Brogren P O, Saltman R B
Health Policy. 1985;5(4):313-29. doi: 10.1016/0168-8510(85)90049-1.
Health policy planners have discussed for some years how to transform existing hospital-based health delivery systems into primary-care-driven systems. Although this policy goal has been adopted in a number of western European nations, the actual process of implementing such a major change has proven stubborn and complex. In particular, efforts to transfer existing resources out of the hospital sector for use in building primary care activities have proven difficult. This paper examines the effort to design and implement a primary health care strategy in Sweden. It is divided into two segments. The first section sketches the broad health system context within which the Swedish primary care effort is being conducted. The second section focuses directly on Sweden's primary care strategy, detailing both its conceptual foundation and the organizational obstacles that have impeded the policy's implementation. This discussion is punctuated with findings from a 1981 survey of county council administrators' attitudes toward this primary care strategy. The paper concludes with a short discussion of several alternative organizational approaches that might speed the development of a primary-care-driven health system.
多年来，卫生政策规划者一直在讨论如何将现有的以医院为基础的卫生服务体系转变为以初级保健为导向的体系。尽管这一政策目标已在一些西欧国家得到采纳，但事实证明，实施如此重大变革的实际过程既棘手又复杂。特别是，将现有资源从医院部门转移出来用于开展初级保健活动的努力一直困难重重。本文考察了瑞典设计和实施初级卫生保健战略的情况。它分为两个部分。第一部分概述了瑞典开展初级保健工作所处的广泛卫生系统背景。第二部分直接聚焦于瑞典的初级保健战略，详细阐述了其概念基础以及阻碍该政策实施的组织障碍。文中穿插了1981年对郡议会管理人员关于这一初级保健战略态度的调查结果。本文最后简要讨论了几种可能加速以初级保健为导向的卫生系统发展的替代性组织方法。
