Ricketts T C, Konrad T R, Wagner E H
Am J Public Health. 1983 Apr;73(4):406-13. doi: 10.2105/ajph.73.4.406.
The placement of subsidized primary care programs in rural communities has been an important aspect of national health policy over the last decade. Using survey and secondary data from programs in over 700 counties in the United States, it was found that while about one-fourth of all counties with some rural populations have been affected by these programs, certain environmental factors are associated with more or less likelihood of placement. High levels of need and low levels of health care resources are positively associated with the presence of a program. States with health policy climates supportive of reimbursement and broader staffing of primary care programs also contained programs in a higher proportion of their rural counties. The effects of decreased federal funding, increased state responsibility, and the precarious market conditions for primary care programs are discussed with emphasis on the mechanisms for developing favorable climates for these programs.
在过去十年中，农村社区补贴性初级保健项目的布局一直是国家卫生政策的一个重要方面。利用来自美国700多个县项目的调查和二手数据发现，虽然约四分之一有农村人口的县受到了这些项目的影响，但某些环境因素与项目布局的可能性或多或少相关。高需求水平和低医疗保健资源水平与项目的存在呈正相关。卫生政策环境支持报销和初级保健项目更广泛配备人员的州，其农村县有项目的比例也更高。讨论了联邦资金减少、州责任增加以及初级保健项目不稳定的市场状况的影响，重点是为这些项目营造有利环境的机制。
