重庆市人口老龄化对社区卫生服务体系的需求研究
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摘要
人口老龄化是社会文明、国家工业化、国家现代化的重要标志,也是社会进步、人民健康水平、生活水平提高的表现；随年龄增长、健康状况逐渐下降、卫生服务需求逐渐增多是公认的普遍规律,加上“健康老年”的需要,努力解决好老年人的医疗卫生、经济供养、生活照料、精神慰籍等问题也是我们必须解决的重要问题。
目的：
社区卫生服务是实现人人享有初级卫生保健目标的基础环节,是落实科学发展观、坚持以人为本、促进社会公平、维护社会稳定、构建社会主义和谐社会的重要内容。社区卫生服务的重要服务对象是老年人,人口老龄化给社区卫生服务带来很大影响。伴随中国的不断强大,社区卫生服务必将形成健全的体系,政府也将作为老年人口的社区卫生服务主导力量,在制度、机制、体制上为老年人享受方便、经济、有效的卫生服务提供坚强保障,让每一个中国老年人病有所医。
本研究希望能为重庆市构建老年人口社区卫生服务体系提出思路,促进重庆经济发展,为重庆市实现社会和谐作出贡献。
方法：
本研究是重庆市科委软科学课题《重庆市人口老龄化对社区卫生服务体系的需求研究》、重庆市教委课题《重庆市社区卫生服务体系与社区建设同步发展的机制研究》的核心,本研究还是重庆市发改委课题《重庆市公立医院改革试点研究》的一部分。研究方法主要包括文献研究、现场调查、规范分析、访谈法等。
结果：
本课题理论研究部分从管理学、社会学、人口学、经济学等不同学科出发,将制度和文化作为本研究的理论基础,以新公共服务理论(只有以人为本,充分重视民生,政府的管理才能取得成效；政府的职责就是最大限度地满足公民的一切合理需求；凸显政府的服务意识、强化政府的服务职能；强调公共管理的权力和合法性来源于公众,公众的满意度是评判政府公共管理活动的最终标准)、底线公平理论(对于老年人口而言,依靠基本生活保障加上医疗卫生保险,就可以获得最基本的社会保护,这是政府的责任；底线公平回答了民生建设的原则要求：确保民众享有与经济社会发展水平相适应的民生建设成果,是政府应当承担的首要责任,也是政府必须坚守的责任底线)、中国的孝文化(树立关心老人、关注老龄、关怀老人,有利于应对老龄化带来的挑战；提倡孝道、孝文化,是实现社会和谐稳定的最佳途径之一；弘扬中国传统孝文化对于缓解我国人口老龄化问题,促进和谐社会建设有着重要的现实意义)、民生理论(加快推进以改善民生为重点的社会建设,是党的十七大提出的重大战略任务；改善民生提高社会福利,让所有的老人都能得到物质上的照料和精神上的尊重是建立中国和谐社会的重要内容)、社区建设理论(社区建设和社区发展过程是社会各个部门合作、协商、融合的过程,也是共同精神和共同价值的培养过程,是社会融合的过程；社区建设是解决社会问题的手段和推动社会发展的重要的内容)作为重庆市人口老龄化对社区卫生服务体系的需求研究的基础理论,很好地从民生角度阐述人口老龄化对社区卫生服务的需求。
课题实证研究部分,研究共抽取了重庆市1102名老年人,社会人口学特征：男女性别比为为1：0.78；平均年龄66.4岁；大部分老年人月收入在1000-5000之间；老年人总体文化程度水平低；基本医疗保险覆盖率高达92.82%。慢性病患病情况：慢性病患病率63.4%；慢病顺位前五位是：高血压、糖尿、冠心病、关节炎、慢性支气管炎；老年人慢性病危险因素logistic回归分析发现,年龄、婚姻、文化程度、居住状态、饮酒与老年人口患慢性病相关。择医行为：老年人最满意的医疗卫生服务机构是社区卫生服务站,患病后56.77%首选社区卫生服务机构；82.28%的老年人有患病未就诊的情况,患病而未就诊危险因素逐步logistic回归分析结果显示性别、工作情况、收入、医疗保障、吸烟、社会活动及自我保健方式对患病后是否就诊有影响。社区卫生服务知晓情况：在被调查的1102名老年人中,全部都知道自己家附近有社区卫生服务机构,知晓率100%；社区卫生服务机构提供的服务中,老年人最熟悉上门出诊(63.91%),最不了解慢性病管理(8.28%)；重庆市81.07%老年人对政府社区卫生服务政策不了解。社区卫生服务利用情况：过去一年中老年人最常去的是社区卫生服务站(46.35%)；45.05%老年人一年体检一次,29.3%的老年人从不体检；老人接受的社区预防保健服务主要是量血压。对社区卫生服务评价：大部分被调查者对社区卫生服务机构满意,社区卫生服务机构设施、环境差最容易使老年人产生不满意。社区卫生服务需求：重庆市老年人口希望社区卫生服务机构提供的服务主要是提供固定的全科医生、上门出诊、建立家庭病床等；绝大多数受访老人认为老年人口社区服务应当由政府负担费用。重庆市社区卫生服务机构对老年人口服务提供的现状：重庆市大多数社区卫生服务中心均提供双向转诊(94.24%)、法定节假日接诊(92.91%)等服务,而临终关怀(17.99%)、家庭病床(32.86%)、家庭康复(32.86%)等老年人喜闻乐见的服务提供者很少；社区卫生服务提供的服务内容与医院非常雷同。
重庆市老年人口获取社区卫生服务的主要障碍是：被医疗保障制度所排斥、卫生资源对老年人口不公平的分配、老年人口社区卫生服务的高需求与低利用。在分析障碍的基础上,提出了重庆市老年人口社区卫生服务体系框架的构想：明确政府职责(政府主导、多部门联合参与、完善投资机制)；建设重庆市老年人口社区卫生服务体系(建立以社区为中心的老年服务体系,加快社区老年服务建设；建立健全重庆市老年人口社区卫生服务网络；强化老年人口社区卫生的全科医疗服务；建立老年人口社区卫生服务机构与医院、预防保健机构的分工合作机制,逐步建立双向转诊制度；培养老年人口社区卫生服务的队伍)。本研究探讨了重庆市老年人口医疗保障制度改革取向,本研究还提出建立和完善老年人口社区卫生服务的政策体系：制定社区老年卫生服务规划、加大社区老年卫生服务建设投入、老年人口社区卫生服务发展的动力是体制和机制创新(培育社会力量参与社区卫生服务、在社区率先推行基本药物制度等改革措施、推行“公共卫生服务包”制度、开展“创富老年”行动、增加社会保障支出预算、大力发展老龄产业)、老年人口社区卫生服务的基础是卫生服务队伍建设。
结论：
1.理论研究
每个社会的政治制度、文化形态决定了政府的管理体系,以及与政府管理体系相适应的社会分工基本组织结构形式,塑造了在特定管理环境下的管理者和被管理者的思想及行为方式。
本研究提出从制度与文化角度来审视和构建老年人口的社区卫生服务体系。
2.实证研究
①老年人口是重庆市社区卫生服务机构的服务重点。
②需要应进一步提升老年人口对社区卫生服务利用率,老年人口对社区卫生服务功能认识不足。
③老年人口社区卫生需求项目和实际利用项目存在较大差异。
④老年人口对重庆市社区卫生服务机构较为满意,不满意之处主要是设备、环境及技术水平。
⑤供需双方需进一步提高对社区卫生服务的认识程度,政府应加强对社区卫生机构的政策指导,加大资金投入力度,把老年人口的预防、保健真正提到议事日程。
3.构建重庆市老年人口社区卫生服务体系
在理论研究与实证研究的基础上,通过对老年人口获取基本卫生服务的主要障碍进行分析,研究提出构建重庆市老年人口社区卫生服务体系框架。明确提出完善老年健康服务的社会保障机制；构建完善的老年人口卫生服务体系；加大对老年卫生服务体系的公共财政投入；加强社区卫生服务体系的老年卫生人才队伍建设；实施与社区建设同步发展的重庆市社区卫生服务体系运行、管理机制等政策建议。
本研究的创新之处
1.本研究提出从制度与文化角度来审视和构建老年人口的社区卫生服务体系。
2.本研究提出社区建设与社区卫生服务同步发展的理念。
The aging of population is an important mark of social civilization, national industrialization and modernization, and also a manifestation of social progress, and improvement of people's health and living standards. As the universal rule, the demand for medical care service increases with the rise in age and fall in health. To guarantee "a healthy old age", we must make great efforts to deal with the challenging issues such as medical care service, economic support, life care, and spiritual consolation.
Objectives:
The community health service is the basic link of primary health care for every person which is the significant implementation of the concept of social development in a scientific, humane, righteous, stable and harmonious way. The target of community health service is the aged people, so population aging affects the community health service substantially. As China grows stronger, the community health service system will be accomplished, and government will play a leading role for the establishment of a system with proper rules and mechanism to guarantee an effective, economic, and convenient medical care service for every single aged person in China.
This research is aimed to provide ideas to build a blueprint of the community health service for the aged people in Chongqing so as to promote the local economic development for the contribution to a harmonious society.
Methods:
This research is the core of the soft science project of Chongqing Science and Technology Commission's "A research of the Demand for the Community Health Service System by the Aging of Population in Chongqing" and the core of the project of Chongqing education commission "A Research of the Mechanism in the Synchronized Development of Both Community Construction and Community Health Service System in Chongqing City". It is also one part of the Chongqing Development and Reform Commission's project "A research of the Experimental Reform of public Hospitals in Chongqing City". The research methods mainly include literature review, field investigation, normative analysis and interview.
Result:
The theoretical part of this research explores from diverse subjects such as management, sociology, demography, and economics. This research is theoretically based on the system and culture, and takes the new public service theory (the government management can get effect only if we stress the people-oriented theory and people's livelihood; the responsibility of government meeting reasonable demand of citizens to the utmost extent; to stress the service awareness of government, to strengthen the service functions of government; to emphasize the power and legality of public administration is derived from public, public satisfaction is the final standard of judgment for public administration), the bottom-line equity theory(the aged people can get the most basic social protection by means of basic living allowance and health insurance which are the responsibilities of government. The bottom-line equity is a response to the principled request of livelihood construction, and ensures that the public get the profit of livelihood construction which is consistent with the development of economic and society. That's the Primary responsibility of government, and the bottom-line of government's responsibilities.), the filial piety of Chinese traditional culture (the caring and concern of aged people is helpful to overcome the challenge of aging population. Advocacy of filial duty and filial piety is one of the best ways to harmonious society. Carrying forward the filial piety of Chinese traditional culture can help us to face the challenge of the aging of population in our country and promote the construction of a harmonious society.), the people's livelihood theory (speeding up socialist construction with the improvement of people's livelihood as its focus is a major strategic task brought forward from the seventeenth national congress of the Communist Party of China. Improvement of people's livelihood and social welfare, and all aged people getting physical care and respect are the important content of a harmonious society in China.) and the community development theory (The construction and development of community is a process of cooperation, negotiation and amalgamation of all social departments. The construction of community is a method of solving social problems, and it is an important element of promoting social development.) as theoretical basis for the research, this paper expatiates the demand for community health service system by the aging of population in Chongqing from the perspective of livelihood.
In the empirical research,1102 aged people in Chongqing were sampled. The sex ratio of the sample is 1 male:0.78 female, and the average age is 66.4 years. Most of the aged people have a monthly income of 1000-5000 yuan. The educational level of the aged people was generally low.92.82% of participants had basic medical insurance. The Situation of Suffering from Chronic Diseases:the prevalence rate was 63.4%, and the top five chronics were:hypertension, diabetes, coronary heart disease, arthritis and chronic bronchitis. The logistic regression analysis of risk factors of chronic diseases of aged people showed that the prevalence of chronic diseases was related to age, marital status, educational level, housing status and alcohol. The Selection of Medical Care Service:the most satisfactory health care institution was community health service station.56.77% of patients preferred community health service because the community health service was close to their home, the cost was lower than hospital, and the service is good.82.28% of the aged people avoided seeing a doctor when they were ill. The logistic regression analysis of risk factors of avoiding seeing a doctor showed that they were related to gender, job, income, medical assurance, smoking, social activity and individual health care method. The awareness of community health service:All of the 1102 aged people were aware of the community health service centers near their home. Visiting a patient at home was the most familiar community health service (63.91% of aged people were aware of visiting a patient at home). Chronic disease management was the most unfamiliar community health service (only 8.28% of aged people were aware of chronic disease management).81.07% of aged people in Chongqing were not familiar with the policy of community health services. The utilization of community health services:the number one medical institution used by the aged people last year was the community health service station (46.35).45.05% of aged people had physical examination once a year.29.3% of aged people never had a physical examination. The community preventive health care services received by the aged people were mainly blood pressure tests. The appraisal of community health service:most of the aged people were satisfactory with the community health service institution. The defect of facility and the dirty environment of community health service institution most likely made the aged people unsatisfied. The demand of community health service:Some of the aged people in Chongqing wanted the community health service institution provide aptotic general practitioner, some of them wanted the community health service institution visit a patient at home, some of them wanted the community health service institution to establish family sickbed. Most of the aged people thought that the cost of community services of aged people should be paid by the government. The current situation of community health service for the aged people in Chongqing:Most of the community health service centers (94.24%) provided the services of two-way transfer of patients and treated patients in statutory holidays. But few of the community health service centers provided the services demanded by the aged people such as terminal care (17.99%), home-ward (32.86%) and home rehabilitation care (32.86%). The services provided by community health service centers were similar to those by hospitals.
The major obstacles for the aged people to obtain community health service:Aged people are excluded by medical insurance system. the distribution of health resources to aged people is unfair. The demand of community health services for aged people is high, and the utilization is low. Ideas of the framework of community health services for aged people in Chongqing are proposed based on the analysis of the obstacles. The responsibility of government must be clarified (Government should be the leader of community health services. Diverse departments should take part in the community health services system. The investment mechanism should be improved.) The community health service system for aged people in Chongqing should be built. (The service system centered on community for aged people should be built to accelerate the construction of community services for aged people. the network of community health service for aged people should be built and improved. The general medical services for aged people in community health service should be strengthened. The mechanism of cooperation and division of health care between community health service centers and hospitals or disease prevention institutions should be built. The two-way transfer system should be established progressively. Community health service medical workers for aged people should be trained.) This research explored the reform orientation of medical security system for aged people in Chongqing. This research also proposes the policy system to establish and improve community health service for aged people and plans the community health service for aged people to increase investment in construction of community health service for aged people. The propulsion of development of community health service for aged people is innovation of system and mechanism. (Social sectors should be mobilized to take part in community health service. Community should take the lead in implementing reform measures such as essential drugs system. The Public health service package should be introduced. The action of creating wealth in old age should be advocated. The budget of social security expenditure should be increased. The industry for the elderly should be developed vigorously.) The basis of community health service for aged people is the construction of the health service team workers.
Conclusion:
1. Theoretical research
The political system and cultural type of every society determine the management system of government and the basic organizational structure of social division of labor which is compatible with the system. And the political system and cultural type of the society shape the mode of thinking and behavior of supervisor and supervisee in the specific management environment.
This research introduces a way to survey and build the system of community health service for aged people from the institutional and cultural perspective.
2. Empirical Study
①The aged people are the focus of community health service in Chongqing.
②It is necessary to help the aged people to understand the function of community health service so as to increase the utilization of the facilities.
③The health projects in use are quite different from what are demanded by the aged people.
④The aged people are comparatively satisfied with the community health service institutions in Chongqing. Dissatisfaction lies mainly in the equipment, environment, and professional skill level.
⑤Both sides of supply and demand should deepen the understanding of community health service. Government should reinforce the policy guidance of community health service institutions, and increase the investment, and put the prevention and health care of aged people on the agenda.
3. Establishment of community health service system for aged people in Chongqing
This research introduces the way to build the framework of community health service system for aged people in Chongqing through the analysis of the major obstacles of aged people in getting basic health services on the basis of theoretical and empirical study. This research put forward suggestions as follows:The health service for aged people in social security system should be improved. A complete health service system for aged people should be established. The public financial investment in health service system for aged people should be increased. The medical workforce in the community health service system for aged people should be strengthened. The mechanism of synchronized development of community health service system with community construction should be implemented in Chongqing.
Innovations in the research
1. This research introduces a way to survey and build the system of community health service for aged people from the perspective of political system and historical culture.
2. This research advocates the concept of synchronized development of community construction with community health care services.
目的：
社区卫生服务是实现人人享有初级卫生保健目标的基础环节,是落实科学发展观、坚持以人为本、促进社会公平、维护社会稳定、构建社会主义和谐社会的重要内容。社区卫生服务的重要服务对象是老年人,人口老龄化给社区卫生服务带来很大影响。伴随中国的不断强大,社区卫生服务必将形成健全的体系,政府也将作为老年人口的社区卫生服务主导力量,在制度、机制、体制上为老年人享受方便、经济、有效的卫生服务提供坚强保障,让每一个中国老年人病有所医。
本研究希望能为重庆市构建老年人口社区卫生服务体系提出思路,促进重庆经济发展,为重庆市实现社会和谐作出贡献。
方法：
本研究是重庆市科委软科学课题《重庆市人口老龄化对社区卫生服务体系的需求研究》、重庆市教委课题《重庆市社区卫生服务体系与社区建设同步发展的机制研究》的核心,本研究还是重庆市发改委课题《重庆市公立医院改革试点研究》的一部分。研究方法主要包括文献研究、现场调查、规范分析、访谈法等。
结果：
本课题理论研究部分从管理学、社会学、人口学、经济学等不同学科出发,将制度和文化作为本研究的理论基础,以新公共服务理论(只有以人为本,充分重视民生,政府的管理才能取得成效；政府的职责就是最大限度地满足公民的一切合理需求；凸显政府的服务意识、强化政府的服务职能；强调公共管理的权力和合法性来源于公众,公众的满意度是评判政府公共管理活动的最终标准)、底线公平理论(对于老年人口而言,依靠基本生活保障加上医疗卫生保险,就可以获得最基本的社会保护,这是政府的责任；底线公平回答了民生建设的原则要求：确保民众享有与经济社会发展水平相适应的民生建设成果,是政府应当承担的首要责任,也是政府必须坚守的责任底线)、中国的孝文化(树立关心老人、关注老龄、关怀老人,有利于应对老龄化带来的挑战；提倡孝道、孝文化,是实现社会和谐稳定的最佳途径之一；弘扬中国传统孝文化对于缓解我国人口老龄化问题,促进和谐社会建设有着重要的现实意义)、民生理论(加快推进以改善民生为重点的社会建设,是党的十七大提出的重大战略任务；改善民生提高社会福利,让所有的老人都能得到物质上的照料和精神上的尊重是建立中国和谐社会的重要内容)、社区建设理论(社区建设和社区发展过程是社会各个部门合作、协商、融合的过程,也是共同精神和共同价值的培养过程,是社会融合的过程；社区建设是解决社会问题的手段和推动社会发展的重要的内容)作为重庆市人口老龄化对社区卫生服务体系的需求研究的基础理论,很好地从民生角度阐述人口老龄化对社区卫生服务的需求。
课题实证研究部分,研究共抽取了重庆市1102名老年人,社会人口学特征：男女性别比为为1：0.78；平均年龄66.4岁；大部分老年人月收入在1000-5000之间；老年人总体文化程度水平低；基本医疗保险覆盖率高达92.82%。慢性病患病情况：慢性病患病率63.4%；慢病顺位前五位是：高血压、糖尿、冠心病、关节炎、慢性支气管炎；老年人慢性病危险因素logistic回归分析发现,年龄、婚姻、文化程度、居住状态、饮酒与老年人口患慢性病相关。择医行为：老年人最满意的医疗卫生服务机构是社区卫生服务站,患病后56.77%首选社区卫生服务机构；82.28%的老年人有患病未就诊的情况,患病而未就诊危险因素逐步logistic回归分析结果显示性别、工作情况、收入、医疗保障、吸烟、社会活动及自我保健方式对患病后是否就诊有影响。社区卫生服务知晓情况：在被调查的1102名老年人中,全部都知道自己家附近有社区卫生服务机构,知晓率100%；社区卫生服务机构提供的服务中,老年人最熟悉上门出诊(63.91%),最不了解慢性病管理(8.28%)；重庆市81.07%老年人对政府社区卫生服务政策不了解。社区卫生服务利用情况：过去一年中老年人最常去的是社区卫生服务站(46.35%)；45.05%老年人一年体检一次,29.3%的老年人从不体检；老人接受的社区预防保健服务主要是量血压。对社区卫生服务评价：大部分被调查者对社区卫生服务机构满意,社区卫生服务机构设施、环境差最容易使老年人产生不满意。社区卫生服务需求：重庆市老年人口希望社区卫生服务机构提供的服务主要是提供固定的全科医生、上门出诊、建立家庭病床等；绝大多数受访老人认为老年人口社区服务应当由政府负担费用。重庆市社区卫生服务机构对老年人口服务提供的现状：重庆市大多数社区卫生服务中心均提供双向转诊(94.24%)、法定节假日接诊(92.91%)等服务,而临终关怀(17.99%)、家庭病床(32.86%)、家庭康复(32.86%)等老年人喜闻乐见的服务提供者很少；社区卫生服务提供的服务内容与医院非常雷同。
重庆市老年人口获取社区卫生服务的主要障碍是：被医疗保障制度所排斥、卫生资源对老年人口不公平的分配、老年人口社区卫生服务的高需求与低利用。在分析障碍的基础上,提出了重庆市老年人口社区卫生服务体系框架的构想：明确政府职责(政府主导、多部门联合参与、完善投资机制)；建设重庆市老年人口社区卫生服务体系(建立以社区为中心的老年服务体系,加快社区老年服务建设；建立健全重庆市老年人口社区卫生服务网络；强化老年人口社区卫生的全科医疗服务；建立老年人口社区卫生服务机构与医院、预防保健机构的分工合作机制,逐步建立双向转诊制度；培养老年人口社区卫生服务的队伍)。本研究探讨了重庆市老年人口医疗保障制度改革取向,本研究还提出建立和完善老年人口社区卫生服务的政策体系：制定社区老年卫生服务规划、加大社区老年卫生服务建设投入、老年人口社区卫生服务发展的动力是体制和机制创新(培育社会力量参与社区卫生服务、在社区率先推行基本药物制度等改革措施、推行“公共卫生服务包”制度、开展“创富老年”行动、增加社会保障支出预算、大力发展老龄产业)、老年人口社区卫生服务的基础是卫生服务队伍建设。
结论：
1.理论研究
每个社会的政治制度、文化形态决定了政府的管理体系,以及与政府管理体系相适应的社会分工基本组织结构形式,塑造了在特定管理环境下的管理者和被管理者的思想及行为方式。
本研究提出从制度与文化角度来审视和构建老年人口的社区卫生服务体系。
2.实证研究
①老年人口是重庆市社区卫生服务机构的服务重点。
②需要应进一步提升老年人口对社区卫生服务利用率,老年人口对社区卫生服务功能认识不足。
③老年人口社区卫生需求项目和实际利用项目存在较大差异。
④老年人口对重庆市社区卫生服务机构较为满意,不满意之处主要是设备、环境及技术水平。
⑤供需双方需进一步提高对社区卫生服务的认识程度,政府应加强对社区卫生机构的政策指导,加大资金投入力度,把老年人口的预防、保健真正提到议事日程。
3.构建重庆市老年人口社区卫生服务体系
在理论研究与实证研究的基础上,通过对老年人口获取基本卫生服务的主要障碍进行分析,研究提出构建重庆市老年人口社区卫生服务体系框架。明确提出完善老年健康服务的社会保障机制；构建完善的老年人口卫生服务体系；加大对老年卫生服务体系的公共财政投入；加强社区卫生服务体系的老年卫生人才队伍建设；实施与社区建设同步发展的重庆市社区卫生服务体系运行、管理机制等政策建议。
本研究的创新之处
1.本研究提出从制度与文化角度来审视和构建老年人口的社区卫生服务体系。
2.本研究提出社区建设与社区卫生服务同步发展的理念。
The aging of population is an important mark of social civilization, national industrialization and modernization, and also a manifestation of social progress, and improvement of people's health and living standards. As the universal rule, the demand for medical care service increases with the rise in age and fall in health. To guarantee "a healthy old age", we must make great efforts to deal with the challenging issues such as medical care service, economic support, life care, and spiritual consolation.
Objectives:
The community health service is the basic link of primary health care for every person which is the significant implementation of the concept of social development in a scientific, humane, righteous, stable and harmonious way. The target of community health service is the aged people, so population aging affects the community health service substantially. As China grows stronger, the community health service system will be accomplished, and government will play a leading role for the establishment of a system with proper rules and mechanism to guarantee an effective, economic, and convenient medical care service for every single aged person in China.
This research is aimed to provide ideas to build a blueprint of the community health service for the aged people in Chongqing so as to promote the local economic development for the contribution to a harmonious society.
Methods:
This research is the core of the soft science project of Chongqing Science and Technology Commission's "A research of the Demand for the Community Health Service System by the Aging of Population in Chongqing" and the core of the project of Chongqing education commission "A Research of the Mechanism in the Synchronized Development of Both Community Construction and Community Health Service System in Chongqing City". It is also one part of the Chongqing Development and Reform Commission's project "A research of the Experimental Reform of public Hospitals in Chongqing City". The research methods mainly include literature review, field investigation, normative analysis and interview.
Result:
The theoretical part of this research explores from diverse subjects such as management, sociology, demography, and economics. This research is theoretically based on the system and culture, and takes the new public service theory (the government management can get effect only if we stress the people-oriented theory and people's livelihood; the responsibility of government meeting reasonable demand of citizens to the utmost extent; to stress the service awareness of government, to strengthen the service functions of government; to emphasize the power and legality of public administration is derived from public, public satisfaction is the final standard of judgment for public administration), the bottom-line equity theory(the aged people can get the most basic social protection by means of basic living allowance and health insurance which are the responsibilities of government. The bottom-line equity is a response to the principled request of livelihood construction, and ensures that the public get the profit of livelihood construction which is consistent with the development of economic and society. That's the Primary responsibility of government, and the bottom-line of government's responsibilities.), the filial piety of Chinese traditional culture (the caring and concern of aged people is helpful to overcome the challenge of aging population. Advocacy of filial duty and filial piety is one of the best ways to harmonious society. Carrying forward the filial piety of Chinese traditional culture can help us to face the challenge of the aging of population in our country and promote the construction of a harmonious society.), the people's livelihood theory (speeding up socialist construction with the improvement of people's livelihood as its focus is a major strategic task brought forward from the seventeenth national congress of the Communist Party of China. Improvement of people's livelihood and social welfare, and all aged people getting physical care and respect are the important content of a harmonious society in China.) and the community development theory (The construction and development of community is a process of cooperation, negotiation and amalgamation of all social departments. The construction of community is a method of solving social problems, and it is an important element of promoting social development.) as theoretical basis for the research, this paper expatiates the demand for community health service system by the aging of population in Chongqing from the perspective of livelihood.
In the empirical research,1102 aged people in Chongqing were sampled. The sex ratio of the sample is 1 male:0.78 female, and the average age is 66.4 years. Most of the aged people have a monthly income of 1000-5000 yuan. The educational level of the aged people was generally low.92.82% of participants had basic medical insurance. The Situation of Suffering from Chronic Diseases:the prevalence rate was 63.4%, and the top five chronics were:hypertension, diabetes, coronary heart disease, arthritis and chronic bronchitis. The logistic regression analysis of risk factors of chronic diseases of aged people showed that the prevalence of chronic diseases was related to age, marital status, educational level, housing status and alcohol. The Selection of Medical Care Service:the most satisfactory health care institution was community health service station.56.77% of patients preferred community health service because the community health service was close to their home, the cost was lower than hospital, and the service is good.82.28% of the aged people avoided seeing a doctor when they were ill. The logistic regression analysis of risk factors of avoiding seeing a doctor showed that they were related to gender, job, income, medical assurance, smoking, social activity and individual health care method. The awareness of community health service:All of the 1102 aged people were aware of the community health service centers near their home. Visiting a patient at home was the most familiar community health service (63.91% of aged people were aware of visiting a patient at home). Chronic disease management was the most unfamiliar community health service (only 8.28% of aged people were aware of chronic disease management).81.07% of aged people in Chongqing were not familiar with the policy of community health services. The utilization of community health services:the number one medical institution used by the aged people last year was the community health service station (46.35).45.05% of aged people had physical examination once a year.29.3% of aged people never had a physical examination. The community preventive health care services received by the aged people were mainly blood pressure tests. The appraisal of community health service:most of the aged people were satisfactory with the community health service institution. The defect of facility and the dirty environment of community health service institution most likely made the aged people unsatisfied. The demand of community health service:Some of the aged people in Chongqing wanted the community health service institution provide aptotic general practitioner, some of them wanted the community health service institution visit a patient at home, some of them wanted the community health service institution to establish family sickbed. Most of the aged people thought that the cost of community services of aged people should be paid by the government. The current situation of community health service for the aged people in Chongqing:Most of the community health service centers (94.24%) provided the services of two-way transfer of patients and treated patients in statutory holidays. But few of the community health service centers provided the services demanded by the aged people such as terminal care (17.99%), home-ward (32.86%) and home rehabilitation care (32.86%). The services provided by community health service centers were similar to those by hospitals.
The major obstacles for the aged people to obtain community health service:Aged people are excluded by medical insurance system. the distribution of health resources to aged people is unfair. The demand of community health services for aged people is high, and the utilization is low. Ideas of the framework of community health services for aged people in Chongqing are proposed based on the analysis of the obstacles. The responsibility of government must be clarified (Government should be the leader of community health services. Diverse departments should take part in the community health services system. The investment mechanism should be improved.) The community health service system for aged people in Chongqing should be built. (The service system centered on community for aged people should be built to accelerate the construction of community services for aged people. the network of community health service for aged people should be built and improved. The general medical services for aged people in community health service should be strengthened. The mechanism of cooperation and division of health care between community health service centers and hospitals or disease prevention institutions should be built. The two-way transfer system should be established progressively. Community health service medical workers for aged people should be trained.) This research explored the reform orientation of medical security system for aged people in Chongqing. This research also proposes the policy system to establish and improve community health service for aged people and plans the community health service for aged people to increase investment in construction of community health service for aged people. The propulsion of development of community health service for aged people is innovation of system and mechanism. (Social sectors should be mobilized to take part in community health service. Community should take the lead in implementing reform measures such as essential drugs system. The Public health service package should be introduced. The action of creating wealth in old age should be advocated. The budget of social security expenditure should be increased. The industry for the elderly should be developed vigorously.) The basis of community health service for aged people is the construction of the health service team workers.
Conclusion:
1. Theoretical research
The political system and cultural type of every society determine the management system of government and the basic organizational structure of social division of labor which is compatible with the system. And the political system and cultural type of the society shape the mode of thinking and behavior of supervisor and supervisee in the specific management environment.
This research introduces a way to survey and build the system of community health service for aged people from the institutional and cultural perspective.
2. Empirical Study
①The aged people are the focus of community health service in Chongqing.
②It is necessary to help the aged people to understand the function of community health service so as to increase the utilization of the facilities.
③The health projects in use are quite different from what are demanded by the aged people.
④The aged people are comparatively satisfied with the community health service institutions in Chongqing. Dissatisfaction lies mainly in the equipment, environment, and professional skill level.
⑤Both sides of supply and demand should deepen the understanding of community health service. Government should reinforce the policy guidance of community health service institutions, and increase the investment, and put the prevention and health care of aged people on the agenda.
3. Establishment of community health service system for aged people in Chongqing
This research introduces the way to build the framework of community health service system for aged people in Chongqing through the analysis of the major obstacles of aged people in getting basic health services on the basis of theoretical and empirical study. This research put forward suggestions as follows:The health service for aged people in social security system should be improved. A complete health service system for aged people should be established. The public financial investment in health service system for aged people should be increased. The medical workforce in the community health service system for aged people should be strengthened. The mechanism of synchronized development of community health service system with community construction should be implemented in Chongqing.
Innovations in the research
1. This research introduces a way to survey and build the system of community health service for aged people from the perspective of political system and historical culture.
2. This research advocates the concept of synchronized development of community construction with community health care services.
引文
1. United Nations. World population prospects.2000.www.un.org/esa/Population/ publications/wpp2000/(accessed 19 Apr 2006)
2. United Nations Department of Economic and Social Affairs, Population Division. World population prospects:The 2004 revision.2005. www.un.org/esa/population/ publications/wpp2004/23004 Highlights_finalre vised. pdf(accessed 19 Apr 2006)
3. Blackman DK, Kamimoto LA, Smith SM. Overview:surveillance for selected public health indicators affecting older adults. United States MMWR 48 (SS08) 1999,1-6
4. Charlton, K.1998. Health, health care and ageing in Africa:challenges and opportunities. Editorial. OECD (2004). DECD health data 2004 user's guide:A comparative ananlysis of 30 Countries. http://www.oecd.org/dataoecd/60/25/ 31819753.pdf.03-Jun-2004Southern African Journal of Gerontology,7(2):1-3.
5. Sengupta M, Agree EM. Gender, health, marriage and mobility difficulty among older adults in India. The Gerontologist,2004; Vol.44 (1):481- 482
6. WHO. Annex Table l:Basic indicators for all WHO member states. Available from: http://www. who.int/whr/2005/annex/en/index.html,25/07/2006
7. N.A.1997. Ageing in Africa. Geneva:World Health Organisation.
8. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Diabetes in the elderly. Clinical Practice Guidelines,2003, S 106-S 107
9. Ahenkora, K.1999. The contribution of older people to development:the Ghana study. London:Help Age International. Apt
10. WHO,WHA58/2005/REC/1, WHA58.16加强积极和健康的老龄化：88-91
11.杜鹏.中国,谁来养老?.厦门鹭江出版社.2000年版
12.汤哲等.北京市老年人卫生服务需求研究.中华医院管理杂志[J].2004(20)8：464-469
13. Chronic Conditions:A challenge for the 21st century. National Academy on an Aging Society. November 1999
14. Manton,K.,and X.L.Gu.Analysis from the National Long Term Care Survey. Proceedings of the National Academy of Sciences.May 8,2001
15. ElizabethVierck, Kris Hodges, Aging:Demographics, Health and Health Services, Greenwood Press, London,2004,P127
16. Institute for the Future:Health and Health Care 2010,P260
17.钱立群等.银川市老年人社区卫生服务需求调查分析.疾病控制杂志[J].2004(8)：49-51
18.刘万福.老年人口的医疗卫生服务需求及影响因素.卫生行政管理[J].2005(8)：51-52
19. Brody S J, Masciocchi C. Commentary data for long-term care planning by health systems agencies. AmJ Public Health,1980,70:1194-1198
20.姜向群等.对我国当前人口老龄化问题研究的概念和理论探析.人口学研究[J].2004(147)5：10-13
21. Sengupta M, Agree EM. Gender, health, marriage and mobility difficulty among older adults in India. The Gerontologist,2004; Vol.44 (1):481-482) (WHO. Annex Table l:Basic indicators for all WHO member states. Available from:http://www.who.int/ whr/2005/annex/en/index.html,25/07/2006
22. OECD (2004). DECD health data 2004 user's guide:A comparative ananlysis of 30 Countries. http://www.oecd.org/dataoecd/60/25131819753.pdf.03-Jun-2004
23.金大鹏等.《全科医师实用手册》.中央广播电视大学出版社.1999年8月：787
24. Blackman DK, Kamimoto LA, Smith SM. Overview:surveillance for selected public health indicators affecting older adults. United States MMWR 48 (SS08).1999,1-6) (Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Diabetes in the elderly. Clinical Practice Guidelines,2003, S 106-S 107
25. Kuo T, Torres-Gi F M. Factors Affecting Utilization of Health Services and Home-and Community-Based Care Programs by Older Taiwanese in the United States. Research on Aging,2001,23:14-36)
26. WHO Integration of health care delivery.Report of a WHO study group Genva, World Health Organization,1996:22
27.孙晓明等.上海社区卫生服务实践与研究.中国卫生政策[J].1999(11)：19.
28.孔灵芝.慢性非传染性疾病防治与社区卫生服务.中国慢性病预防与控制[J].1988,6(1)：35
29. OECD Health Division. OECD Health Data 2007-Frequently Requested Data. http:// www.oecd.org/document/16/0,3343, en_2825_495642_2085200_1_1_1_1,00.html
30. Technical Steering Committee.GP Earnings and Expenses Enquiry 2005/06 Initial Report, http://www.ic.nhs.uk/webfiles/publications/
31. Sitzia J, Wood N. Patient satisfaction:A review of issues and concepts. Social Science and Medicine 1997,45:1829-43
32. Irvine, B. Background Briefing on US Healthcare, Health Policy Consensus Group.2002
33. Borger, C., S. Smith, et al. Health Spending Projections Through 2015:Changes On The Horizon. Health Affairs-Web Exclusive:2006. W61-W73.
34. Health, United States,2006.Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey
35. Australian Government Productivity Commission. Economic Implications of an Aging Australia,2005
36. Department of Foreign Affairs and Trade. Health Care in Australia. http://www. dfat. gov. au/facts/healthcare.html/
37. Australian Government Department of Helth and Ageing. Health and Ageing Factbook 2006. http://www.aodgp.gov.au/
38. The Scottish Government. Health and Community Care Trends. http://www. scotland. gov.uk/Topics/Statics/Browse/Health
39. The Royal New Zealand College of General Practitioners, Forecasting; Workforce Capacity:Towards an Understanding of GP Workforce Capacity, long-term forecasting and benchmarking tools, http://www. Rnzcgp. org. nz/documents/workforce Capacity_OP8_4WEB.pdf
40. Australian Institute of Health and Welfare:Annual report 2006-07.http:// www.healthworkforce.health.nsw. gov. au
41.陈方武等.老年人卫生服务需求情况分析.卫生软科学[J].2007(4)
42. Health Authority,Redesign Accomplishments,A Four-Year Picture. Better Care for Seniors. September 2005
43. MURRAY, C. FRENK, J.World Health Report 2000:A step towards evidence-based health policy. Lancet,2001,357:1698-1700.
44.王放.中国人口老龄化与老年社会服务.中国青年政治学院学报[J].2004(3)：134-138
45.李斯.曹云清.中国人口老龄化对老年社会保障体系的挑战.科学与管理[J].2008(4)：9-10
46. Fraser, S., Bunce, C., Wormald, R. and Brunner, E.,2001.Deprivation and late presentation of glaucoma:Case-control study. British Medical Journal.322:639-643
47. Pameal M. Jolicoour & Teresa, Madden. The good daughters:Acceultumtion and caregiving among Mexican-American women [J]. Journal of Aging Studies,2002(16): 107-120.
48.李琴.改善民生视角下的我国政府社会管理改革探讨.湖北经济学院学报(人文社会科学版)[J].2008(5)：11-12
49. R.C. Burack, P.A. Gimotty. 'Promoting Screening Mammography in Inner-City Settings:The Sustained Effectiveness of Computerized Reminders in a Randomized Controlled Trial.'Medical Care.1997,35(9):921-931
50. Keigher, S, and R.I. Stone. Payment for Care in the U.S.:A Very Mixed Policy Bag. Paper presented at the International Meeting on Payment for Dependent Care, Vienna, Austria.1992,71-98
51. Kenney, G, S. Rajan, S. Soscia. State Spending for Medicare and Medicaid Home Care Programs. Health Affairs.1998,17(1):201-212
52. Jackson, B., and P. Doty. Unmet and Undermet Need for Functional Assistance among the U.S. Disabled Elderly. Paper presented at the annual meeting of the Gerontological Society of America, Cincinnati.1997
53. Kane, R.A., R.L. Kane, L.H Illston, J. Nyman, and M Finch. Adult Foster Care for the Elderly in Oregon:A Mainstream Alternative to Nursing Homes? American Journal of Public Health,1991,81 (9):1113-1120
54. Kane, R.L., R.A. Kane, M. Finch, et al. S/HMOs, the Second Generation:Building on the Experience of the First Social Health Maintenance Organization Demonstrations. Journal of the American Geriatrics Society,1997,45(1):101-107
55. Kane, R.A., R.L. Kane, R.L., and R.C. Ladd. The Heart of Long-Term Care. New York:Oxford University Press.1998
56. Kane, R.A. Boundaries of Home Care:Can a Home-Care Approach Transform LTC Institutions? In Fox and Raphael, eds.1997,23-46
57. Linda B. Haas, PhC, RN, CDE. Caring for Community-Dwelling Older Adults With Diabetes:Perspectives From Health Care Providers and Caregivers. Diabetes Spectrum Volume 19, Number 4,2006,240-244
58. Lennart Bogg. Health care financing in China:equity in transition. [M]Stockholm, 2002
59. Betbeder-Matihet L, Fridgant Y Harris MF, et al. Where's the conlln On ground? A survey of hospitals, community health centres and divisions of general practice in Australia. Australian Family Physician,2000,29(4):378-83.
60. Anell A. Persson M. International comparisons of health care resources. Lakartidningen,1998,95(30-31):3315-8
61. Imm IE, V enneman Mr. Supplementing state and national health care work force planning:a regional effort. J Allied Health,1998,27(2):77-82
62. Mal DB, Plant AJ, Toussaint S. I have learnt a different way of looking at People s health:all evaluation of a prevocational medical training program in public health medicine and primary health care in remote Australia. Medical Teacher,2006,28(6): 149-55
63. Norman I. Inter-professional educmion for pre-registration students in the health professions:recent developments in the UK and emerging lessons. International Journal of Nursing Studies.2005,42(2):119-23
64. Ranz J,Stueve a,Mcquistion H L.The role of the psychi-atrist job satisfaction of medical directors and staff psychiatrists [J]. Community Mental Health Journal 2001,37(6):25-39.
65. Leigh JP, Kravitz RL,Schembri M. Physician career satisfaction across specialties[J]. Arch Intern Mel.2002 Jul 22;162(14):1577-1584.
66. Garcia-Altes A, Borrell C, Cote L, Plaza A, Benet J, Guarga A. Measuring the performance of urban healthcare services:results of an international experience.J Epidemiol Community Health.2007 Sep;61(9):791-6
67. Australian Primary Health Care Research Institute. Integration, Co-ordination & Multidisciplinary Care in Australia:growth via optimal governance arrangements. http: //www.anu.edu.au
68. Rummery, K. and Coleman, A. Primary health and social care services in the UK: progress towards partnership? Social Science and Medicine 2003,56:1773-1782.
69. Star eld, B. and Shi, L. Policy relevant determinants of health:an international perspective, Health Policy.2002,60(3):201-18
70. Average Annual Expenditures Per Consumer for Health Care:1990-2003. http://www.infoplease.com/ipa/A0931275. html/
71. Thai Than Dang, Pablo Antolin & Howard Oxley, Fiscal Implications of Ageing: Projections of Age-Related Spending, OECD EconomicsDepartment Working Papers 305, OECD Economics Department.2001
72. SteveLeeder et al. Arace against time:the challenge of cardio Vascular diserase in developing economies. New York, Columbia University,2004
73. Rabinowitz HK, Diamond JJ, Markham FW, Paynter NP. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA.2001 Sep 5;286(9):1041-8.
74. Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle-and low-income countries:aliterature review of attraction and retention. BMC Health Servres.2008;8:19
75. Denham, L.A., & Shaddock, A.J.(2004). Recruitment and retention of rural allied health professionals in developmental disability services in New South Wales. Australian Journal of Rural Health,12(1):28-29.
76. [64] Farrah J. Mateen. Future practice location and satisfaction with rural medical education:Survey of medical students. Can Fam Physician.2006 September 10;52(9): 1106. Published online 2006 September 10.
77. Aday L. A.Anderson R., M. Aframework for the study of access to medical care
78. Stephen J. Willisms, Paul R. torrens. Introduction to Health Service.5 edition. U. S. A Delmar Publishers.1999:88--108
79. Ander G F., Hurst J. Husser PS, et al. Health spending and outcomes:Trends in OECD countries,1960-1998. Health Af. Fairs,19(3):150-157,2000
80. Wan-Tzu Connie Tai, Frank W Porell, and E Kathleen Adams. Hospital Choice of Rural Medicare Beneficiaries:Patient, Hospital Attributes, and the Patient-Physician Relationship Health Servres.2004 December; 39(6 Pt 1):1903--1922.
81. Rosalind Coleman, Louie Loppy, & Gijs Walraven. The treatment gap and primary health care for people with epilepsy in rural Gambia. Bulletin of the World Health Organization 2002,80(5),378-383
82. Muller CF. Economic costs of illness and health policy[J], Am J Public Health, 1980,70(12):1245-1246.
83.曹元应.全面推进社区卫生服务体系建设.安徽卫生职业技术学院学报[J].2009(8)2：5-6
84. Koolman X, van Doorslaer E, on the interpretation of a concentratjon index of inequality [J]. Health Economics 204,13 (7)
85. J. VEILLARD, F. CHAMPAGNE, N. KLAZINGA A,et al. performance assessment framework for hospitals:the WHO regional office for Europe PATH project. Internationa Journal for Quality in Health Care,2005,17,(6):487-496
86. Alliance of Health Policy and System Research Stlengthening health system, the role & promise of policy & systems research[R].Monogmph,2004
87. Evans.D,Tandon.A,Murry.C.et al. Comparative efficiency of National Health Systems: Cross-national econometric analysis, British Medical journal,2001,323(1):307-310
88. Provan K.G, Milward H.B. Apreliminary theory of inter organizational effectiveness [J]. Administrative Science Quarterly,1995,40(1):1-33
89. Organisation for Economic Co-Operation and Development, 《Measuring Up: Improving Health System Performance in OECD Countries》. OECD Publishing, 2002,Chapter1:P8
90. Measuring up. Improving health system performance in OECD countries. In: Proceedings of conference "Measuring up:improving health system performance in OECD countries,5-7 Nov.2001, Ottawa". Paris, OECD,2002
91.史萌.中国社区卫生服务的制度选择.中国卫生事业管理[J].2009(4)：229-231,245
92.邓大凤.某城区社区卫生服务与可持续发展探讨.中国医疗前沿[J].2009(8)：138-139
1.安南.建立不分年龄.人人共享的社会.《中国老年》.1998(11)
2.张小溪.从容面对老龄化社会.《决策》2006(11)：38-39
3.张卫.人口老龄化与完善城市老年社会保障体系.《现代经济探讨》2001(12)：28-30
4.姜向群等.《对我国当前人口老龄化问题研究的概念和理论探析》.人口学研究.2004(147)5：10-13
5.金大鹏等.《全科医师实用手册》.中央广播电视大学出版社.1999年8月.P787
6. 阎安.联合国老龄行动历程和主要经验.《社会工作》.2006年第十期下半月.P20-24
7. WHO.WHA58/2005/REC/1.WHA58.16加强积极和健康的老龄化.P88-91
8.张文范.《我国人口老龄化与战略性选择》.载于《中澳中国人口老龄化宏观对策研讨会论文集》.P1-7
9. 李玉玲.我国老年弱势群体的现状及救助对策分析.西北人口.2007(2)
10.杜鹏.《中国, 谁来养老?》.厦门鹭江出版社.2000年版
11. Cheng YH.Chi I. Boey KW. Ko LS. Chou KL. Self-rated economic condition and the health of elderly persons in Hong Kong. Soc Sci Med.2002.Oct.55(8):1415-1424
12.郭清.《社区卫生服务理论与实践》.暨南大学出版社.2000(3)：1
13.蒋烽.促进人类健康的社区卫生服务.《中国妇幼保健》.1997(12)：25-27
14.刘伟红.从“自然而治”到“自觉而治”：社区自治问题再探讨.《行政与法》.2008(1)：55-58
15.徐庆文.社区自治：理想与现实.《民政论坛》.2001(3)：18-24
16.侯钧生,陈钟林.《发达国家与地区社区发展经验》.机械工业出版社.2004年版
17.王明美.社区建设的中外比较研究.《江西社会科学》.2007(8)：151-158
18.邹明洪.城市化进程中社区建设面临的主要问题与对策分析.《江西社会科学》.2005(6)
19.李长明.《社区卫生服务文献汇编》.内部资料.2000(5)：74
20.梁浩材.跨世纪的卫生战略：论社区卫生服务.《中国卫生政策》.1996.11.11
21. WHO. Integration of health care delivery. Report of a WHO study group. Genva, World Health Organization,1996:22.
22.孙晓明等.上海社区卫生服务实践与研究(上).《中国卫生政策》1999(11)：19
23.孔灵芝.慢性非传染性疾病防治与社区卫生服务.《中国慢性病预防与控制》.1988,6(1)35.
24.杨涛.全国城市社区卫生服务联系点研讨会纪要.《中国初级卫生保健》199913(8)11.
25.专稿.2002年卫生部基层卫生与妇幼保健司工作要点.《中国初级卫生保健》 20024(16)1.
26.龚幼龙,冯学山.主编.《卫生服务研究》.第一版.上海.复旦大学出版社.2002.319.
27.仇雨临,孙树菡.主编.《医疗保险》.第一版.北京.中国人民大学出版社.2001.83.
28.李惠娟,季正明.《社区卫生服务实用手册》.第一版.上海.复旦大学出版社2002.17
29.何宪平.社区卫生服务的基本特点和宏观意义.《社区医学杂志》2008年6卷第10期
30. Drummond M.OBrien B, Stoddart G.etal.Methods for the Economic Evaluation of Health Care programmers[M]. oxford:oxford University Press,1997
31. Krahn M. principles of Economic Evaluation in Surgery[J]. World J Surg,1999, (23):1242
32.颛慧琳等.关于我国城市社区卫生服务发展的思考.《经济问题》2008(6)：127-129
33.卫生部基层卫生与妇幼保健司.《社区卫生服务进展、问题与对策》.内部资料.2000年7月.P1-2
34.任苒,初伟,周玲等.城市居民社区卫生服务需求意愿及影响因素分析.《卫生经济研究》2001(4)：3-5.
35. Electronic Health Record Definition, Scope and Context. ISO/TC 215 Technical Report, First Draft, July 2003. http://www.iso.org.2007.6.29
36. R. Hillestad, J. Bigelow, A.Bower, et al. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs Health Affairs. 2005,24,(5):1103}1117.
37. J.H. Bigelow et al., Analysis of Healthcare Interventions That Change Patient Trajectories (Santa Monica, Cali#:BAND,2005
38.]S.J. Wang et al., A Cost-Benefit Analysis of Electronic Medical Records in Primary Care, American Journal of Medicine,2003,114(5):397-403
39. D.W. Bates et al., Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors, Journal of the American Medical Association 1999,280(15):1311 - 1316.
40. D. Johnston et al., Patient Safety in the Physician's Office:Assessing the Value of Ambulatory CPOE, April 2004,www.chcf.org/tonics/view.cfm?itemID-101965.2007.5.31
41. S.J. Wang et al., A Cost-Benefit Analysis of Electronic Medical Records in Primary Care, American Journal of Medicine,2003,114(5):397-403
42. E.A. McGlynn et al., The Quality of Health Care Delivered to Adults in the United States, New England Journal of Medicine,2003,348(26):2635-2645
43. R.C. Burack and P.A. Gimotty. Promoting Screening Mammography in Inner-City Settings:The Sustained Effectiveness of Computerized Reminders in a Randomized Controlled Tria. Medical Care,1997,35(9):921-931
44. B. Kaplan, Evaluating Informatics Applications-Clinic Decision Support Systems Literature Review. International Journal of Medical Informatics.2001,64(1):15-37
45. Heslop, A.1999. Poverty and livelihoods in an ageing world. In:Randel, J., German, T. &Ewing, D. (Eds). The ageing and development report:poverty, independence and theworld's older people. London:Earthscan Publications, pp.22-32
46. Ikegami, N., Morris, J.N.&Fries, B.E. Low-care cases in long-term care settings: variation among nations. Age&Ageing,1997,26(suppl 2):67-71
47. Dylan G. Harwood, Warren W. Barkcr, Raymond L. Ownby, Ranjan Duara. Caregiver self-rated health in alzheimer's disease. Clinical Gerontologist,2000,21(4):19-33.
48. B. Kaplan. Evaluating informatics applications-clinic decision support systems literature review. International journal of medical informatics.2001,64(1):15-37
49. Paul R.Kowal, P.V.Chalapati Rao and Colin Mathers.Creating a minimum data set on agieng in sub-Saharan Africa.Preport on a WHO workshop Pretoria, South Africa,12- 14 February,2004
50. WHO Integration of Health Care Delivery. Report of a WHO Study Group. Geneva, World Health Organization.1996:(WHO Technical Report Service, No891)22
51. Colledge MJ. Statistical integration through metadata management. Internat stat rev. 1999; 67:79-98
52. John P. Hirdes, Dinnus H. Frijters and Gary F.Teare. The MDS-CHESS Scale:A New Measure to Predict Mortality in Institutionalized Older People.JAGS 2003,51:96-100.
53. Zheng-Bo Huang, Richard R.Neufeld, Atonios Likourezos, Brenda Breuer, Albert Khaski, Evelin Milano and Leslie S.Libow. Sociodemographic and health characteristics of older Chinese on Admission to a nursing home:Across-Racial/Ethnic study. JAGS,2003,51:404-409.
54. Kowal, P.R, Wolfson, L.J. and Dowd, J.E. Creating a Minimum Data Set on Ageing in Sub-Saharan Africa. Southern African Journal of Gerontology,2000,9, (2):18-23.
55. Munsch CM. Managing the measurement:A model of data support in an integrated delivery system Journal of Nursing Care Quality; Gaithersburg; Jan 2002; 16(2):1-9.
56. Blewitt, Darby K. MS, RNC; Jones, Katherine R. PhD, RN, FAAN Using Elements of the Nursing Minimum Data Set for Determining Outcomes. Journal of Nursing Administration.26(6):48-56, June 1996.
57. Saba M. Overview of nursing information systems. In:Werley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company, Inc.; 1988:89-102.
58. Shaw C. External assessment of health care British Medical Journal; London; Apr 7, 2001;7290;851-854.
59. Provisional list of indicators for consideration (for inclusion in a Minimum Data Set) Paul R. Kowal, Lara J. Wolfson and John E. Dowd. (2002)Creating a Minimum Data Set on ageing in sub-Saharan Africa. World Health Organization, Geneva, Switzerland
60. Relman AS. Assessment and accountability:the third revolution in medical care. N Engl J Med.1988; 319(18):1220-1222.
61. Jan Stevenson. Comprehensive Assessment of Older People. Managing Community Care,1999,9:3-22.
62. Callahan D. Aging, death, and population health.JAMA; Chicago; Dec 1,1999; 282(21):2077
63. World Health Organization.2004. Report on a WHO Workshop:Minimum Data Set on Ageing in Sub-Saharan Africa. Pretoria, South Africa. February 12-14,2003.Geneva: WHO, Evidence and Information for Policy
64. Rantz, M. J. Petroski, G F., Madsen, R. W., Mehr, D. R., Popejoy, L., Hicks, L. L. Porter, R., Zwygart-Stauffacher, M.&Grando, V. Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports:an update. JointCommission Journal on Quality Improvement,2000,26(2):101 - 110
65. Rantz, M.J., Popejoy, L., Zwygart-Stauffacher, M., Wipke-Tevis, D.&Grando, V.T. Minimum Data Set and resident assessment instrument. Can usingstandardized assessment improve clinical practice and outcomes of care? Journal of Gerontological Nursing,1999,25(6):35-43
66. Ribbe, M.W., Ljunggren, G, Steel, K., Topinkova, E., Hawes, C., Ikegami, N., Henrard, J.C. & Johnson, P.V. Nursing homes in 10 nations:a comparison between countries and settings. Age& Ageing,1997,26(suppl.2):3 -12
67. World Health Organisation (WHO). Monitoring reproductive health:selecting a short list of national and global indicators. WHO Technical Report.1997, Ref. WHO/RHT/HRP/97.256. Geneva:World Health Organisation.
68. WHO. Information Needs for Research, Policy and Action on Ageing and Older Adults:report of a workshop on creating a minimum data set (mds) for research, policy and action on ageing and the aged in Africa, Harare, Zimbabwe,2000:40-42
69.刘艳,吴群鸿.哈尔滨市社区卫生服务需求利用及影响因素分析.《医学与社会》2002,15(1)11-13.
70.罗力,郝模,吴延风等.社区卫生人力定性和定量分析.《中华医院管理杂志》1998,15(8)471-472.
71.曹亦农,朱秀萍,谢征.关于社区卫生服务人力资源开发的思考与探讨.《中国全科医学杂志》2000,3(1)33-34.
72.褚詹玄,秦美娇,胡函锦等.上海市社区卫生服务中心人力资源调查与分析.《上海第二医科大学学报》.2002,22(5)468-470.
73.杨苿,来则民.天津市全科医学人力资源的状况分析.《天津医科大学学报》.2001,7(4)481-482.
74.武桂英,龚幼龙,卢福今等.上海市社区卫生服务站建站费用房屋与设备配置情况分析.《中国初级卫生保健》1999,13(6)14-16.
75.李士雪,董海东,王舒宏.山东省社区卫生服务中心(站)的配置现状及功能发挥.《中国卫生经济》1999,18(8)17-19.
76.杨辉,李曼春,张拓红等.我国城市社区卫生服务现状的快速调查结果分析.《中国初级卫生保健》.1999,13(8)3-7.
77.钟天伦,黄毓明,方华贵.深圳宝安区社区卫生服务质量评价.《中国初级卫生保健》.1999,13(4)18-20.
78.梁万年,杨兴华,王虹.中国城市社区卫生服务评价指标体系的应用.《中国卫生事业管理》.2002,11 644-646.
79.郭清,唐继志,马海燕等.城市社区卫生服务评价指标研究.《中国社区医学》.2001,7(4)12-13.
80. Apt, N.A.1997. Ageing in Africa. Geneva:World Health Organisation.
81. Provisional list of indicators for consideration for inclusion in a Minimum Data Set) Paul R. Kowal, Lara J. Wolfson and John E. Dowd. (2002)Creating a Minimum Data Set on ageing in sub-Saharan Africa. World Health Organization, Geneva, Switzerland
82. Ikegami, N, Morris, J.N.&Fries, B.E.1997. Low-care cases in long-term care settings: variation among nations. Age&Ageing,26(suppl.2):67-71.Ribbe, M.W., Ljunggren, G, Steel, K., Topinkova, E., Hawes, C., Ikegami, N., Henrard, J.C. & Jonnson, P.V. 1997. Nursing homes in 10 nations:a comparison between countries and settings. Age & Ageing,26(suppl.2):3-12
83. ORLYGSDOTTIR, BRYNJA RN, MSN Use of NIDSEC-Compliant CIS in Community-Based Nursing-Directed Prenatal Care to Determine Support of Nursing Minimum Data Set Objectives. CIN:Computers, Informatics, Nursing.25(5):283-293, September/October 2007
84. Callahan D. Aging, death, and population health.JAMA; Chicago; Dec 1, 1999;282(21):2077-2079
85. Shaw C. External assessment of health care British Medical Journal; London; Apr 7, 2001; 7290; 851-854
86. Munsch CM:Managing the measurement:A model of data support in an integrated delivery system Journal of Nursing Care Quality; Gaithersburg; Jan 2002; 16(2):1-9
87. Blewitt, Darby K. MS, RNC; Jones, Katherine R. PhD, RN, FAAN Using Elements of the Nursing Minimum Data Set for Determining Outcomes. Journal of Nursing Administration.26(6):48-56, June 1996
88. Saba M. Overview of nursing information systems. In:Werley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set.New York, NY:Springer Publishing Company, Inc.; 1988:89-102
89. Delaney C, Moorhead S. The nursing minimum data set, standardized language, and health care quality. J Nurs Care Qual.1995;10(1):16-30
90. Wan TTH. Analysis and Evaluation of Health Care System:An Integrated Approach to Managerial Decision Making. Baltimore:Health Professions Press; 1995.
91. Gallant BJ. Data Requirements for the nursing minimum data set as seen by a nurse administrator. In:West HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company Inc.; 1988:165-176
92. Sovie MD. Establishing the nursing minimum data set as a part of the data requirements for DRGs. In:Westley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company, Inc.;1988:300-312
93. Pearce ND. Uniform minimum health data sets:Concepts, development, testing, recognition for the federal health use and current status. In:Werley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company, Inc.; 1988:122-132
94.李曼春,吴秀云,李菁晶等.社区卫生服务工作效率研究.《中华医院管理杂志》.200016(7)413-415.
95.郭清.英国社区卫生服务简介.《中国社区医学》.2001,7(4)103
96.魏荃.芬兰的卫生策略与社区服务.《中国慢性病预防与控制》
97.卢祖洵,孙奕,姚岚等.国外社区卫生服务焦点分析.中国全科医学.2002,5(3)209-211.
98.刘吉成.城市社区卫生服务模式的探讨.《中国医院管理》.2000,20(2)24-25.
99.殷祖泽,张企良,陈爱芳等.社区卫生服务新模式的思考与实践.《中国医院管理》.2000 20(1)45-45.
100.朱月伟.以医改为契机积极探索社区卫生服务新模式.中国社区医学.7(4)44-45.
101.吴秀云,李曼春,马凤云等.城市社区卫生技术人员社区卫生知识与技能需求调查.《中国卫生事业管理》.2000,135-37.
102.王声涌,荆春霞,池桂波.广东省城市社区全科医师培训模式探讨.《中国医院管理》.2003 23(3)57-59.
103.解军.全科医师必备知识技能现况调查及对策研究.《中国全科医学杂志》.2000,3(2)30-32.
104.傅华,王祝三,朱冰玲等.城市社区卫生服务可持续发展的对策探讨.《中国初级卫生保健》.1997 11(7)4-6.
105.鲍勇,龚幼龙,顾杏元等.上海市社区卫生服务中心可持续发展的研究.《中国卫生事业管理》.2000,138-40.
106.徐瑛,张广慧,刘军.社区卫生服务可持续发展思考.《中国卫生经济》.2001,20(11)54-55.
107.郝模,张勇,罗力等.促进社区卫生服务可持续发展的政策研究概述.《中国医院管理》.2001,21(9)3-4
108.陈文,吴凡,应晓华.社区基本预防服务的成本测算.《中国卫生经济》.2003,22(1)45-48
109. Saranummi, N., Demeesterb, M., Talens, A. F., Harrington, J., Heimly, V., Grandal, M.J. et al. Healthcare Information Framework. International Journal of Bio-Medical Computing 1995,39:99-104
110. Linsell, L., Dawson, J., Zondervan, K., Rose, P., Carr, A., Randall, T., et al. Pain and overall health status in older people with hip and knee replacement:a population perspective. Journal of Public Health.2006,28(3):267-273
111. Grundy, E., Glaser, K.,&Murphy, M. (2000). The importance of institutional populations in analyses of health in later life. In A. Dale (Ed.), Analyzing census microdata (pp.188-195). London:Arnold
112. Campbell SM, Braspenning J, Hutchinson A, Marshall M. Research methods used in developing quality indicators in primary care. Qual Saf Health Care 2002; 11: 358-364
113. Department ofHealth,1999. NHS R&D Strategic Review,Ageing and age associated diseases and disability. Department ofHealth, London
114. White, I. R., Blane, D., Morris, J. N.,&Mourouga, P.(I999). Educational attainment, deprivation-affluence and selfreported health in Britain: A cross sectional study. Journal of Epidemiology and Community Health,53,535-541
115. IOM:Institute of Medicine. Nursing Staff in Hospitals and Nursing Homes:Is It Adequate? Washington, D.C.:National Academy Press.1996
116. Paula Wilton, Richard D. smith. Primary care reform:a three countries comparison of'budget holding'. Health Policy 1998,44:149-166.
117. David K. Whynes, Darrin L. Baines. Primary care physicians attitudes to health care reform in England. Health Policy 2002,60:111-132.
118. Rachel Wilf-Miron, Zeev Rotstein, Shlomo Noy, etc. Newly implemented health system reform in Israel:Physician's attitudes. Health Policy 1999,49:137-147.
119. Donna M. Southern, Doris Young, David Dunt, etc. Integration of primary health care services:perceptions of Australian general practitioners, non-general practitioner health service providers and consumers at the general practice-primary care interface. Evaluation and program planning.2002,25:47-59.
120.匡远深,乔公先.意大利社区卫生服务见闻.《健康报》.2001.3.20
121.吴秀云等.城市居民社区卫生服务意向影响因素分析.《中国全科医学》.2000(3)；3：194。
122.张宏星等.6000名老年人社区卫生服务意向调查分析.《中国初级卫生保健》,1999(162)：11：18。
123.钱立群等.银川市老年人社区卫生服务需求调查分析.《疾病控制杂志》,2004(8)：49-51
124.刘万福.老年人口的医疗卫生服务需求及影响因素.《卫生行政管理》.2005(8)：51-52
125.高尔生.《医学人口学》,上海：复旦大学出版社.2004.10
126.武桂英,龚幼龙等.社区家庭卫生保健合同服务的持续发展探讨.《中国初级卫生保健》.1999(13)8：9
127.卫生部卫生经济研究所.《中国卫生改革与发展战略高层研讨会专集》.内部资料,P174
128. Kenneth Hill, Dawn M. Upchurch. Gender Differences in Child Health:Evidence from the Demographic and Health Surveys. Population and Development Review. 1995,21(1):127-151
129.卫生部.《国家卫生服务研究》.内部资料.1999年7月.P36。
130.曲镭.老年病的康复.《中国全科医学杂志》.2000(3)1：4-5
131.王焕强等.北京市朝阳区老年人就诊机构的利用和意向分析.《中国初级卫生保健》.2002(16)8：6-7
132.郭清等.普及社区卫生服务的障碍和所需配套政策研究.《中国卫生事业管理》.1999(8)：893
133.张宏星等.6000名老年人社区卫生服务意向调查分析.《中国初级卫生保健》.1999(13)11：18-19
134. Theo Lippeveld, Rainer Sauerborn,Claude Bodart. Design and implementation of health information systems. World Health Organization.Geneva.2000:1-3.
135. Newbrander W. Thomason JA. Computerizing a national health system in Papua New Guinea. Health Policy and Planning.1978,3:255-259
136.申一帆等.1000名老年人卫生服务需求及社区卫生服务意向研究.《中华医院管理杂志》.1999(15)12：713-715
137.储焰云,汪光亮.面对我国人口老龄化的社区卫生服务.《中国卫生》.2000.8.20。
138.陈方武等.老年人卫生服务需求情况分析.《卫生软科学》.2007(21)4：346-348
139.武桂英,龚幼龙等.社区家庭卫生保健合同服务的持续发展探讨.《中国初级卫生保健》.1999(13)8：10
140. Carpenter I.Gamhassi G.Topinkova E.et al.,Community care in Enrope. The Aged in Home care project. Aging Clin Exp Res,2004,16(4):259-269
141. WHO Study Group.Home-based long term care. Geneva. World Health organ Tech Rep Ser.2000:1-43
2. United Nations Department of Economic and Social Affairs, Population Division. World population prospects:The 2004 revision.2005. www.un.org/esa/population/ publications/wpp2004/23004 Highlights_finalre vised. pdf(accessed 19 Apr 2006)
3. Blackman DK, Kamimoto LA, Smith SM. Overview:surveillance for selected public health indicators affecting older adults. United States MMWR 48 (SS08) 1999,1-6
4. Charlton, K.1998. Health, health care and ageing in Africa:challenges and opportunities. Editorial. OECD (2004). DECD health data 2004 user's guide:A comparative ananlysis of 30 Countries. http://www.oecd.org/dataoecd/60/25/ 31819753.pdf.03-Jun-2004Southern African Journal of Gerontology,7(2):1-3.
5. Sengupta M, Agree EM. Gender, health, marriage and mobility difficulty among older adults in India. The Gerontologist,2004; Vol.44 (1):481- 482
6. WHO. Annex Table l:Basic indicators for all WHO member states. Available from: http://www. who.int/whr/2005/annex/en/index.html,25/07/2006
7. N.A.1997. Ageing in Africa. Geneva:World Health Organisation.
8. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Diabetes in the elderly. Clinical Practice Guidelines,2003, S 106-S 107
9. Ahenkora, K.1999. The contribution of older people to development:the Ghana study. London:Help Age International. Apt
10. WHO,WHA58/2005/REC/1, WHA58.16加强积极和健康的老龄化：88-91
11.杜鹏.中国,谁来养老?.厦门鹭江出版社.2000年版
12.汤哲等.北京市老年人卫生服务需求研究.中华医院管理杂志[J].2004(20)8：464-469
13. Chronic Conditions:A challenge for the 21st century. National Academy on an Aging Society. November 1999
14. Manton,K.,and X.L.Gu.Analysis from the National Long Term Care Survey. Proceedings of the National Academy of Sciences.May 8,2001
15. ElizabethVierck, Kris Hodges, Aging:Demographics, Health and Health Services, Greenwood Press, London,2004,P127
16. Institute for the Future:Health and Health Care 2010,P260
17.钱立群等.银川市老年人社区卫生服务需求调查分析.疾病控制杂志[J].2004(8)：49-51
18.刘万福.老年人口的医疗卫生服务需求及影响因素.卫生行政管理[J].2005(8)：51-52
19. Brody S J, Masciocchi C. Commentary data for long-term care planning by health systems agencies. AmJ Public Health,1980,70:1194-1198
20.姜向群等.对我国当前人口老龄化问题研究的概念和理论探析.人口学研究[J].2004(147)5：10-13
21. Sengupta M, Agree EM. Gender, health, marriage and mobility difficulty among older adults in India. The Gerontologist,2004; Vol.44 (1):481-482) (WHO. Annex Table l:Basic indicators for all WHO member states. Available from:http://www.who.int/ whr/2005/annex/en/index.html,25/07/2006
22. OECD (2004). DECD health data 2004 user's guide:A comparative ananlysis of 30 Countries. http://www.oecd.org/dataoecd/60/25131819753.pdf.03-Jun-2004
23.金大鹏等.《全科医师实用手册》.中央广播电视大学出版社.1999年8月：787
24. Blackman DK, Kamimoto LA, Smith SM. Overview:surveillance for selected public health indicators affecting older adults. United States MMWR 48 (SS08).1999,1-6) (Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Diabetes in the elderly. Clinical Practice Guidelines,2003, S 106-S 107
25. Kuo T, Torres-Gi F M. Factors Affecting Utilization of Health Services and Home-and Community-Based Care Programs by Older Taiwanese in the United States. Research on Aging,2001,23:14-36)
26. WHO Integration of health care delivery.Report of a WHO study group Genva, World Health Organization,1996:22
27.孙晓明等.上海社区卫生服务实践与研究.中国卫生政策[J].1999(11)：19.
28.孔灵芝.慢性非传染性疾病防治与社区卫生服务.中国慢性病预防与控制[J].1988,6(1)：35
29. OECD Health Division. OECD Health Data 2007-Frequently Requested Data. http:// www.oecd.org/document/16/0,3343, en_2825_495642_2085200_1_1_1_1,00.html
30. Technical Steering Committee.GP Earnings and Expenses Enquiry 2005/06 Initial Report, http://www.ic.nhs.uk/webfiles/publications/
31. Sitzia J, Wood N. Patient satisfaction:A review of issues and concepts. Social Science and Medicine 1997,45:1829-43
32. Irvine, B. Background Briefing on US Healthcare, Health Policy Consensus Group.2002
33. Borger, C., S. Smith, et al. Health Spending Projections Through 2015:Changes On The Horizon. Health Affairs-Web Exclusive:2006. W61-W73.
34. Health, United States,2006.Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey
35. Australian Government Productivity Commission. Economic Implications of an Aging Australia,2005
36. Department of Foreign Affairs and Trade. Health Care in Australia. http://www. dfat. gov. au/facts/healthcare.html/
37. Australian Government Department of Helth and Ageing. Health and Ageing Factbook 2006. http://www.aodgp.gov.au/
38. The Scottish Government. Health and Community Care Trends. http://www. scotland. gov.uk/Topics/Statics/Browse/Health
39. The Royal New Zealand College of General Practitioners, Forecasting; Workforce Capacity:Towards an Understanding of GP Workforce Capacity, long-term forecasting and benchmarking tools, http://www. Rnzcgp. org. nz/documents/workforce Capacity_OP8_4WEB.pdf
40. Australian Institute of Health and Welfare:Annual report 2006-07.http:// www.healthworkforce.health.nsw. gov. au
41.陈方武等.老年人卫生服务需求情况分析.卫生软科学[J].2007(4)
42. Health Authority,Redesign Accomplishments,A Four-Year Picture. Better Care for Seniors. September 2005
43. MURRAY, C. FRENK, J.World Health Report 2000:A step towards evidence-based health policy. Lancet,2001,357:1698-1700.
44.王放.中国人口老龄化与老年社会服务.中国青年政治学院学报[J].2004(3)：134-138
45.李斯.曹云清.中国人口老龄化对老年社会保障体系的挑战.科学与管理[J].2008(4)：9-10
46. Fraser, S., Bunce, C., Wormald, R. and Brunner, E.,2001.Deprivation and late presentation of glaucoma:Case-control study. British Medical Journal.322:639-643
47. Pameal M. Jolicoour & Teresa, Madden. The good daughters:Acceultumtion and caregiving among Mexican-American women [J]. Journal of Aging Studies,2002(16): 107-120.
48.李琴.改善民生视角下的我国政府社会管理改革探讨.湖北经济学院学报(人文社会科学版)[J].2008(5)：11-12
49. R.C. Burack, P.A. Gimotty. 'Promoting Screening Mammography in Inner-City Settings:The Sustained Effectiveness of Computerized Reminders in a Randomized Controlled Trial.'Medical Care.1997,35(9):921-931
50. Keigher, S, and R.I. Stone. Payment for Care in the U.S.:A Very Mixed Policy Bag. Paper presented at the International Meeting on Payment for Dependent Care, Vienna, Austria.1992,71-98
51. Kenney, G, S. Rajan, S. Soscia. State Spending for Medicare and Medicaid Home Care Programs. Health Affairs.1998,17(1):201-212
52. Jackson, B., and P. Doty. Unmet and Undermet Need for Functional Assistance among the U.S. Disabled Elderly. Paper presented at the annual meeting of the Gerontological Society of America, Cincinnati.1997
53. Kane, R.A., R.L. Kane, L.H Illston, J. Nyman, and M Finch. Adult Foster Care for the Elderly in Oregon:A Mainstream Alternative to Nursing Homes? American Journal of Public Health,1991,81 (9):1113-1120
54. Kane, R.L., R.A. Kane, M. Finch, et al. S/HMOs, the Second Generation:Building on the Experience of the First Social Health Maintenance Organization Demonstrations. Journal of the American Geriatrics Society,1997,45(1):101-107
55. Kane, R.A., R.L. Kane, R.L., and R.C. Ladd. The Heart of Long-Term Care. New York:Oxford University Press.1998
56. Kane, R.A. Boundaries of Home Care:Can a Home-Care Approach Transform LTC Institutions? In Fox and Raphael, eds.1997,23-46
57. Linda B. Haas, PhC, RN, CDE. Caring for Community-Dwelling Older Adults With Diabetes:Perspectives From Health Care Providers and Caregivers. Diabetes Spectrum Volume 19, Number 4,2006,240-244
58. Lennart Bogg. Health care financing in China:equity in transition. [M]Stockholm, 2002
59. Betbeder-Matihet L, Fridgant Y Harris MF, et al. Where's the conlln On ground? A survey of hospitals, community health centres and divisions of general practice in Australia. Australian Family Physician,2000,29(4):378-83.
60. Anell A. Persson M. International comparisons of health care resources. Lakartidningen,1998,95(30-31):3315-8
61. Imm IE, V enneman Mr. Supplementing state and national health care work force planning:a regional effort. J Allied Health,1998,27(2):77-82
62. Mal DB, Plant AJ, Toussaint S. I have learnt a different way of looking at People s health:all evaluation of a prevocational medical training program in public health medicine and primary health care in remote Australia. Medical Teacher,2006,28(6): 149-55
63. Norman I. Inter-professional educmion for pre-registration students in the health professions:recent developments in the UK and emerging lessons. International Journal of Nursing Studies.2005,42(2):119-23
64. Ranz J,Stueve a,Mcquistion H L.The role of the psychi-atrist job satisfaction of medical directors and staff psychiatrists [J]. Community Mental Health Journal 2001,37(6):25-39.
65. Leigh JP, Kravitz RL,Schembri M. Physician career satisfaction across specialties[J]. Arch Intern Mel.2002 Jul 22;162(14):1577-1584.
66. Garcia-Altes A, Borrell C, Cote L, Plaza A, Benet J, Guarga A. Measuring the performance of urban healthcare services:results of an international experience.J Epidemiol Community Health.2007 Sep;61(9):791-6
67. Australian Primary Health Care Research Institute. Integration, Co-ordination & Multidisciplinary Care in Australia:growth via optimal governance arrangements. http: //www.anu.edu.au
68. Rummery, K. and Coleman, A. Primary health and social care services in the UK: progress towards partnership? Social Science and Medicine 2003,56:1773-1782.
69. Star eld, B. and Shi, L. Policy relevant determinants of health:an international perspective, Health Policy.2002,60(3):201-18
70. Average Annual Expenditures Per Consumer for Health Care:1990-2003. http://www.infoplease.com/ipa/A0931275. html/
71. Thai Than Dang, Pablo Antolin & Howard Oxley, Fiscal Implications of Ageing: Projections of Age-Related Spending, OECD EconomicsDepartment Working Papers 305, OECD Economics Department.2001
72. SteveLeeder et al. Arace against time:the challenge of cardio Vascular diserase in developing economies. New York, Columbia University,2004
73. Rabinowitz HK, Diamond JJ, Markham FW, Paynter NP. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA.2001 Sep 5;286(9):1041-8.
74. Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle-and low-income countries:aliterature review of attraction and retention. BMC Health Servres.2008;8:19
75. Denham, L.A., & Shaddock, A.J.(2004). Recruitment and retention of rural allied health professionals in developmental disability services in New South Wales. Australian Journal of Rural Health,12(1):28-29.
76. [64] Farrah J. Mateen. Future practice location and satisfaction with rural medical education:Survey of medical students. Can Fam Physician.2006 September 10;52(9): 1106. Published online 2006 September 10.
77. Aday L. A.Anderson R., M. Aframework for the study of access to medical care
78. Stephen J. Willisms, Paul R. torrens. Introduction to Health Service.5 edition. U. S. A Delmar Publishers.1999:88--108
79. Ander G F., Hurst J. Husser PS, et al. Health spending and outcomes:Trends in OECD countries,1960-1998. Health Af. Fairs,19(3):150-157,2000
80. Wan-Tzu Connie Tai, Frank W Porell, and E Kathleen Adams. Hospital Choice of Rural Medicare Beneficiaries:Patient, Hospital Attributes, and the Patient-Physician Relationship Health Servres.2004 December; 39(6 Pt 1):1903--1922.
81. Rosalind Coleman, Louie Loppy, & Gijs Walraven. The treatment gap and primary health care for people with epilepsy in rural Gambia. Bulletin of the World Health Organization 2002,80(5),378-383
82. Muller CF. Economic costs of illness and health policy[J], Am J Public Health, 1980,70(12):1245-1246.
83.曹元应.全面推进社区卫生服务体系建设.安徽卫生职业技术学院学报[J].2009(8)2：5-6
84. Koolman X, van Doorslaer E, on the interpretation of a concentratjon index of inequality [J]. Health Economics 204,13 (7)
85. J. VEILLARD, F. CHAMPAGNE, N. KLAZINGA A,et al. performance assessment framework for hospitals:the WHO regional office for Europe PATH project. Internationa Journal for Quality in Health Care,2005,17,(6):487-496
86. Alliance of Health Policy and System Research Stlengthening health system, the role & promise of policy & systems research[R].Monogmph,2004
87. Evans.D,Tandon.A,Murry.C.et al. Comparative efficiency of National Health Systems: Cross-national econometric analysis, British Medical journal,2001,323(1):307-310
88. Provan K.G, Milward H.B. Apreliminary theory of inter organizational effectiveness [J]. Administrative Science Quarterly,1995,40(1):1-33
89. Organisation for Economic Co-Operation and Development, 《Measuring Up: Improving Health System Performance in OECD Countries》. OECD Publishing, 2002,Chapter1:P8
90. Measuring up. Improving health system performance in OECD countries. In: Proceedings of conference "Measuring up:improving health system performance in OECD countries,5-7 Nov.2001, Ottawa". Paris, OECD,2002
91.史萌.中国社区卫生服务的制度选择.中国卫生事业管理[J].2009(4)：229-231,245
92.邓大凤.某城区社区卫生服务与可持续发展探讨.中国医疗前沿[J].2009(8)：138-139
1.安南.建立不分年龄.人人共享的社会.《中国老年》.1998(11)
2.张小溪.从容面对老龄化社会.《决策》2006(11)：38-39
3.张卫.人口老龄化与完善城市老年社会保障体系.《现代经济探讨》2001(12)：28-30
4.姜向群等.《对我国当前人口老龄化问题研究的概念和理论探析》.人口学研究.2004(147)5：10-13
5.金大鹏等.《全科医师实用手册》.中央广播电视大学出版社.1999年8月.P787
6. 阎安.联合国老龄行动历程和主要经验.《社会工作》.2006年第十期下半月.P20-24
7. WHO.WHA58/2005/REC/1.WHA58.16加强积极和健康的老龄化.P88-91
8.张文范.《我国人口老龄化与战略性选择》.载于《中澳中国人口老龄化宏观对策研讨会论文集》.P1-7
9. 李玉玲.我国老年弱势群体的现状及救助对策分析.西北人口.2007(2)
10.杜鹏.《中国, 谁来养老?》.厦门鹭江出版社.2000年版
11. Cheng YH.Chi I. Boey KW. Ko LS. Chou KL. Self-rated economic condition and the health of elderly persons in Hong Kong. Soc Sci Med.2002.Oct.55(8):1415-1424
12.郭清.《社区卫生服务理论与实践》.暨南大学出版社.2000(3)：1
13.蒋烽.促进人类健康的社区卫生服务.《中国妇幼保健》.1997(12)：25-27
14.刘伟红.从“自然而治”到“自觉而治”：社区自治问题再探讨.《行政与法》.2008(1)：55-58
15.徐庆文.社区自治：理想与现实.《民政论坛》.2001(3)：18-24
16.侯钧生,陈钟林.《发达国家与地区社区发展经验》.机械工业出版社.2004年版
17.王明美.社区建设的中外比较研究.《江西社会科学》.2007(8)：151-158
18.邹明洪.城市化进程中社区建设面临的主要问题与对策分析.《江西社会科学》.2005(6)
19.李长明.《社区卫生服务文献汇编》.内部资料.2000(5)：74
20.梁浩材.跨世纪的卫生战略：论社区卫生服务.《中国卫生政策》.1996.11.11
21. WHO. Integration of health care delivery. Report of a WHO study group. Genva, World Health Organization,1996:22.
22.孙晓明等.上海社区卫生服务实践与研究(上).《中国卫生政策》1999(11)：19
23.孔灵芝.慢性非传染性疾病防治与社区卫生服务.《中国慢性病预防与控制》.1988,6(1)35.
24.杨涛.全国城市社区卫生服务联系点研讨会纪要.《中国初级卫生保健》199913(8)11.
25.专稿.2002年卫生部基层卫生与妇幼保健司工作要点.《中国初级卫生保健》 20024(16)1.
26.龚幼龙,冯学山.主编.《卫生服务研究》.第一版.上海.复旦大学出版社.2002.319.
27.仇雨临,孙树菡.主编.《医疗保险》.第一版.北京.中国人民大学出版社.2001.83.
28.李惠娟,季正明.《社区卫生服务实用手册》.第一版.上海.复旦大学出版社2002.17
29.何宪平.社区卫生服务的基本特点和宏观意义.《社区医学杂志》2008年6卷第10期
30. Drummond M.OBrien B, Stoddart G.etal.Methods for the Economic Evaluation of Health Care programmers[M]. oxford:oxford University Press,1997
31. Krahn M. principles of Economic Evaluation in Surgery[J]. World J Surg,1999, (23):1242
32.颛慧琳等.关于我国城市社区卫生服务发展的思考.《经济问题》2008(6)：127-129
33.卫生部基层卫生与妇幼保健司.《社区卫生服务进展、问题与对策》.内部资料.2000年7月.P1-2
34.任苒,初伟,周玲等.城市居民社区卫生服务需求意愿及影响因素分析.《卫生经济研究》2001(4)：3-5.
35. Electronic Health Record Definition, Scope and Context. ISO/TC 215 Technical Report, First Draft, July 2003. http://www.iso.org.2007.6.29
36. R. Hillestad, J. Bigelow, A.Bower, et al. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs Health Affairs. 2005,24,(5):1103}1117.
37. J.H. Bigelow et al., Analysis of Healthcare Interventions That Change Patient Trajectories (Santa Monica, Cali#:BAND,2005
38.]S.J. Wang et al., A Cost-Benefit Analysis of Electronic Medical Records in Primary Care, American Journal of Medicine,2003,114(5):397-403
39. D.W. Bates et al., Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors, Journal of the American Medical Association 1999,280(15):1311 - 1316.
40. D. Johnston et al., Patient Safety in the Physician's Office:Assessing the Value of Ambulatory CPOE, April 2004,www.chcf.org/tonics/view.cfm?itemID-101965.2007.5.31
41. S.J. Wang et al., A Cost-Benefit Analysis of Electronic Medical Records in Primary Care, American Journal of Medicine,2003,114(5):397-403
42. E.A. McGlynn et al., The Quality of Health Care Delivered to Adults in the United States, New England Journal of Medicine,2003,348(26):2635-2645
43. R.C. Burack and P.A. Gimotty. Promoting Screening Mammography in Inner-City Settings:The Sustained Effectiveness of Computerized Reminders in a Randomized Controlled Tria. Medical Care,1997,35(9):921-931
44. B. Kaplan, Evaluating Informatics Applications-Clinic Decision Support Systems Literature Review. International Journal of Medical Informatics.2001,64(1):15-37
45. Heslop, A.1999. Poverty and livelihoods in an ageing world. In:Randel, J., German, T. &Ewing, D. (Eds). The ageing and development report:poverty, independence and theworld's older people. London:Earthscan Publications, pp.22-32
46. Ikegami, N., Morris, J.N.&Fries, B.E. Low-care cases in long-term care settings: variation among nations. Age&Ageing,1997,26(suppl 2):67-71
47. Dylan G. Harwood, Warren W. Barkcr, Raymond L. Ownby, Ranjan Duara. Caregiver self-rated health in alzheimer's disease. Clinical Gerontologist,2000,21(4):19-33.
48. B. Kaplan. Evaluating informatics applications-clinic decision support systems literature review. International journal of medical informatics.2001,64(1):15-37
49. Paul R.Kowal, P.V.Chalapati Rao and Colin Mathers.Creating a minimum data set on agieng in sub-Saharan Africa.Preport on a WHO workshop Pretoria, South Africa,12- 14 February,2004
50. WHO Integration of Health Care Delivery. Report of a WHO Study Group. Geneva, World Health Organization.1996:(WHO Technical Report Service, No891)22
51. Colledge MJ. Statistical integration through metadata management. Internat stat rev. 1999; 67:79-98
52. John P. Hirdes, Dinnus H. Frijters and Gary F.Teare. The MDS-CHESS Scale:A New Measure to Predict Mortality in Institutionalized Older People.JAGS 2003,51:96-100.
53. Zheng-Bo Huang, Richard R.Neufeld, Atonios Likourezos, Brenda Breuer, Albert Khaski, Evelin Milano and Leslie S.Libow. Sociodemographic and health characteristics of older Chinese on Admission to a nursing home:Across-Racial/Ethnic study. JAGS,2003,51:404-409.
54. Kowal, P.R, Wolfson, L.J. and Dowd, J.E. Creating a Minimum Data Set on Ageing in Sub-Saharan Africa. Southern African Journal of Gerontology,2000,9, (2):18-23.
55. Munsch CM. Managing the measurement:A model of data support in an integrated delivery system Journal of Nursing Care Quality; Gaithersburg; Jan 2002; 16(2):1-9.
56. Blewitt, Darby K. MS, RNC; Jones, Katherine R. PhD, RN, FAAN Using Elements of the Nursing Minimum Data Set for Determining Outcomes. Journal of Nursing Administration.26(6):48-56, June 1996.
57. Saba M. Overview of nursing information systems. In:Werley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company, Inc.; 1988:89-102.
58. Shaw C. External assessment of health care British Medical Journal; London; Apr 7, 2001;7290;851-854.
59. Provisional list of indicators for consideration (for inclusion in a Minimum Data Set) Paul R. Kowal, Lara J. Wolfson and John E. Dowd. (2002)Creating a Minimum Data Set on ageing in sub-Saharan Africa. World Health Organization, Geneva, Switzerland
60. Relman AS. Assessment and accountability:the third revolution in medical care. N Engl J Med.1988; 319(18):1220-1222.
61. Jan Stevenson. Comprehensive Assessment of Older People. Managing Community Care,1999,9:3-22.
62. Callahan D. Aging, death, and population health.JAMA; Chicago; Dec 1,1999; 282(21):2077
63. World Health Organization.2004. Report on a WHO Workshop:Minimum Data Set on Ageing in Sub-Saharan Africa. Pretoria, South Africa. February 12-14,2003.Geneva: WHO, Evidence and Information for Policy
64. Rantz, M. J. Petroski, G F., Madsen, R. W., Mehr, D. R., Popejoy, L., Hicks, L. L. Porter, R., Zwygart-Stauffacher, M.&Grando, V. Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports:an update. JointCommission Journal on Quality Improvement,2000,26(2):101 - 110
65. Rantz, M.J., Popejoy, L., Zwygart-Stauffacher, M., Wipke-Tevis, D.&Grando, V.T. Minimum Data Set and resident assessment instrument. Can usingstandardized assessment improve clinical practice and outcomes of care? Journal of Gerontological Nursing,1999,25(6):35-43
66. Ribbe, M.W., Ljunggren, G, Steel, K., Topinkova, E., Hawes, C., Ikegami, N., Henrard, J.C. & Johnson, P.V. Nursing homes in 10 nations:a comparison between countries and settings. Age& Ageing,1997,26(suppl.2):3 -12
67. World Health Organisation (WHO). Monitoring reproductive health:selecting a short list of national and global indicators. WHO Technical Report.1997, Ref. WHO/RHT/HRP/97.256. Geneva:World Health Organisation.
68. WHO. Information Needs for Research, Policy and Action on Ageing and Older Adults:report of a workshop on creating a minimum data set (mds) for research, policy and action on ageing and the aged in Africa, Harare, Zimbabwe,2000:40-42
69.刘艳,吴群鸿.哈尔滨市社区卫生服务需求利用及影响因素分析.《医学与社会》2002,15(1)11-13.
70.罗力,郝模,吴延风等.社区卫生人力定性和定量分析.《中华医院管理杂志》1998,15(8)471-472.
71.曹亦农,朱秀萍,谢征.关于社区卫生服务人力资源开发的思考与探讨.《中国全科医学杂志》2000,3(1)33-34.
72.褚詹玄,秦美娇,胡函锦等.上海市社区卫生服务中心人力资源调查与分析.《上海第二医科大学学报》.2002,22(5)468-470.
73.杨苿,来则民.天津市全科医学人力资源的状况分析.《天津医科大学学报》.2001,7(4)481-482.
74.武桂英,龚幼龙,卢福今等.上海市社区卫生服务站建站费用房屋与设备配置情况分析.《中国初级卫生保健》1999,13(6)14-16.
75.李士雪,董海东,王舒宏.山东省社区卫生服务中心(站)的配置现状及功能发挥.《中国卫生经济》1999,18(8)17-19.
76.杨辉,李曼春,张拓红等.我国城市社区卫生服务现状的快速调查结果分析.《中国初级卫生保健》.1999,13(8)3-7.
77.钟天伦,黄毓明,方华贵.深圳宝安区社区卫生服务质量评价.《中国初级卫生保健》.1999,13(4)18-20.
78.梁万年,杨兴华,王虹.中国城市社区卫生服务评价指标体系的应用.《中国卫生事业管理》.2002,11 644-646.
79.郭清,唐继志,马海燕等.城市社区卫生服务评价指标研究.《中国社区医学》.2001,7(4)12-13.
80. Apt, N.A.1997. Ageing in Africa. Geneva:World Health Organisation.
81. Provisional list of indicators for consideration for inclusion in a Minimum Data Set) Paul R. Kowal, Lara J. Wolfson and John E. Dowd. (2002)Creating a Minimum Data Set on ageing in sub-Saharan Africa. World Health Organization, Geneva, Switzerland
82. Ikegami, N, Morris, J.N.&Fries, B.E.1997. Low-care cases in long-term care settings: variation among nations. Age&Ageing,26(suppl.2):67-71.Ribbe, M.W., Ljunggren, G, Steel, K., Topinkova, E., Hawes, C., Ikegami, N., Henrard, J.C. & Jonnson, P.V. 1997. Nursing homes in 10 nations:a comparison between countries and settings. Age & Ageing,26(suppl.2):3-12
83. ORLYGSDOTTIR, BRYNJA RN, MSN Use of NIDSEC-Compliant CIS in Community-Based Nursing-Directed Prenatal Care to Determine Support of Nursing Minimum Data Set Objectives. CIN:Computers, Informatics, Nursing.25(5):283-293, September/October 2007
84. Callahan D. Aging, death, and population health.JAMA; Chicago; Dec 1, 1999;282(21):2077-2079
85. Shaw C. External assessment of health care British Medical Journal; London; Apr 7, 2001; 7290; 851-854
86. Munsch CM:Managing the measurement:A model of data support in an integrated delivery system Journal of Nursing Care Quality; Gaithersburg; Jan 2002; 16(2):1-9
87. Blewitt, Darby K. MS, RNC; Jones, Katherine R. PhD, RN, FAAN Using Elements of the Nursing Minimum Data Set for Determining Outcomes. Journal of Nursing Administration.26(6):48-56, June 1996
88. Saba M. Overview of nursing information systems. In:Werley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set.New York, NY:Springer Publishing Company, Inc.; 1988:89-102
89. Delaney C, Moorhead S. The nursing minimum data set, standardized language, and health care quality. J Nurs Care Qual.1995;10(1):16-30
90. Wan TTH. Analysis and Evaluation of Health Care System:An Integrated Approach to Managerial Decision Making. Baltimore:Health Professions Press; 1995.
91. Gallant BJ. Data Requirements for the nursing minimum data set as seen by a nurse administrator. In:West HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company Inc.; 1988:165-176
92. Sovie MD. Establishing the nursing minimum data set as a part of the data requirements for DRGs. In:Westley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company, Inc.;1988:300-312
93. Pearce ND. Uniform minimum health data sets:Concepts, development, testing, recognition for the federal health use and current status. In:Werley HH, Lang NM, eds. Identification of the Nursing Minimum Data Set. New York, NY:Springer Publishing Company, Inc.; 1988:122-132
94.李曼春,吴秀云,李菁晶等.社区卫生服务工作效率研究.《中华医院管理杂志》.200016(7)413-415.
95.郭清.英国社区卫生服务简介.《中国社区医学》.2001,7(4)103
96.魏荃.芬兰的卫生策略与社区服务.《中国慢性病预防与控制》
97.卢祖洵,孙奕,姚岚等.国外社区卫生服务焦点分析.中国全科医学.2002,5(3)209-211.
98.刘吉成.城市社区卫生服务模式的探讨.《中国医院管理》.2000,20(2)24-25.
99.殷祖泽,张企良,陈爱芳等.社区卫生服务新模式的思考与实践.《中国医院管理》.2000 20(1)45-45.
100.朱月伟.以医改为契机积极探索社区卫生服务新模式.中国社区医学.7(4)44-45.
101.吴秀云,李曼春,马凤云等.城市社区卫生技术人员社区卫生知识与技能需求调查.《中国卫生事业管理》.2000,135-37.
102.王声涌,荆春霞,池桂波.广东省城市社区全科医师培训模式探讨.《中国医院管理》.2003 23(3)57-59.
103.解军.全科医师必备知识技能现况调查及对策研究.《中国全科医学杂志》.2000,3(2)30-32.
104.傅华,王祝三,朱冰玲等.城市社区卫生服务可持续发展的对策探讨.《中国初级卫生保健》.1997 11(7)4-6.
105.鲍勇,龚幼龙,顾杏元等.上海市社区卫生服务中心可持续发展的研究.《中国卫生事业管理》.2000,138-40.
106.徐瑛,张广慧,刘军.社区卫生服务可持续发展思考.《中国卫生经济》.2001,20(11)54-55.
107.郝模,张勇,罗力等.促进社区卫生服务可持续发展的政策研究概述.《中国医院管理》.2001,21(9)3-4
108.陈文,吴凡,应晓华.社区基本预防服务的成本测算.《中国卫生经济》.2003,22(1)45-48
109. Saranummi, N., Demeesterb, M., Talens, A. F., Harrington, J., Heimly, V., Grandal, M.J. et al. Healthcare Information Framework. International Journal of Bio-Medical Computing 1995,39:99-104
110. Linsell, L., Dawson, J., Zondervan, K., Rose, P., Carr, A., Randall, T., et al. Pain and overall health status in older people with hip and knee replacement:a population perspective. Journal of Public Health.2006,28(3):267-273
111. Grundy, E., Glaser, K.,&Murphy, M. (2000). The importance of institutional populations in analyses of health in later life. In A. Dale (Ed.), Analyzing census microdata (pp.188-195). London:Arnold
112. Campbell SM, Braspenning J, Hutchinson A, Marshall M. Research methods used in developing quality indicators in primary care. Qual Saf Health Care 2002; 11: 358-364
113. Department ofHealth,1999. NHS R&D Strategic Review,Ageing and age associated diseases and disability. Department ofHealth, London
114. White, I. R., Blane, D., Morris, J. N.,&Mourouga, P.(I999). Educational attainment, deprivation-affluence and selfreported health in Britain: A cross sectional study. Journal of Epidemiology and Community Health,53,535-541
115. IOM:Institute of Medicine. Nursing Staff in Hospitals and Nursing Homes:Is It Adequate? Washington, D.C.:National Academy Press.1996
116. Paula Wilton, Richard D. smith. Primary care reform:a three countries comparison of'budget holding'. Health Policy 1998,44:149-166.
117. David K. Whynes, Darrin L. Baines. Primary care physicians attitudes to health care reform in England. Health Policy 2002,60:111-132.
118. Rachel Wilf-Miron, Zeev Rotstein, Shlomo Noy, etc. Newly implemented health system reform in Israel:Physician's attitudes. Health Policy 1999,49:137-147.
119. Donna M. Southern, Doris Young, David Dunt, etc. Integration of primary health care services:perceptions of Australian general practitioners, non-general practitioner health service providers and consumers at the general practice-primary care interface. Evaluation and program planning.2002,25:47-59.
120.匡远深,乔公先.意大利社区卫生服务见闻.《健康报》.2001.3.20
121.吴秀云等.城市居民社区卫生服务意向影响因素分析.《中国全科医学》.2000(3)；3：194。
122.张宏星等.6000名老年人社区卫生服务意向调查分析.《中国初级卫生保健》,1999(162)：11：18。
123.钱立群等.银川市老年人社区卫生服务需求调查分析.《疾病控制杂志》,2004(8)：49-51
124.刘万福.老年人口的医疗卫生服务需求及影响因素.《卫生行政管理》.2005(8)：51-52
125.高尔生.《医学人口学》,上海：复旦大学出版社.2004.10
126.武桂英,龚幼龙等.社区家庭卫生保健合同服务的持续发展探讨.《中国初级卫生保健》.1999(13)8：9
127.卫生部卫生经济研究所.《中国卫生改革与发展战略高层研讨会专集》.内部资料,P174
128. Kenneth Hill, Dawn M. Upchurch. Gender Differences in Child Health:Evidence from the Demographic and Health Surveys. Population and Development Review. 1995,21(1):127-151
129.卫生部.《国家卫生服务研究》.内部资料.1999年7月.P36。
130.曲镭.老年病的康复.《中国全科医学杂志》.2000(3)1：4-5
131.王焕强等.北京市朝阳区老年人就诊机构的利用和意向分析.《中国初级卫生保健》.2002(16)8：6-7
132.郭清等.普及社区卫生服务的障碍和所需配套政策研究.《中国卫生事业管理》.1999(8)：893
133.张宏星等.6000名老年人社区卫生服务意向调查分析.《中国初级卫生保健》.1999(13)11：18-19
134. Theo Lippeveld, Rainer Sauerborn,Claude Bodart. Design and implementation of health information systems. World Health Organization.Geneva.2000:1-3.
135. Newbrander W. Thomason JA. Computerizing a national health system in Papua New Guinea. Health Policy and Planning.1978,3:255-259
136.申一帆等.1000名老年人卫生服务需求及社区卫生服务意向研究.《中华医院管理杂志》.1999(15)12：713-715
137.储焰云,汪光亮.面对我国人口老龄化的社区卫生服务.《中国卫生》.2000.8.20。
138.陈方武等.老年人卫生服务需求情况分析.《卫生软科学》.2007(21)4：346-348
139.武桂英,龚幼龙等.社区家庭卫生保健合同服务的持续发展探讨.《中国初级卫生保健》.1999(13)8：10
140. Carpenter I.Gamhassi G.Topinkova E.et al.,Community care in Enrope. The Aged in Home care project. Aging Clin Exp Res,2004,16(4):259-269
141. WHO Study Group.Home-based long term care. Geneva. World Health organ Tech Rep Ser.2000:1-43