Wang Zhaoxin, Shi Jianwei, Wu Zhigui, Xie Huiling, Yu Yifan, Li Ping, Liu Rui, Jing Limei
Department of General Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
Tongji University School of Medicine, Shanghai, China.
Int J Health Plann Manage. 2017 Jul;32(3):317-328. doi: 10.1002/hpm.2433. Epub 2017 Jun 22.
Since the 1980s, China has been criticized for its mode of chronic disease management (CDM) that passively provides treatment in secondary and tertiary hospitals but lacks active prevention in community health centers (CHCs). Since there are few systematic evaluations of the CHCs' methods for CDM, this study aimed to analyze their abilities. On the macroperspective, we searched the literature in China's largest and most authoritative databases and the official websites of health departments. Literature was used to analyze the government's efforts in improving CHCs' abilities to perform CDM. At the microlevel, we examined the CHCs' longitudinal data after the New Health Reform in 2009, including financial investment, facilities, professional capacities, and the conducted CDM activities. A policy analysis showed that there was an increasing tendency towards government efforts in developing CDM, and the peak appeared in 2009. By evaluating the reform at CHCs, we found that there was an obvious increase in fiscal and public health subsidies, large-scale equipment, general practitioners, and public health physicians. The benefited vulnerable population in this area also rose significantly. However, rural centers were inferior in their CDM abilities compared with urban ones, and the referral system is still not effective in China. This study showed that CHCs are increasingly valued in managing chronic diseases, especially after the New Health Reform in 2009. However, we still need to improve collaborative management for chronic diseases in the community and strengthen the abilities of CHCs, especially in rural areas.
自20世纪80年代以来，中国的慢性病管理模式一直备受批评，该模式在二级和三级医院被动提供治疗，但在社区卫生中心缺乏积极预防。由于对社区卫生中心慢性病管理方法的系统评估较少，本研究旨在分析其能力。在宏观层面，我们检索了中国最大、最权威的数据库以及卫生部门官方网站上的文献。通过文献分析政府在提高社区卫生中心慢性病管理能力方面的努力。在微观层面，我们研究了2009年新医改后社区卫生中心的纵向数据，包括财政投入、设施、专业能力以及开展的慢性病管理活动。政策分析表明，政府在发展慢性病管理方面的努力呈上升趋势，峰值出现在2009年。通过评估社区卫生中心的改革，我们发现财政和公共卫生补贴、大型设备、全科医生和公共卫生医生都有明显增加。该领域受益的弱势群体也显著增加。然而，农村社区卫生中心的慢性病管理能力不如城市社区，而且中国的转诊系统仍然效率不高。本研究表明，社区卫生中心在慢性病管理中越来越受到重视，尤其是在2009年新医改之后。然而，我们仍需改善社区慢性病的协同管理，加强社区卫生中心的能力，特别是农村地区的能力。
