政府管制视角下城市社区卫生服务需求影响因素及对策研究
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摘要
城市社区卫生服务作为卫生事业的重要组成部分，得到党和政府的高度重视。然而，随着我国城市社区卫生服务的不断发展，居民对社区卫生服务需求日益增加，社区卫生服务供需矛盾也逐渐凸显。例如，城市社区卫生服务供需关系不平衡，城市社区卫生资源配置不合理、不能很好地满足城市居民的卫生服务需求。国家以及各级政府通过颁布相关政策法规完善城市社区卫生服务体系建设、保障城市社区卫生服务供给。政府在城市社区卫生政策制定、社区卫生资源配置和监管方面起到了至关重要的作用。
本文以政府管制理论、制度经济学理论、卫生服务需求理论为基础，研究市场环境下影响城市社区卫生服务机构运行与发展的原因，挖掘社区卫生机构的优势以及有利于社区卫生工作开展的影响因素。以吉林省长春市为例，研究城市社区卫生服务机构、社区居民、社区卫生服务中心人员、慢病患者对社区卫生服务的需求与利用情况。一方面，了解城市社区卫生服务机构运行现状及卫生服务利用情况，分析社区居民及慢病患者卫生服务需求的影响因素，探讨供需双方存在的矛盾，提出完善城市社区卫生服务发展，满足居民卫生需求的对策与建议。另一方面，通过研究政府管制视角下的城市社区卫生服务供需关系，构建相应的概念框架，从需求方的变化考虑供给方的适应对策，为完善社区卫生事业发展提供依据。
本文采用文献回顾法、实地调查法、问卷调查法，对长春市9个城区进行级分层整群抽样，采用描述性分析、趋势卡方检验与logistic回归分析对城市社区卫生服务需求与利用情况进行系统的分析。
理论研究结果，构建出政府管制下社区卫生服务需求及利用概念框架，即从理论上政府通过管制手段调整、改革、完善现有的社区卫生资源，向医疗市场提供经费支持，利用市场调节机制，提供相应的政策引导；同时，政府通过收集社区卫生服务供需双方的反馈信息，及时调整管制手段，满足居民的卫生需求。实证研究结果显示，长春市9个行政区共有户籍总人口数247.90万人，社区卫生服务中心51个，社区卫生服务中心的机构设置、人员编制不合理。药品收入所占业务收入比例的62.67%。2011年长春市9个行政区的上门出诊人次数与家庭病床数仅分别为20670与735个。双向转诊项目中转出人次与转入人次仅为2356与537人。408名社区卫生服务中心人员对社区卫生服务利用情况的调查结果显示，学历为大专及以下的占调查总数的65.94%，职称为中级以下的占调查总人数的87.50%，从业时间为1-3年的居多，占35.54%，高达49.50%的医务人员表示工资状况不满意。1461名社区居民对社区卫生服务需求的调查结果显示，65.71%的社区居民在患有一般常见病时会首选社区卫生服务中心就诊，其原因为医疗技术水平的提高（39.97%），服务态度好（34.77%），地理位置方便（17.18%），回归分析结果显示，居民是否选择社区卫生服务机构就诊与交通情况、医疗费用、药品价格、医务人员态度、等待时间、是否纳入医保报销范围等因素相关。居民的卫生需求依次为建立家庭病床（23.48%）、提供一名固定的、长期的全科医生（20.67%）、提供电话咨询（19.85%）。416名社区慢性病患者对社区卫生服务需求的调查结果显示：93.82%的社区慢病患者会选择在社区卫生服务机构就诊，且绝大多数选择在社区就诊的原因为价格便宜（42.28%）、离家近、交通方便（40.76%），未在社区卫生服务机构就诊的原因主要因为对医生的技术持怀疑的态度（占38.46%）、对社区卫生服务的内容不了解、利用率低（占30.77%）。回归分析结果显示，慢病患者是否选择社区卫生服务机构就诊与诊疗技术、交通情况、医药价格、服务态度、是否参加社区宣传及家庭月收入等因素相关。
研究表明，被调查的城市社区卫生服务机构资源没有得到充分的利用，社区卫生服务不能完全满足社区居民的卫生服务需求。社区居民利用社区卫生服务资源的影响因素按其优势排列依次为交通情况、医疗费用、药品价格、医务人员态度、就诊等待时间、是否纳入医保报销范围。社区卫生服务供需间存在差异，可以由政府调控解决。
基于上述的研究结果，应通过规范城市社区卫生服务机构设置及城市社区医疗、药品价格的制定、完善社区卫生服务机构监管体系等途径加强国家与各级政府对社区卫生服务机构的宏观调控；通过提升城市社区卫生服务中心人员综合素质与服务质量、加强社区内涵建设，从而进一步提升城市社区卫生服务能力；引导居民充分利用城市社区卫生服务，合理配置城市社区卫生服务资源，满足人民群众不断增长的卫生服务需求。
The city community health service is an important part of health, get the partyand government attach great importance. However, as our country city communityhealth service development, residents of community health service demand hasincreased, the contradiction between supply and demand of community health servicealso gradually highlight.
For example, the city community health service supply and demand imbalance,the city community health resources allocation is not reasonable, not good enough tomeet the city residents' health service needs. Countries and governments at all levelsthrough the related policy laws and regulations promulgated by perfecting the urbancommunity health service system construction, guarantee the city community healthservice supply. The government in the city community health policies, communityhealth resource allocation and regulatory played a crucial role.
In this paper the government control theory, institutional economics theory,health service demand theory as the foundation, the market environment impact ofurban community health service organization operation and development of reason,mining community health institutions advantage and be helpful for community healthwork to influence factors.
Changchun city in jilin province as an example, the study of urban communityhealth service institutions, community residents, community health service center staff,slow patients to community health service demand and utilization. On the one hand, tounderstand the city community health service organization operation status and healthservices utilization situation, analysis the community residents and slow patientshealth service demand, this paper discusses the influence factors of supply anddemand contradiction between the two sides, and puts forward the perfect citycommunity health service development, meet the residents health needs ofcountermeasures and Suggestions. On the other hand, through the researchperspective of government control of the city community health service supply anddemand relations, constructing the corresponding conceptual framework, from thechange of home-textile consider suppliers' adaptation measures, to improvecommunity health service provides the basis for the development.
Based on the literature review method, field survey method, questionnaire surveymethod, nine in changchun city for level stratified cluster sampling, using descriptiveanalysis, trend chi-square test and logistic regression analysis of urban communityhealth service demand and utilization system analysis.
Theoretical research results, construct the government control the communityhealth service demand and utilization conceptual framework, that is, from theory thegovernment through the control means adjustment, reform and improvement of theexisting community health resources and medical market to provide funding support,the use of market regulation mechanism, and provides the corresponding policyguiding, At the same time, the government through the collection of communityhealth service supply and demand both sides of the feedback information, timelyadjustment of control means, meet the residents' health needs. The empirical researchshows that there are nine administrative region of changchun city census register thetotal population of2.479million people, community health service center51,community health service center of the institutional setup, staffing is not reasonable.
The drug income accounted for62.67%of the proportion of the business income.2011changchun nine administrative region of the people to call number and domesticsickbed only number respectively for20670and735. Two-way referral projecttransfer out people and into the people only for2356and537.408community healthservice center staff to the community health service utilization survey results showthat education for college and the following accounted for65.94%of the total numberof investigation, the title for intermediate the following accounts for87.50%of thetotal number of investigation, from the time of1-3years in the majority,35.54%, upto49.50%of the medical staff said wage condition not satisfied.
1461community residents of community health service needs of the results ofthe survey showed that65.71%of the community residents in common with generalwill first community health service center to see a doctor, the reasons for the rise ofthe technical level of the medical treatment (39.97%), service attitude good (34.77%),the geographical position convenient (17.18%), regression analysis shows that theresidents choose whether community health service agencies to see a doctor andtraffic conditions, medical costs, the price of drugs, medical personnel attitude,waiting time, whether into the medical insurance reimbursement range related to suchfactors. Residents' health needs, in order to establish a home sickbed (23.48%), provide a fixed, long-term general practitioners (20.67%), provide telephonecounseling (19.85%).416patients with chronic diseases community to communityhealth service needs of the results of the survey showed that93.82%of thecommunity slow patients will choose in community health service agencies to see adoctor, and the vast majority of selection in community medical reasons for cheap(42.28%), near home, convenient transportation (40.76%), not in community healthservice institutions of medical reasons for the doctor's technology skeptical (38.46%),to the community health service content don't understand, utilization rate is low(30.77%). Regression analysis shows that the slow patients whether you choose tocommunity health service institutions and medical diagnosis and treatment technology,transportation, medical price, service attitude, whether to participate in communitypublicity and family income and other factors.
Research shows that, by investigation of the city community health serviceorganization resources has not been fully utilized, and community health servicecannot fully meet the needs of the community health service. Community residentstake use of community health service resources influence factors according to theiradvantage in the order the traffic, medical costs, the price of drugs, medical personnelattitude, see a doctor waiting time, whether into the medical insurance reimbursementrange. Community health service the differences between the supply and demand, thegovernment regulation to solve.
Based on the above research results, should be through the standard citycommunity health service organization setup and urban community medical,pharmaceutical price formulation, perfect the community health service organizationsupervision system way to strengthen countries and governments at all levels to thecommunity health service organization of macroeconomic regulation and control; Throughascension city community health service center personnel comprehensive quality and servicequality, strengthen community connotation construction, in order to further promote the urbancommunity health service ability; Guide people to make full use of urban community healthservices, reasonable distribution of urban community health service resources, and satisfy thepeople's growing health service needs.
本文以政府管制理论、制度经济学理论、卫生服务需求理论为基础，研究市场环境下影响城市社区卫生服务机构运行与发展的原因，挖掘社区卫生机构的优势以及有利于社区卫生工作开展的影响因素。以吉林省长春市为例，研究城市社区卫生服务机构、社区居民、社区卫生服务中心人员、慢病患者对社区卫生服务的需求与利用情况。一方面，了解城市社区卫生服务机构运行现状及卫生服务利用情况，分析社区居民及慢病患者卫生服务需求的影响因素，探讨供需双方存在的矛盾，提出完善城市社区卫生服务发展，满足居民卫生需求的对策与建议。另一方面，通过研究政府管制视角下的城市社区卫生服务供需关系，构建相应的概念框架，从需求方的变化考虑供给方的适应对策，为完善社区卫生事业发展提供依据。
本文采用文献回顾法、实地调查法、问卷调查法，对长春市9个城区进行级分层整群抽样，采用描述性分析、趋势卡方检验与logistic回归分析对城市社区卫生服务需求与利用情况进行系统的分析。
理论研究结果，构建出政府管制下社区卫生服务需求及利用概念框架，即从理论上政府通过管制手段调整、改革、完善现有的社区卫生资源，向医疗市场提供经费支持，利用市场调节机制，提供相应的政策引导；同时，政府通过收集社区卫生服务供需双方的反馈信息，及时调整管制手段，满足居民的卫生需求。实证研究结果显示，长春市9个行政区共有户籍总人口数247.90万人，社区卫生服务中心51个，社区卫生服务中心的机构设置、人员编制不合理。药品收入所占业务收入比例的62.67%。2011年长春市9个行政区的上门出诊人次数与家庭病床数仅分别为20670与735个。双向转诊项目中转出人次与转入人次仅为2356与537人。408名社区卫生服务中心人员对社区卫生服务利用情况的调查结果显示，学历为大专及以下的占调查总数的65.94%，职称为中级以下的占调查总人数的87.50%，从业时间为1-3年的居多，占35.54%，高达49.50%的医务人员表示工资状况不满意。1461名社区居民对社区卫生服务需求的调查结果显示，65.71%的社区居民在患有一般常见病时会首选社区卫生服务中心就诊，其原因为医疗技术水平的提高（39.97%），服务态度好（34.77%），地理位置方便（17.18%），回归分析结果显示，居民是否选择社区卫生服务机构就诊与交通情况、医疗费用、药品价格、医务人员态度、等待时间、是否纳入医保报销范围等因素相关。居民的卫生需求依次为建立家庭病床（23.48%）、提供一名固定的、长期的全科医生（20.67%）、提供电话咨询（19.85%）。416名社区慢性病患者对社区卫生服务需求的调查结果显示：93.82%的社区慢病患者会选择在社区卫生服务机构就诊，且绝大多数选择在社区就诊的原因为价格便宜（42.28%）、离家近、交通方便（40.76%），未在社区卫生服务机构就诊的原因主要因为对医生的技术持怀疑的态度（占38.46%）、对社区卫生服务的内容不了解、利用率低（占30.77%）。回归分析结果显示，慢病患者是否选择社区卫生服务机构就诊与诊疗技术、交通情况、医药价格、服务态度、是否参加社区宣传及家庭月收入等因素相关。
研究表明，被调查的城市社区卫生服务机构资源没有得到充分的利用，社区卫生服务不能完全满足社区居民的卫生服务需求。社区居民利用社区卫生服务资源的影响因素按其优势排列依次为交通情况、医疗费用、药品价格、医务人员态度、就诊等待时间、是否纳入医保报销范围。社区卫生服务供需间存在差异，可以由政府调控解决。
基于上述的研究结果，应通过规范城市社区卫生服务机构设置及城市社区医疗、药品价格的制定、完善社区卫生服务机构监管体系等途径加强国家与各级政府对社区卫生服务机构的宏观调控；通过提升城市社区卫生服务中心人员综合素质与服务质量、加强社区内涵建设，从而进一步提升城市社区卫生服务能力；引导居民充分利用城市社区卫生服务，合理配置城市社区卫生服务资源，满足人民群众不断增长的卫生服务需求。
The city community health service is an important part of health, get the partyand government attach great importance. However, as our country city communityhealth service development, residents of community health service demand hasincreased, the contradiction between supply and demand of community health servicealso gradually highlight.
For example, the city community health service supply and demand imbalance,the city community health resources allocation is not reasonable, not good enough tomeet the city residents' health service needs. Countries and governments at all levelsthrough the related policy laws and regulations promulgated by perfecting the urbancommunity health service system construction, guarantee the city community healthservice supply. The government in the city community health policies, communityhealth resource allocation and regulatory played a crucial role.
In this paper the government control theory, institutional economics theory,health service demand theory as the foundation, the market environment impact ofurban community health service organization operation and development of reason,mining community health institutions advantage and be helpful for community healthwork to influence factors.
Changchun city in jilin province as an example, the study of urban communityhealth service institutions, community residents, community health service center staff,slow patients to community health service demand and utilization. On the one hand, tounderstand the city community health service organization operation status and healthservices utilization situation, analysis the community residents and slow patientshealth service demand, this paper discusses the influence factors of supply anddemand contradiction between the two sides, and puts forward the perfect citycommunity health service development, meet the residents health needs ofcountermeasures and Suggestions. On the other hand, through the researchperspective of government control of the city community health service supply anddemand relations, constructing the corresponding conceptual framework, from thechange of home-textile consider suppliers' adaptation measures, to improvecommunity health service provides the basis for the development.
Based on the literature review method, field survey method, questionnaire surveymethod, nine in changchun city for level stratified cluster sampling, using descriptiveanalysis, trend chi-square test and logistic regression analysis of urban communityhealth service demand and utilization system analysis.
Theoretical research results, construct the government control the communityhealth service demand and utilization conceptual framework, that is, from theory thegovernment through the control means adjustment, reform and improvement of theexisting community health resources and medical market to provide funding support,the use of market regulation mechanism, and provides the corresponding policyguiding, At the same time, the government through the collection of communityhealth service supply and demand both sides of the feedback information, timelyadjustment of control means, meet the residents' health needs. The empirical researchshows that there are nine administrative region of changchun city census register thetotal population of2.479million people, community health service center51,community health service center of the institutional setup, staffing is not reasonable.
The drug income accounted for62.67%of the proportion of the business income.2011changchun nine administrative region of the people to call number and domesticsickbed only number respectively for20670and735. Two-way referral projecttransfer out people and into the people only for2356and537.408community healthservice center staff to the community health service utilization survey results showthat education for college and the following accounted for65.94%of the total numberof investigation, the title for intermediate the following accounts for87.50%of thetotal number of investigation, from the time of1-3years in the majority,35.54%, upto49.50%of the medical staff said wage condition not satisfied.
1461community residents of community health service needs of the results ofthe survey showed that65.71%of the community residents in common with generalwill first community health service center to see a doctor, the reasons for the rise ofthe technical level of the medical treatment (39.97%), service attitude good (34.77%),the geographical position convenient (17.18%), regression analysis shows that theresidents choose whether community health service agencies to see a doctor andtraffic conditions, medical costs, the price of drugs, medical personnel attitude,waiting time, whether into the medical insurance reimbursement range related to suchfactors. Residents' health needs, in order to establish a home sickbed (23.48%), provide a fixed, long-term general practitioners (20.67%), provide telephonecounseling (19.85%).416patients with chronic diseases community to communityhealth service needs of the results of the survey showed that93.82%of thecommunity slow patients will choose in community health service agencies to see adoctor, and the vast majority of selection in community medical reasons for cheap(42.28%), near home, convenient transportation (40.76%), not in community healthservice institutions of medical reasons for the doctor's technology skeptical (38.46%),to the community health service content don't understand, utilization rate is low(30.77%). Regression analysis shows that the slow patients whether you choose tocommunity health service institutions and medical diagnosis and treatment technology,transportation, medical price, service attitude, whether to participate in communitypublicity and family income and other factors.
Research shows that, by investigation of the city community health serviceorganization resources has not been fully utilized, and community health servicecannot fully meet the needs of the community health service. Community residentstake use of community health service resources influence factors according to theiradvantage in the order the traffic, medical costs, the price of drugs, medical personnelattitude, see a doctor waiting time, whether into the medical insurance reimbursementrange. Community health service the differences between the supply and demand, thegovernment regulation to solve.
Based on the above research results, should be through the standard citycommunity health service organization setup and urban community medical,pharmaceutical price formulation, perfect the community health service organizationsupervision system way to strengthen countries and governments at all levels to thecommunity health service organization of macroeconomic regulation and control; Throughascension city community health service center personnel comprehensive quality and servicequality, strengthen community connotation construction, in order to further promote the urbancommunity health service ability; Guide people to make full use of urban community healthservices, reasonable distribution of urban community health service resources, and satisfy thepeople's growing health service needs.
引文
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