Feldman R, Deitz D M, Brooks E F
Am J Public Health. 1978 Oct;68(10):981-8. doi: 10.2105/ajph.68.10.981.
Primary health care centers have been proposed to meet the health care needs of rural America. Some centers become financially "self-sufficient", receiving their entire budgets from direct patient or third-party payments; others shut down when external funding is withdrawn. An explanation for this difference is important, because funding agencies may not wish to subsidize centers whose financial futures appear bleak. This study identifies the correlates of financial self-sufficiency. A survey conducted in late 1976 or 164 rural clinics provided 101 usable responses. Multiple regression analysis of the data shows that the longer a center has been in operation, the more self-sufficient it will become. Hospital control of the center and provision of laboratory tests increase self-sufficiency; outreach services and nonprofit status reduce it. Two variables related to financial self-sufficiency are separately examined. Clinics with a faster growth rate of patient visits are more self-sufficient, and smaller clinics tend to grow faster. More self-sufficient clinics experience less difficulty in keeping professional staff. The presence of a state Area Health Education Center (AHEC) program also eases the problem of staff retention.
有人提议设立基层医疗中心，以满足美国农村地区的医疗需求。一些中心在财务上实现了“自给自足”，其全部预算来自直接患者支付或第三方支付；另一些中心在外部资金撤出时则会关闭。解释这种差异很重要，因为资助机构可能不希望补贴那些财务前景黯淡的中心。本研究确定了财务自给自足的相关因素。1976年末对164家农村诊所进行的一项调查得到了101份可用回复。对数据的多元回归分析表明，中心运营的时间越长，就会越自给自足。医院对中心的控制以及提供实验室检测会提高自给自足程度；外展服务和非营利地位则会降低自给自足程度。分别考察了与财务自给自足相关的两个变量。患者就诊增长率较快的诊所自给自足程度更高，规模较小的诊所往往增长更快。自给自足程度更高的诊所在留住专业人员方面遇到的困难更少。州地区健康教育中心（AHEC）项目的存在也缓解了人员留用问题。
