Wei Xiaolin, Yang Nan, Gao Yang, Wong Samuel Y S, Wong Martin C S, Wang Jiaji, Wang Harry H X, Li Donald K T, Tang Jinling, Griffiths Sian M
Assistant Professor, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China Assistant Professor, Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of The Chinese University of Hong Kong, China
Research Assistant, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, China.
J Health Serv Res Policy. 2015 Jul;20(3):162-9. doi: 10.1177/1355819615579700. Epub 2015 Apr 21.
Community health centres are the main form of provision of primary care in China. There are three models: government managed, hospital managed and private. Our aim was to describe and compare primary care under the three ownership models.
Four aspects of primary care were studied: services, organization, financing and human resources. Interviews were undertaken with 60 managerial and professional staff in 13 community health centres in the Pearl River Delta region in 2010. Three community health centres were selected in the capital city and two were selected from each of the other five cities. Thematic framework analysis was conducted.
Government-managed community health centres received the largest public funding, followed by hospital-managed community health centres, while private community health centres received the least. Private community health centres were the smallest in scale and provided lower quality public health services compared with the other two models. Patient out-of-pocket costs accounted for the majority of the revenue in all models of community health centres despite improved government funding for preventive services. General challenges such as the shortage of public funding, the exclusion of migrants in the funding for preventive services, low capacity in human resources and the separation of clinical and preventive care in community health centres were identified in all three models of community health centres.
The ownership and management of a community health centre greatly influence the service it provides. Private community health centres are in a disadvantaged position to deliver high quality clinical and preventive care.
社区卫生中心是中国提供初级保健的主要形式。有三种模式：政府管理型、医院管理型和民营型。我们的目的是描述和比较这三种所有制模式下的初级保健情况。
对初级保健的四个方面进行了研究：服务、组织、筹资和人力资源。2010年，对珠江三角洲地区13个社区卫生中心的60名管理人员和专业人员进行了访谈。在省会城市选取了3个社区卫生中心，在其他5个城市各选取了2个社区卫生中心。进行了主题框架分析。
政府管理的社区卫生中心获得的公共资金最多，其次是医院管理的社区卫生中心，而民营社区卫生中心获得的资金最少。民营社区卫生中心规模最小，与其他两种模式相比，提供的公共卫生服务质量较低。尽管政府增加了对预防服务的资金投入，但在所有社区卫生中心模式中，患者自付费用仍占收入的大部分。在所有三种社区卫生中心模式中，都发现了一些普遍存在的挑战，如公共资金短缺、预防服务资金中排除了外来务工人员、人力资源能力低下以及社区卫生中心临床与预防保健分离等问题。
社区卫生中心的所有制和管理模式对其提供的服务有很大影响。民营社区卫生中心在提供高质量临床和预防保健方面处于劣势。
