服务功能定位和实现对策的研究__以上海市黄浦区社

上海交通大学硕士学位论文社区卫生服务功能定位和实现对策的研究——以上海市黄浦区社区卫生服务发展为例姓名：戴星申请学位级别：硕士专业：公共管理指导教师：胡苏云20080607III501997III20051.2.3.4.5.6.IV7.8.1.2.3VAPOLICYRESEARCHONTHEFUNCTIONANDIMPLEMENTATIONOFCOMMUNITYHEALTHSERVICES——ACASESTUDYOFCOMMUNITYHEALTHSERVICEREFORMOFHUANGPUDISTRICT,SHANGHAIABSTRACTCommunityhealthservice(CHS)istheprimaryhealthservicethatcoverscommunities,aimsatresidents’health,regardsfamilyasunit,focusesonindividualpatients,andremainsdemand-oriented.Byreasonablyandthoroughlyexploringsanitoryresourcesofacommunityandadoptingappropriatemedicaltechniques,CHSintegratesfunctionsofprevention,healthcare,healing,healtheducation,andthefamilyplanning.Asapublicwelfareundertaking,CHSisalsoareflectionofsocialandpublicfunctionofagovernment.ChinaisinacrucialphaseofCHSdevelopmentnow.CitieshavestartedexploringorapplyingnewCHSformatlity.ItaccumulatesnecessaryexperienceforaCHSdevelopmentofnationalscale.Fromatheoreticalperspectiveofpublicgoodsandgovernment’sVIresponsibility,theessayproceedsacasestudyoftheCHSinHuangpuDistrict,Shanghai.Throughquestionnairesandinterviews,theauthorassessesthepresentstatusofHuangpuCHSanditsproblems,thusemphasizestheimportancerolethatgovernmentshallplayinCHSdevelopment.TheauthoralsoadvocatesclarifyingCHScontentandtargetgroup,designsdetailedmethodsforchronicdiseasemanagement,anddeliverssomepolicyadvicesforCHSdevelopment.TheessayincludessectionsasfollowsTheFirstSectionelaboratestheconnotationandfeaturesofbasictheoryofpublicgoodsandconcludesthathealthserviceshallbecatogarizedasquasi-publicgoods.Thus,government’sresponsibilityshallbesortedinCHSestablishment.SomedomesticandforeignpublicationsarereferredtodescribeandassessthecurrentsituationofCHS.IntheSecondSection,theCHSmodelsinU.K.,USAandGermanyarecomparedandtheirrespectiveandcommonprincipalfeaturesaredomenstrated.UKundertakesanationalhealthcareservicesystemthatfeaturesinuniversalandfreeservice.TheUnitedStatesdevelopesdiversifiedhealthservicesystem,inwhichmarketplaysasthecoremechanism.Germanhealthservicesystemfeaturesasinsurance-oriented.ButallassessedhealthservicemodelsadoptthesamepracticethatCHScomesfirstforallpatients.AsanpreliminarywhileidealhealthserviceVIIprovider,CHScannotonlyguaranteesimpartiality,efficiencyandeffectivenessofhealthservice,butalsoputincreasingmedicalexpendituresundereffectivecontrolandimprovethehealthinessofresidents.IntheThirdSection,theauthordescribesanddiscussesthebackgroundofChineseandShanghaiCHSdevelopment.Thecountry’sCHSdevelopmentcandatebacktothe1950’sandawellestablishednationalsystemfunctionedfordecades.AsaresultofcommercializationofChinesemedicalservice,thewellestablishedpreliminarysanitaryandhealthcaremechanismwasrestructuredfrompublicwelfareentitiesintoprofit-makingmarketsurvivors,makingmedicaltreatmentincreasinglymoreexpensiveandlessaccessibletopatients.ToaddressthefunctionalabsenceofCHS,severallaws,regulationsandfilesonCHShavecomeintoeffectssince1997,andtimelyformsofCHShavebeenexporedandtestedalloverChina.ShanghaipioneersinChina’sCHSreform,inventingnewwaysofCHSpracticesthatwerepromotedasnationalstandards,suchasprepaidmedicareinsuranceororientationalpatientreferral.However,anunneglectablequantityofproblemsstillremain,includingtheunderperformanceofCHS,unqualifiedorevenlackofsupportingfacilities,health-relateddepartments’unawarenessofnecessityortheirpoorlycoordinatedeffortsofCHSdevelopment,irrationalcompositionofcommunitymedicalteam,hamperedgeneralVIIIpractitionerstraining,andlackofrationalityinselectingmedicalservices.TheFourthSectionisaboutthedevelopmentofCHSinShanghai.In2005,asoneofCHSfrontrunnersinChina,ShanghaiappointedSongjiangandChangningastwopilotdistrictsofCHSreform.Inthetwodistricts,newmedicalfinancemanagementtoseparateflowsofincomeandexpenditureandaprepaidmedicaresystemwasimplemented.CHSmedicalteamscomposedofgeneralpractitionerswasorganizedandsix-function-in-oneCHScenterswereestablished.TheCHSreformwasprovedeffective.AsoneofthesecondgroupofCHSreform,HuangpudistrictfollowsupinimplementingCHSreform.Alsointhissection,basedonquestionnairestowardsmanagers,patientsandmedicalpersonnelsofCHScenters,andinterviewwithgovernmentofficialsofsanitorydepartments,theauthoranalyzesthesepcialtiesofHuangpuDicstrict’seconomyandresidents,assessesitssanitoryresourcesandresidents’demandofmedicalservices,andevaluatesitsCHSdevelopment.Basedontheoutcomesofdata-collectionandanalysis,intheFifthSection,theauthorintroducesseveralpolicyadvices,asfollows,forShanghaitofurtherimproveitsCHSdevelopment.TofurtherpositiontheroleofCHScentersbydefiningCHScontentandtargetgroups,soastomeetdiversifiedCHSneeds.ToimproveCHS’sfunctionofpublicsanitory,coordinateCHSwithIXurbanmedicareinsurance,andconstructasystematicmanagementofchronicdiseases,soastoachievebettereffectsofCHS.Todeveloplocalizedservicestoaddressspecificdemandsofresidents.ToadvanceinformationalizationofCHS,improvedatabaseofresidentialhealthrecords,andachievebetterefficiencyandhighereffectiveness.Topromotequalificationandpersonneltraining,improveskillandprofessionalismofgeneralpractitioners,andupgradequali