Kirkman-Liff B L, Kaluzny A D
J Community Health. 1982 Winter;8(2):69-86. doi: 10.1007/BF01326552.
The elimination of categorical grants and their replacement by block grants provides public health departments the opportunity to integrate their services and provide general primary care to the underserved. While some may consider this an opportunity long overdue such a change may generate considerable conflict with private physicians. Questionnaire data from private physicians and health department personnel collected in North Carolina during an experimental program of primary care delivery by health department shows that there is substantial conflict. Private physicians oppose health department involvement in general primary care and in acute ambulatory care for the medically underserved. Physicians expect health departments to focus on preventive services, especially environmental monitoring and communicable disease control. Health department personnel want to expand their efforts beyond these more traditional areas into primary care and are in apparent conflict with private physicians. The community attitudes of a group of physicians within a community as well as the attitudes of a group of public health workers were found to be a major determinant of each individual's attitude toward public health, followed by the individual's age, sex, and years of working in the community.
取消分类拨款并代之以整笔拨款，为公共卫生部门提供了整合其服务并为服务不足人群提供一般初级保健的机会。虽然有些人可能认为这是早就该有的机会，但这种变化可能会与私人医生产生相当大的冲突。在北卡罗来纳州卫生部门提供初级保健的一个实验项目期间收集的来自私人医生和卫生部门人员的问卷调查数据表明，存在大量冲突。私人医生反对卫生部门参与为医疗服务不足人群提供一般初级保健和急性门诊护理。医生期望卫生部门专注于预防服务，尤其是环境监测和传染病控制。卫生部门人员希望将工作扩展到这些更传统领域之外，进入初级保健领域，这显然与私人医生存在冲突。研究发现，社区内一组医生的社区态度以及一组公共卫生工作者的态度是每个人对公共卫生态度的主要决定因素，其次是个人的年龄、性别和在社区工作的年限。
