．江萍，肖峰．上海市长宁区社区公共卫生服务的补偿机制探索．中国全科医学，2008，11(13)：1216．
24．李顺平．城市社区基本公共卫生服务内容及成本初探．卫生经济研究，2008，7：26-27．
25．陈艳，程晓明，许伟．沈阳市社区卫生服务成本测算研究．中国卫生经济，2003，3(3)：13-14．
26．万红．创新思路探索政府购买社区公共卫生服务运行机制．中华全科医师杂志，2007，6(12)：742-743．
27．邹晓春，林衍超，邱星元，等．城市社区公共卫生服务人才发展困境与对策研究--以深圳市宝安区为例．中国初级卫生保健，2008，22(12)：29-30．
28．戴真．立足社区完善服务让社区卫生机构成为实施公共卫生服务的摇篮．中国初级卫生保健，2009，23(2)：26．
29．江萍，肖峰．上海市长宁区社区公共卫生服务的补偿机制探索．中国全科医学，2008，11(13)：1216．
30．梁鸿，郭有德，李佩珊．社区卫生服务发展评价指标体系研究．中国卫生经济，2004，23(2)：64-67．
31．何岚．发展全科医学教育为推进社区卫生服务提供人才保障．江苏卫生事业管理，2008，19(6)：40．
32．王跃平，罗乐宣，周勇，等．深圳市福田区社区卫生服务成本构成分析．中国全科医学，2008，11(21)：2007-2008．
33．鲍勇，蔡仁华，彭慧珍，等．上海市社区卫生服务中心配置现况及区域发展研究．中华全科医学，2009，7(2)：111-112．
34. Kemp L, Comino E, Harris E, et al. A decade of change in a community health service: a shift to acute and short-term care. Aust Health Rev,2002,25(6): 148-155.
35. Wirtz A, Andres M, Gottschalk R, et al. The role of public health service in prevention and control of infectious diseases in the Federal Republic of Germany. Tasks, structures and responsibilities--an overview. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2005,48(9):971-978.
36. Mu|¨ller W. Do both the public health service and public health have a future despite developing in different directions. Bundesgesundheitsblatt Gesundheit- sforschung Gesundheitsschutz, 2005,48(10): 1145-1152.
37. Pag(?)n JA, Asch DA, Brown CJ, et al. Lack of community insurance and mammography screening rates among insured and uninsured women. J Clin Oncol, 2008,26(11): 1865-1870.
38．曲相艳，潘志峰，杨广伟．基本公共社区卫生服务项目界定原则的研究．中国卫生事业管理，2007，22(9)：569-570．
39. Salerno S, Bosco MG, Valcella F. Mental health and work environment of a group of public health preventive service users. Med Lav,2002,93(4):329-337.
40. Rittenhouse DR, Fryer GE Jr, Phillips RL Jr, et al. Impact of Title Ⅶ training programs on community health center staffing and national health service corps participation. Ann Fam Med, 2008,6(5):397-405.
41. Gafni A, Walter SD, Birch S,et al. An opportunity cost approach to sample size calculation in cost-effectiveness analysis. Health Econ,2008,17(1):99-107.
42. Ehrlich MA. Health professionals, Jewish religion and community structure in the service of the aging holocaust survivor. Arch Gerontol Geriatr,2004, 38(3):289-295.
43．程晓明，于跃，盛锋，等．社区卫生服务项目成本测算方法．中国卫生经济，2004，23(10)：48-50．
44．严慧杰，田晓洁，鲍勇．上海市社区公共卫生服务主要项目流程的研究．中国全科医学，2007，10(15)：1234-1236．
45．杨霞．广州：政府“购买服务”补助社区卫生．中国卫生，2008，3：6-7．
46．沈莉．城市社区卫生服务“收支两条线”运行模式研究．中国卫生资源．2009，12(1)：29-31，
47. Panlilio AL, Cardo DM, Grohskopf LA, et al. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep,2005, 54(RR-9): 1-17.
48．梁万年．论社区卫生服务的定位与发展．中国全科医学，2004，7(1)：4-10．
49．李顺平．城市社区基本公共卫生服务内容及成本初探．卫生经济研究，2008，7：26-27．
50. Skvirskaia GP. Public health service and occupational medicine. Med Tr Prom Ekol,2002,(11): 1-6.
51. Leidel J.The role of the German public health service in social medicine. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2005, 48(10): 1130-1137.
52. Sugawara M. Community mental health service, social work activity and clinical ethics. Seishin Shinkeigaku Zasshi,2003,105(12):1437-1443.
53. Pan X, Dib HH, Wang X,et al. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res,2006,6:93.
54. Freedman DA, Bess KD, Tucker HA, et al. Public health literacy defined. Am J Prey Med,2009,36(5):446-451.
55. Loss J, Nagel E. Problems and ethical challenges in public health communication. Gesundheitsschutz,2009,52(5):502-511.
56. Pierce SE. Public health: a fellowship in government and community service. WMJ,2005,104(1): 13.
57. Oida Y, Morozumi K, Nakamura N,et al. Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial. Nippon Koshu Eisei Zasshi, 2008,55(4):228-237.
58.Moreno K, Sanchez E, Salvador-Carulla L. Methodological advances in unit cost calculation of psychiatric residential care in Spain. J Ment Health Policy Econ,2008,11(2): 79-88.
59.Westin J.Patient-specific cost calculation--a good way to evaluate new therapeutic methods. Lakartidningen,2003,100(42):3304-3306.
60.Moran JL, Peisach AR, Solomon PJ,et al. Cost calculation and prediction in adult intensive care: a ground-up utilization study. Anaesth Intensive Care,2004,32(6): 787-797.
61.Gulis G, Garrido-Herrero L, Katreniakova Z,et al. Public health research priorities in Europe seen by non-governmental organizations. Cent Eur J Public Health, 2008,16(4): 209-212.
62.Ko GT, Tang JS. Metabolic syndrome in the Hong Kong community: the United Christian Nethersole Community Health Service primary healthcare programme 2001-2002. Singapore Med J,2007,48(12):1111 -1116.
63.Bruns-Philipps E, Pohlabeln H, Hoopmann M, et al. Public health service as cooperative partner in prevention. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2005 ,48(10): 1153-1161.
64.Pemkofer-Menath C, Hausner H, Spiessl H. The public health service in the community psychiatry association. Psychiatr Prax,2009,36(2):93-94.
65.Marwick C. US public health service needs strengthening to fight infectious disease. BMJ,2003 ,326(7391):680.
2. Kalanda B, Mandala C, Maoni M. Costing of community health service packages--the Malawi Social Action Fund (MASAF) experience. Malawi Med J,2008, 20(1):7-14.
3. Al-Qutob R, Nasir LS. Provider perceptions of reproductive health service quality in jordanian public community health centers. Health Care Women Int, 2008, 29(5):539-50.
4. Bronwyn Howell. Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets Australia and New Zealand Health Policy,2005,6(2):20.
5．滕芬，尹爱田，朱荣．济南市社区卫生服务机构现状及服务提供研究．中国初级卫生保健，2009，23(2)：18-20．
6. Candreva MA, Wilson RJ. Selecting a mode of practice: Public Health Service and community health centers. Optometry,2006,77(12):629-633.
7．周亚东，黄绪凯．目前我国社区卫生服务发展的困境探析．卫生软科学，2007，21(2)：158．
8．路洁，陈伟伦．积极探索完善社区卫生服务体系．中国初级卫生保健，2005，19(1)：31-32．
9．鲍勇，蔡仁华，彭慧珍，等．上海市社区卫生服务中心配置现况及区域发展研究．中华全科医学，2009，7(2)：111-112．
10. Zhang X, Wang T. Quantitative analysis on economic contribution of community health service in Chinav. J Huazhong Univ Sci Technolog Med Sci, 2004,24 (1):103-106.
11．范莉，冯泽永，张培林，等．三甲医院兴办社区卫生服务的思考．中国医院管理，2007，27(6)：38-40．
12．李顺平．城市社区基本公共卫生服务内容及成本初探．卫生经济研究，2008，7：26-27．
13. Andrulis DP. Community, service, and policy strategies to improve health care access in the changing urban environment.Am J Public Health.,2000,90(6): 858-862.
14. Alford K. Reforming Victoria's primary health and community service sector: rural implications. Aust Health Rev,2000,23(3):58-67.
15. Robra BP, Felder S, Scholz N. Evaluation of the public health service law of the Saxony-Anhalt region--community affairs, transfer of power and loss of control. Gesundheitswesen, 2001,63(5):289-296.
16. Kemp L, Comino E, Harris E, et al. A decade of change in a community health service: a shift to acute and short-term care. Aust Health Rev,2002,25(6): 148-155.
17. Skvirskaia GP. Public health service and occupational medicine. Med Tr Prom Ekol,2002,(11): 1-6.
18. Marwick C. US public health service needs strengthening to fight infectious disease. BMJ,2003,326(7391):680.
19. Wirtz A, Andres M, Gottschalk R, et al. The role of public health service in prevention and control of infectious diseases in the Federal Republic of Germany. Tasks, structures and responsibilities--an overview. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2005,48(9):971-978.
20．徐艳华，杜亚平．绍兴县社区卫生服务机构运营现状与成本结构分析．中国社会医学，2006，23(3)：165-168．
21．沈莉．城市社区卫生服务“收支两条线”运行模式研究．中国卫生资源．2009，12(1)：29-31．
22. Ko GT, Tang JS. Metabolic syndrome in the Hong Kong community: the United Christian Nethersole Community Health Service primary healthcare programme 2001-2002. Singapore Med J,2007,48(12): 1111 - 1116.
23. Leidel J.The role of the German public health service in social medicine. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2005, 48(10): 1130-1137.
24. Panlilio AL, Cardo DM, Grohskopf LA, et al. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep, 2005, 54(RR-9):1-17.
25. Bruns-Philipps E, Pohlabeln H, Hoopmarm M, et al. Public health service as cooperative partner in prevention. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2005,48(10): 1153-1161.
26. Walter K. Organization and role of the German public health service. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2005,48(10): 1095-1102.
27. Mu|¨ller W. Do both the public health service and public health have a future despite developing in different directions. Bundesgesundheitsblatt Gesundheit- sforschung Gesundheitsschutz, 2005,48(10): 1145-1152.
28. Kay A, Johnson. Public Finance Policy Strategies to Increase Access to Preconception Care. Matern Child Health J,2006,10(5 Suppl):S85-91.
29．徐林山，程晓明，周召梅，等．城市社区公共卫生服务项目分类研究．中华医院管理杂志，2005，21(2)：86-88．
30．戴真．立足社区完善服务让社区卫生机构成为实施公共卫生服务的摇篮．中国初级卫生保健，2009，23(2)：26．
31．张媚，景琳，谢屏萍，等．用ABC法测算城市社区公共卫生服务项目成本的探讨．卫生经济研究，2008，5：48-50．
32. Pan X, Dib HH, Wang X,et al. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res,2006,6:93.
33. Yang J, Guo A, Wang Y, et al. Human resource staffing and service functions of community health services organizations in China. Ann Fam Med,2008, 6(5): 421-427.
34. Pag(?)n JA, Asch DA, Brown CJ, et al. Lack of community insurance and mammography screening rates among insured and uninsured women. J Clin Oncol, 2008,26(11): 1865-1870.
35．姚建红．我国社区卫生服务进展、问题和展望．中国初级卫生保健，2004，18(2)：1-2．
36．万红．创新思路 探索政府购买社区公共卫生服务运行机制．中华全科医师杂志，2007，6(12)：742-743．
37. Sugawara M. Community mental health service, social work activity and clinical ethics. Seishin Shinkeigaku Zasshi,2003,105(12):1437-1443.
38. Ehrlich MA. Health professionals, Jewish religion and community structure in the service of the aging holocaust survivor. Arch Gerontol Geriatr,2004, 38(3):289-295.
39. Pierce SE. Public health: a fellowship in government and community service. WMJ,2005,104(1): 13.
40. Salerno S, Bosco MG, Valcella F. Mental health and work environment of a group of public health preventive service users. Med Lav,2002,93(4):329-337.
41. Freedman DA, Bess KD, Tucker HA, et al. Public health literacy defined. Am J Prev Med,2009,36(5) :446-451.
42. Loss J, Nagel E. Problems and ethical challenges in public health communication. Gesundheitsschutz,2009,52(5):502-511.
43. Rittenhouse DR, Fryer GE Jr, Phillips RL Jr, et al. Impact of Title Ⅶ training programs on community health center staffing and national health service corps participation. Ann Fam Med, 2008,6(5):397-405.
44．程晓明，陈兴宝，叶露，等．社区卫生服务成本、收费与补偿现况分析．中国全科医学，2004，7(15)：1031-1033．
45. Gafni A, Walter SD, Birch S,et al. An opportunity cost approach to sample size calculation in cost-effectiveness analysis. Health Econ,2008,17(1):99-107.
46．江萍，肖峰．上海市长宁区社区公共卫生服务的补偿机制探索．中国全科医学，2008，11(13)：1216．
47．杨霞．广州：政府“购买服务”补助社区卫生．中国卫生，2008，3：6-7．
48．徐林山，程晓明，朱坤，等．四城市社区公共卫生服务项目成本测算．中国卫生经济，2005，24(7)：37-39．
49．程晓明，于跃，盛锋，等．社区卫生服务项目成本测算方法．中国卫生经济，2004，23(10)：48-50．
50．江萍，肖峰．上海市长宁区社区公共卫生服务的补偿机制探索．中国全科医学，2008，11(13)：1216．
51．邹晓春，林衍超，邱星元，等．城市社区公共卫生服务人才发展困境与对策研究--以深圳市宝安区为例．中国初级卫生保健，2008，22(12)：29-30．
52．曲相艳，潘志峰，杨广伟．基本公共社区卫生服务项目界定原则的研究．中国卫生事业管理，2007，22(9)：569-570．
53. Moran JL, Peisach AR, Solomon PJ, et al. Cost calculation and prediction in adult intensive care: a ground-up utilization study. Anaesth Intensive Care,2004,32(6): 787-797.
54. Gulls G, Garrido-Herrero L, Katreniakova Z, et al. Public health research priorities in Europe seen by non-governmental organizations. Cent Eur J Public Health, 2008,16(4): 209-212.
55. Oida Y, Morozumi K, Nakamura N,et al. Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial. Nippon Koshu Eisei Zasshi, 2008,55(4):228-237.
56. Westin J.Patient-specific cost calculation--a good way to evaluate new therapeutic methods. Lakartidningen,2003,100(42):3304-3306.
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