Cowen D L, Hochstrasser D L, Friedericks C, Payne J
J Community Health. 1976 Fall;2(1):52-9. doi: 10.1007/BF01349492.
For 18 months between July 1973 and December 1974, the development of a primary care center for a rural Appalacian county engaged the efforts of local community leaders and the Department of Community Medicine of the University of Kentucky College of Medicine. This case study discusses some of the major events and factors contributing to this unsuccessful endeavor. The local cultural and sociomedical circumstances, including economic and political forces, and the errors in institutional relations and communication are analyzed. Many of the community problems encountered, at both the local and regional levels, are common to various rural areas. Considerations discussed in some detail include medical care payment mechanisms, rural economics, and local sociocultural systems. These community health problems, and the broader health policy issues that they represent, must be addressed before any significant changes or advances can be made in health care in rural America.
在1973年7月至1974年12月的18个月间，为阿巴拉契亚山区一个乡村县建立初级保健中心的项目，凝聚了当地社区领袖以及肯塔基大学医学院社区医学系的心血。本案例研究探讨了导致这一努力未获成功的一些主要事件和因素。分析了当地的文化和社会医学环境，包括经济和政治力量，以及机构关系和沟通方面的失误。在地方和区域层面遇到的许多社区问题，在各个农村地区都很常见。详细讨论的因素包括医疗支付机制、农村经济和当地社会文化体系。在美国农村地区的医疗保健取得任何重大变革或进展之前，必须先解决这些社区健康问题以及它们所代表的更广泛的健康政策问题。
