宁波市城乡居民对社区医疗服务利用及其影响因素分析
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摘要
A研究背景与目的
近年来,随着政府和社会对社区卫生服务的重视和支持,社区卫生服务得到了较快的发展,国内外的研究表明,社区卫生服务是满足城乡居民基本卫生服务需求的最佳方式,在提供便捷、连续、综合、协调、价廉的卫生服务方面有着明显的优势,不仅有利于提高卫生服务的公平性、可及性和服务效率,而且在控制医疗卫生费用增长和提高居民健康水平方面能起卓有成效的作用,因此如何进一步发展社区卫生服务,提高城乡居民对社区卫生服务利用已逐步成为当前各级卫生行政部门研究的重点。
本文旨在通过宁波市城乡居民对社区卫生服务机构利用状况的调查,试图了解城乡居民对社区卫生服务机构利用状况及其影响因素,及时掌握纵向和横向趋势变化,正确了解和评估各影响因素,提出相关有利于促进社区卫生服务机构利用的建议和意见,来达到提高城乡居民对社区卫生服务机构高利用率,同时也为卫生决策部门制定卫生服务相关政策、贯彻落实医改政策及卫生事业单位改革提供理论依据和详实的基础信息。
B研究方法
研究现场为宁波市。利用2008宁波市第四次国家卫生服务调查有关数据资料,调查采用多阶段分层整群随机抽样的方法,抽取余姚市和奉化市为农村调查样本市,江东区为城市调查样本区。每一样本市、区随机抽取5个乡(镇、街道),每一乡(镇、街道)抽取2个村(居委会),并按城乡人口比例,奉化市每个村抽60户,余姚市每个村抽取90户,江东区每个居委会抽40户。全市抽取3个市、区,15个乡(镇、街道),30个村(居委会),共1900户,5248人。调查采用上门入户的方式,主要调查内容为家庭一般情况、人口学特征、就医患病情况和卫生服务的可及性等。本文将调查对象中两周患病就诊的319人中利用社区卫生服务机构的178名人员作为研究对象,通过研究,了解宁波市城乡居民对社区卫生服务机构利用状况及其影响因素。资料分析采用X2分析社区卫生服务利用影响因素的单因素分析；采用logistic回归模型对社区卫生服务利用影响因素进行多因素分析。调查数据资料使用SPSS17统计包进行分析。
C研究结果
在319名两周患病就诊人群中,有178名选择城乡社区卫生服务机构,就诊比例为55.80%,其中城市为58.82%,农村为54.00%；男性利用率为57.60%,女性利用率为54.04%；不同婚姻状态的人员社区卫生服务机构利用为52.31-60.63%,文化程度中以高中／中专利用率最高71.05%,初中的为最低,50.60%,不同年龄段中,65岁以上的利用率最高；不同收入分析,<5000元的利用率最高68.97%,最低的为5000元与10000元之间,为46.58%；不同保险类型中,参加城镇职工保险的利用率为62.75%,没参加保险的最低为42.11%；从就诊距离来看,<1公里的更倾向于就诊社区卫生服务机构,利用率为57.95%；选择社区卫生服务机构就诊的主要原因为距离近,方便的人员利用率为74.51%,选择技术水平高的人员利用率最低为21.25%；自觉疾病不严重和一般的社区卫生服务机构利用率分别为74.51%和59.49%,自觉严重的人员利用率为32.88%。
对区域、性别、年龄等采用单因素X2分析后,结果显示,影响社区卫生服务就诊的主要影响因素为：自觉疾病严重程度、选择就诊的主要原因,进一步用Lojistic分析后,影响因素为自觉疾病严重程度、选择就诊的主要原因。(B分别为0.853和0.861,显著性水平均为0.00)
D研究结论
相对于2003年的25.93%,宁波市城乡居民对社区卫生服务机构利用有较为明显的增加,已上升到39.18%,其中城市由32.88%增加至51.26%,农村由24.10%增加至32.00%,(为与2003年相比较,剔除站的就诊人数),城市和农村的社区卫生服务利用均有不同幅度的增加,这显示政府近几年加强社区卫生服务体系建设提高社区卫生服务的可及性取得了一定的成效。
影响城乡居民对社区卫生服务机构利用的因素有：选择机构就诊的主要原因和自觉疾病的严重程度。方便距离近能增加居民对社区卫生服务机构的利用,此外自觉疾病不严重和一般的居民更愿意利用社区卫生服务机构就诊。
宁波市城乡社区卫生服务已赢得居民一定的利用率,但与国外发达国家社区卫生服务为总医疗卫生服务的90%相比,还有不少的差距,社区卫生服务利用还有较大的上升空间,作为经济发达地区的宁波市还需要通过各种措施,大力发展社区卫生服务,不断提高社区卫生服务利用率。建议差异发展,逐步建立社区卫生服务机构特色；多措并举,深度提高社区卫生机构医务人员服务水平；扩大宣传,不断提升社区卫生知晓度和美誉度；建章立制,持续引导居民利用社区卫生服务机构。
Research Background and Objective
In recent years, as more emphasis and support have been given to community health service by the government and the society, the community health service has sustained rapid development. The research, conducted both domestically and abroad, indicates that community health service is the best system to meet basic health needs of urban and rural residents, has a clear advantage in providing convenient, continuous, comprehensive, coordinated and affordable health service [1], and not only contributes in promoting the fairness, accessibility and efficiency of health care service but also plays an effective role in controlling healthcare cost increases and in improving the health standard for people. Thus the further development of community health service and the enhancement of the community health service utilization by the urban and rural residents have been gradually become the focus of study at all levels of administrations.
By the investigation on the status of use of community-based health service institution in Ningbo, this study aims to understand the status of use of community-based health service institution among urban and rural residents, analyze the influencing factors, promptly monitor the trend in longitudinal and transverse directions, know and evaluate the influencing factors properly, and then propound the related constructive suggestions to promote the use of community-based health service institution, to increase the utilization rate of community-based health service institution among urban and rural residents, at the same time, to provide the theory basis and the detailed and basic information for government policy making, the implementation of medical reform and the reform of health institution in Ningbo.
Methods
The case study is the city of Ningbo. The related data for Ningbo City is from the Fourth National Health Service Survey, and the multi-stage stratified random sampling method is used to conduct the survey, for which Yuyao City and Fenghua City are selected for rural sample and Jiangdong District is selected for urban sample. Five townships (towns or neighborhoods) are randomly selected from each sample city or district, two villages (or residential committees) are randomly selected for each township (or neighborhood), and, in proportion to urban and rural population,60 households are chosen for each village in Fenghua City,90 households are chosen for each village in Yuyao City and 40 households are chosen for each residential committee in Jiangdong District. In total,1900 households consisting of 5248 people are selected from 30 villages (or residential committees) in 15 townships (or neighborhoods) in three cities or district in the City. The survey is conducted through home visit method, and the main contents of the survey are general family data, demographic characteristics, medical conditions and health service accessibility. This paper uses 178 people seeking treatment at community health service agencies among 319 people, who fell sick in two weeks during the survey, as study subjects, and the study provides information on the (?)tilization and related factors of community health service agencies by urban and rural residents in Ningbo City. The x2 analysis is used for the single-factor analysis of the community health service utilization factors and the Logistic regression model is used for the multi-factor analysis of the community health service utilization factors. Survey data are analyzed using the statistical package SPSS 17.
Results
Among 319 people who fell sick in the two weeks,178 people sought treatment at urban or rural community health service agencies, a percentage of 55.80%,58.82% among urban residents and 54.00%among rural residents; the utilization rate by male residents is 57.60%and is 54.04%by female residents; the utilization of the community health service for various marital status is 52.31%-60.63%, in terms of education level, the utilization rate is highest with education of high school/secondary technical school at 71.05%and is lowest with education of junior high school at 50.60%, in terms of age groups, the utilization rate is highest among the over 65 group; in terms of income level, the utilization rate is highest for those earning less than 5000 Yuan at 68.97%and is lowest for those earning between 5000 Yuan and 10000 Yuan at 46.58%; in terms of insurance policy, the utilization rate is 62.75%for those participating in Urban Worker Insurance and is 42.11%for those without insurance; in terms of closeness for treatment, those living within one kilometer are more likely to seek treatment at the community health service agencies with utilization rate of 57.95%; the main reason for the choice of community health service agencies is the proximity, the utilization rate is 74.51%for those living nearby, the rate is lowest at 21.25%for those seeking personnel with high level of expertise; the utilization rates of the community health service agencies are 74.51%and 59.49%for those sensing the illness is not serious and common, respectively, and the utilization rate is 32.88%for those sensing the illness is serious. The single-factor 2 analysis is used for region, gender, and age, the result shows that the main impact factors affecting the treatment at the community health service are the perceived seriousness of illness and the main reason for the choice of institution; further analysis using logistic analysis shows that the impact factors are the perceived seriousness of illness and the main reason for the choice of treatment. (B are 0.853 and 0.861 respectively and the significance levels are both 0.00.)
Conclusion and Suggestion
Compared to 25.9%in 2003, the utilization of the community health service agencies in Ningbo City by urban and rural residents has a significant increase, rising to 39.18%, rising from 32.88%to 51.26%for urban region and from 24.10%to 32.00%for rural region (in order to compare with 2003, some patients in stations are excluded), the utilization of both urban and rural community health service has increased, which indicates that the policy of strengthening community health service system by the government to improve the accessibility of the community health service has achieved some success.
The factors affecting the utilization of community health service agencies by urban and rural residents are:the main reason for the choice of treatment and the perceived seriousness of illness. Convenient proximity will increase the utilization of the community health service agencies by residents; in addition, those residents who perceive that the illness is not serious or common are more likely to seek treatment at community health service agencies.
The urban and rural community health service in Ningbo has gained a certain degree of utilization by residents, but compared with the 90%utilization of community health service for overall medical and health care service in developed countries, there is some gap, and therefore there is some room for significant increase in the utilization of community health service; as a developed region in economy, Ningbo needs to introduce a variety of measures to develop the community health service greatly and to improve the utilization of the community health service continuously. We propose to adopt differential developments to gradually establish the community health service with special characteristics, to introduce a variety of measures to vastly raise the professional level of medical service personnel at community health service agencies, to expand publicity to continuously increase the awareness and reputation of the community health service, and to implement new policies to steadily guide residents to seek treatment at the community health service agencies.
近年来,随着政府和社会对社区卫生服务的重视和支持,社区卫生服务得到了较快的发展,国内外的研究表明,社区卫生服务是满足城乡居民基本卫生服务需求的最佳方式,在提供便捷、连续、综合、协调、价廉的卫生服务方面有着明显的优势,不仅有利于提高卫生服务的公平性、可及性和服务效率,而且在控制医疗卫生费用增长和提高居民健康水平方面能起卓有成效的作用,因此如何进一步发展社区卫生服务,提高城乡居民对社区卫生服务利用已逐步成为当前各级卫生行政部门研究的重点。
本文旨在通过宁波市城乡居民对社区卫生服务机构利用状况的调查,试图了解城乡居民对社区卫生服务机构利用状况及其影响因素,及时掌握纵向和横向趋势变化,正确了解和评估各影响因素,提出相关有利于促进社区卫生服务机构利用的建议和意见,来达到提高城乡居民对社区卫生服务机构高利用率,同时也为卫生决策部门制定卫生服务相关政策、贯彻落实医改政策及卫生事业单位改革提供理论依据和详实的基础信息。
B研究方法
研究现场为宁波市。利用2008宁波市第四次国家卫生服务调查有关数据资料,调查采用多阶段分层整群随机抽样的方法,抽取余姚市和奉化市为农村调查样本市,江东区为城市调查样本区。每一样本市、区随机抽取5个乡(镇、街道),每一乡(镇、街道)抽取2个村(居委会),并按城乡人口比例,奉化市每个村抽60户,余姚市每个村抽取90户,江东区每个居委会抽40户。全市抽取3个市、区,15个乡(镇、街道),30个村(居委会),共1900户,5248人。调查采用上门入户的方式,主要调查内容为家庭一般情况、人口学特征、就医患病情况和卫生服务的可及性等。本文将调查对象中两周患病就诊的319人中利用社区卫生服务机构的178名人员作为研究对象,通过研究,了解宁波市城乡居民对社区卫生服务机构利用状况及其影响因素。资料分析采用X2分析社区卫生服务利用影响因素的单因素分析；采用logistic回归模型对社区卫生服务利用影响因素进行多因素分析。调查数据资料使用SPSS17统计包进行分析。
C研究结果
在319名两周患病就诊人群中,有178名选择城乡社区卫生服务机构,就诊比例为55.80%,其中城市为58.82%,农村为54.00%；男性利用率为57.60%,女性利用率为54.04%；不同婚姻状态的人员社区卫生服务机构利用为52.31-60.63%,文化程度中以高中／中专利用率最高71.05%,初中的为最低,50.60%,不同年龄段中,65岁以上的利用率最高；不同收入分析,<5000元的利用率最高68.97%,最低的为5000元与10000元之间,为46.58%；不同保险类型中,参加城镇职工保险的利用率为62.75%,没参加保险的最低为42.11%；从就诊距离来看,<1公里的更倾向于就诊社区卫生服务机构,利用率为57.95%；选择社区卫生服务机构就诊的主要原因为距离近,方便的人员利用率为74.51%,选择技术水平高的人员利用率最低为21.25%；自觉疾病不严重和一般的社区卫生服务机构利用率分别为74.51%和59.49%,自觉严重的人员利用率为32.88%。
对区域、性别、年龄等采用单因素X2分析后,结果显示,影响社区卫生服务就诊的主要影响因素为：自觉疾病严重程度、选择就诊的主要原因,进一步用Lojistic分析后,影响因素为自觉疾病严重程度、选择就诊的主要原因。(B分别为0.853和0.861,显著性水平均为0.00)
D研究结论
相对于2003年的25.93%,宁波市城乡居民对社区卫生服务机构利用有较为明显的增加,已上升到39.18%,其中城市由32.88%增加至51.26%,农村由24.10%增加至32.00%,(为与2003年相比较,剔除站的就诊人数),城市和农村的社区卫生服务利用均有不同幅度的增加,这显示政府近几年加强社区卫生服务体系建设提高社区卫生服务的可及性取得了一定的成效。
影响城乡居民对社区卫生服务机构利用的因素有：选择机构就诊的主要原因和自觉疾病的严重程度。方便距离近能增加居民对社区卫生服务机构的利用,此外自觉疾病不严重和一般的居民更愿意利用社区卫生服务机构就诊。
宁波市城乡社区卫生服务已赢得居民一定的利用率,但与国外发达国家社区卫生服务为总医疗卫生服务的90%相比,还有不少的差距,社区卫生服务利用还有较大的上升空间,作为经济发达地区的宁波市还需要通过各种措施,大力发展社区卫生服务,不断提高社区卫生服务利用率。建议差异发展,逐步建立社区卫生服务机构特色；多措并举,深度提高社区卫生机构医务人员服务水平；扩大宣传,不断提升社区卫生知晓度和美誉度；建章立制,持续引导居民利用社区卫生服务机构。
Research Background and Objective
In recent years, as more emphasis and support have been given to community health service by the government and the society, the community health service has sustained rapid development. The research, conducted both domestically and abroad, indicates that community health service is the best system to meet basic health needs of urban and rural residents, has a clear advantage in providing convenient, continuous, comprehensive, coordinated and affordable health service [1], and not only contributes in promoting the fairness, accessibility and efficiency of health care service but also plays an effective role in controlling healthcare cost increases and in improving the health standard for people. Thus the further development of community health service and the enhancement of the community health service utilization by the urban and rural residents have been gradually become the focus of study at all levels of administrations.
By the investigation on the status of use of community-based health service institution in Ningbo, this study aims to understand the status of use of community-based health service institution among urban and rural residents, analyze the influencing factors, promptly monitor the trend in longitudinal and transverse directions, know and evaluate the influencing factors properly, and then propound the related constructive suggestions to promote the use of community-based health service institution, to increase the utilization rate of community-based health service institution among urban and rural residents, at the same time, to provide the theory basis and the detailed and basic information for government policy making, the implementation of medical reform and the reform of health institution in Ningbo.
Methods
The case study is the city of Ningbo. The related data for Ningbo City is from the Fourth National Health Service Survey, and the multi-stage stratified random sampling method is used to conduct the survey, for which Yuyao City and Fenghua City are selected for rural sample and Jiangdong District is selected for urban sample. Five townships (towns or neighborhoods) are randomly selected from each sample city or district, two villages (or residential committees) are randomly selected for each township (or neighborhood), and, in proportion to urban and rural population,60 households are chosen for each village in Fenghua City,90 households are chosen for each village in Yuyao City and 40 households are chosen for each residential committee in Jiangdong District. In total,1900 households consisting of 5248 people are selected from 30 villages (or residential committees) in 15 townships (or neighborhoods) in three cities or district in the City. The survey is conducted through home visit method, and the main contents of the survey are general family data, demographic characteristics, medical conditions and health service accessibility. This paper uses 178 people seeking treatment at community health service agencies among 319 people, who fell sick in two weeks during the survey, as study subjects, and the study provides information on the (?)tilization and related factors of community health service agencies by urban and rural residents in Ningbo City. The x2 analysis is used for the single-factor analysis of the community health service utilization factors and the Logistic regression model is used for the multi-factor analysis of the community health service utilization factors. Survey data are analyzed using the statistical package SPSS 17.
Results
Among 319 people who fell sick in the two weeks,178 people sought treatment at urban or rural community health service agencies, a percentage of 55.80%,58.82% among urban residents and 54.00%among rural residents; the utilization rate by male residents is 57.60%and is 54.04%by female residents; the utilization of the community health service for various marital status is 52.31%-60.63%, in terms of education level, the utilization rate is highest with education of high school/secondary technical school at 71.05%and is lowest with education of junior high school at 50.60%, in terms of age groups, the utilization rate is highest among the over 65 group; in terms of income level, the utilization rate is highest for those earning less than 5000 Yuan at 68.97%and is lowest for those earning between 5000 Yuan and 10000 Yuan at 46.58%; in terms of insurance policy, the utilization rate is 62.75%for those participating in Urban Worker Insurance and is 42.11%for those without insurance; in terms of closeness for treatment, those living within one kilometer are more likely to seek treatment at the community health service agencies with utilization rate of 57.95%; the main reason for the choice of community health service agencies is the proximity, the utilization rate is 74.51%for those living nearby, the rate is lowest at 21.25%for those seeking personnel with high level of expertise; the utilization rates of the community health service agencies are 74.51%and 59.49%for those sensing the illness is not serious and common, respectively, and the utilization rate is 32.88%for those sensing the illness is serious. The single-factor 2 analysis is used for region, gender, and age, the result shows that the main impact factors affecting the treatment at the community health service are the perceived seriousness of illness and the main reason for the choice of institution; further analysis using logistic analysis shows that the impact factors are the perceived seriousness of illness and the main reason for the choice of treatment. (B are 0.853 and 0.861 respectively and the significance levels are both 0.00.)
Conclusion and Suggestion
Compared to 25.9%in 2003, the utilization of the community health service agencies in Ningbo City by urban and rural residents has a significant increase, rising to 39.18%, rising from 32.88%to 51.26%for urban region and from 24.10%to 32.00%for rural region (in order to compare with 2003, some patients in stations are excluded), the utilization of both urban and rural community health service has increased, which indicates that the policy of strengthening community health service system by the government to improve the accessibility of the community health service has achieved some success.
The factors affecting the utilization of community health service agencies by urban and rural residents are:the main reason for the choice of treatment and the perceived seriousness of illness. Convenient proximity will increase the utilization of the community health service agencies by residents; in addition, those residents who perceive that the illness is not serious or common are more likely to seek treatment at community health service agencies.
The urban and rural community health service in Ningbo has gained a certain degree of utilization by residents, but compared with the 90%utilization of community health service for overall medical and health care service in developed countries, there is some gap, and therefore there is some room for significant increase in the utilization of community health service; as a developed region in economy, Ningbo needs to introduce a variety of measures to develop the community health service greatly and to improve the utilization of the community health service continuously. We propose to adopt differential developments to gradually establish the community health service with special characteristics, to introduce a variety of measures to vastly raise the professional level of medical service personnel at community health service agencies, to expand publicity to continuously increase the awareness and reputation of the community health service, and to implement new policies to steadily guide residents to seek treatment at the community health service agencies.
引文
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[6]江泽慧,周小军,钟豪翔.南昌市居民对社区卫生服务利用情况调查和满意度调查[J].卫生软科学,2009,2：59—62
[7]张静,赵桂兰,王礼桂,等.项目区居民社区卫生服务利用和满意度调查.中国卫生事业管理,2008,3：311
[8]叶恒波.国内外卫生服务需要利用模式研究进展.国外医学社会医学分册,9(2)；53—57
[9]刘艳,吴群鸿.哈尔滨市社区卫生服务需求、利用及影响因素分析[J].中国农村卫生事业管理,3(22)：33—35
[10]卢祖询,刘军安,彭绩,等.深圳市社区卫生服务利用及其影响因素分析.中国医院管理杂志,2005：2(21)：464467.
[11]龚幼龙.卫生服务研究[M].上海：复旦大学出版社,2.002.
[12]ThaiKv,Wimberleg ET,MeManusSM.Handbook of international health care systems.New York,Basel,MarcelDekker.INC.
[13]杜绢,赵艳萍,路孝勤,等.北京市大兴区农村居民社区卫生服务需求与利用调查,2007：5：353——358
[14]彭绩,程锦泉,刘军安,等.慢性病人社区卫生服务需求影响因素分析.中国公共卫生,2005：21(8)：934—936
[15]倪茹新,龚幼龙.上海市彭浦街道老年人慢性病人就医行为的研究.中国全科医
学杂志,2000：12(3)：46中63
[16]吴秀云,马凤云,李曼春,等.城市居民社区卫生服务意想影响因素分析[J].中国全科医学,2000,3：194—196.
[17]陈天辉,杜亚平,李鲁,等.城乡社区卫生服务相关问题的比较研究[J].中国农村卫生事业管理,2003,23：30—34.
[18]陈艳,程晓明,许伟,等.沈阳市社区卫生服务的需求和利用影响因素分析[J].中国卫生经济,2003,22：52-53.
[19]肖峰,马军,荣湘江,等.北京市亚运村社区卫生服务利用现状调查,中国公共卫生管理,2007：5(23)523—524
[20]夏挺松,彭绩,周指明,等.深圳市居民社区卫生服务知晓程度与利用程度关系及其印象因素[J].中国全科医学,2005,1(2)：541—543
[21]李向红,黎燕宁,汤泽群,等.居民就医行为的影响因素和医疗体制改革[J].广医科大学学报,2004,21(3)：453—456.
[22]刑海燕,沈毅,赵华娟,等.农村居民就医行为及影响因素的对应分[J].中国农村卫生事业管理,2002,22(5)：12—15.
[23]冉志成.谈社区卫生服务.卫生行政管理,2005,8(23)：43—45
[24]刘岱富.广元市中区社区卫生服务工作“三到位”
[25]姜黎明,白雅敏,邵瑞太.发达国家以社区为基础的慢性病综合干预经验.中国慢性病预防与控制,2002；10(5)235：—237
[26]李立明,胡永华,曹卫华,等.原发性高血压的社区综合防治研究.北京大学学报(医学版),2002；34(5)：519—524
[27]陈文力,黄庭标,蔡成活,等.中山市古镇以慢性病综合防治为切入点开展社区卫生服务的理论和实践.中国全科医学,2004：7(23)：1764—1766
[28]罗桂华.试论我国城市社区卫生服务的发展.国外医学,2009,2(26)：94—96
[29]中国中医药报,9月13日.
[30]JolveyB.Assuring the health of the public in the 21st century:Advancing health population:The Pfizer guide to careers in public health [M].New York:Pfizer Pharmaceuticals Group,2002:4.
[1]高强.发展医疗卫生事业构建社会主义和谐社会.产经.高端,2005,9(2)13—15
[2]龚幼龙.卫生服务研究[M].上海：复旦大学出版社,2002.
[3]汪凯,王国庆,李朴,等.黑水县居民医疗需要和卫生服务利用研究[J].中国卫生事业管理,1999,15(7)：376—379.
[4]曹宇环,刘险峰,郑建中,等.包头市城区居民医疗服务需求利用及影响因素研究[J].中国卫生事业管理,2003,12：746—748.
[5]刘亚玲,徐勇勇,王汉民,等.陕西省城乡不同地区居民两周患病情况的比较.第四军医大学学报,2004,25：2297—2299.
[6]刘新奎,雷卫河,田庆丰.河南省农村卫生服务需求与利用影响因素分析[J].河南医学研究,2005,9：271—274.
[7]中华人民共和国卫生部.第三次国家卫生服务调查方案及调查指导手册,2003,8：13—14.
[8付云,全晓燕,梅树珍,等.包头市老年人卫生服务需要利用及影响因素[J].调查研究,2006,3：11—13.
[9]叶恒波.国内外卫生服务需要利用模式研究进展.国外医学社会医学分册,9(2)：53—57.
[10]第三次国家卫生服务调查主要结果,国家卫生部卫生政策与管理。
[11]李瑞光,方子节.中国农村卫生事业要有新起点.中国农村卫生事业管理,2005,2：3—5
[12]胡志,汤质如,秦侠,等.安徽省肥西县新型农村合作医疗研究(一)农村 居民医疗服务需要与利用状况.中国卫生经济,2004,12：12—14.
[13]刘丽娜,徐凌中.威海市城乡居民住院服务利用研究.中国卫生统计,2007,2：60—62
[14]刘亚玲,徐勇勇,刘丹红,等.陕西农业人口的门诊医疗需要、需求及影响因素分析.现代医学,2005,4：88—91.
[15]左惠娟,邓利群,姚崇华。北京农村居民健康状况及卫生服务需求调查.中国全科医学,2004,7：187—189.
[16]包士峰,张雷.城市居民卫生服务状况纵向分析[J].中国全科医学,2006,10：1650—1652
[17]Volmink J,Craner P.Drectly observed therapy for treating tuberculous. Orchrane Database Syst Rev,2003,(1):CD003343.
[18]崔丹,杜玉开.贫困地区农村家庭卫生状况及影响因素研究.中国初级卫生保健,2004(6)：3—4.
[19]王洵.城乡老人健康和医疗状况分析.中国初级卫生保健,1997,11(2)：45
[20]贺国平,周杏元.社区慢性病防工作的和政策保障.中华医院管理,1999,8：398—400
[21]史雅翼,谢隆化.浙江农村15岁以上居民两周患病及就诊影响因素分析.中国卫生事业管理,2001,4：231—233
[22]2009年中国卫生统计提要
[23]刘梅,陈金华.社区卫生服务机构与医院实施双向转诊的意义及建议.中国社区卫生服务,2004,7(11)：38—39
[24]张宇,’肖十力,张拓红,等.社区卫生服务机构与医院双向转诊实现途径和管理办法的研究[J].中国全科医学,2002,2(5)：123—125
[25]宁黎霞.江西省第三次卫生服务调查—医疗服务的需要和利用[J].中国医院统计,2004,9(11)：248—249.
[26]李向红,黎燕宁,林江.农村居民卫生服务需要、利用现状及影响因素分析[J].广西医科大学学报,2004,21(3)：453—456.
[27]邢海燕,沈毅,赵华娟,等.农村居民就医行为及影响因素的对应分析[J]. 浙江大学硕士学位论文 综述中国农村卫生事业管理,2002,22(5)：12—15.
[28]刘晓强,周世观.江苏省卫生服务需求现状及变化研究.卫生软科学,2002,16(6)35—36.
[29]魏新刚,孟群.黑龙江省家庭健康询问调查分析及卫生服务综合评价.中国卫生经济,2007,4(4)：19—21.
[30]李孜,金新政,李道萍.城市贫弱人群健康问题及卫生服务利用研究.卫生事业管理,2003,19(6)：359—363。
[31]黄焕峰,王维夫.农村地区慢性病防治网络建设现状与出路.中国初级卫生保健,2008,11：5—6
[32]中国高血压防治指南起草委员会.中国高血压防治指南[J].高血压杂志,2000,8(1)：103—112
[33]林中,曾念彬,潘建清.深圳福田区社区慢性病防治现状与对策.中国慢性病预防与控制,2005,4：82—83
[34]胡容.对临床健康教育存在问题的分析及对策.中华护理杂志,2002,37(11)841—843
[2]李鲁,主编.社会医学[M].上海：复旦大学出版社。2002年：178-179
[3]叶向明,吴日荣.政府主导齐推动社区卫生促和谐-义乌市创建浙江省社区卫生先进市活动的启示[J].卫生经济研究,2007,236(5)：25—26
[4]高博,任晓晖,刘丹萍,等.成都市武候区社区居民卫生服务需求[J].现代预防医学,2005,8(9)：705—708
[5]马海燕,刘婷婕,许亮文.浙江三地城市居民社区卫生服务需求与利用评价[J].中国初级卫生保健,2007,1：25—27
[6]江泽慧,周小军,钟豪翔.南昌市居民对社区卫生服务利用情况调查和满意度调查[J].卫生软科学,2009,2：59—62
[7]张静,赵桂兰,王礼桂,等.项目区居民社区卫生服务利用和满意度调查.中国卫生事业管理,2008,3：311
[8]叶恒波.国内外卫生服务需要利用模式研究进展.国外医学社会医学分册,9(2)；53—57
[9]刘艳,吴群鸿.哈尔滨市社区卫生服务需求、利用及影响因素分析[J].中国农村卫生事业管理,3(22)：33—35
[10]卢祖询,刘军安,彭绩,等.深圳市社区卫生服务利用及其影响因素分析.中国医院管理杂志,2005：2(21)：464467.
[11]龚幼龙.卫生服务研究[M].上海：复旦大学出版社,2.002.
[12]ThaiKv,Wimberleg ET,MeManusSM.Handbook of international health care systems.New York,Basel,MarcelDekker.INC.
[13]杜绢,赵艳萍,路孝勤,等.北京市大兴区农村居民社区卫生服务需求与利用调查,2007：5：353——358
[14]彭绩,程锦泉,刘军安,等.慢性病人社区卫生服务需求影响因素分析.中国公共卫生,2005：21(8)：934—936
[15]倪茹新,龚幼龙.上海市彭浦街道老年人慢性病人就医行为的研究.中国全科医
学杂志,2000：12(3)：46中63
[16]吴秀云,马凤云,李曼春,等.城市居民社区卫生服务意想影响因素分析[J].中国全科医学,2000,3：194—196.
[17]陈天辉,杜亚平,李鲁,等.城乡社区卫生服务相关问题的比较研究[J].中国农村卫生事业管理,2003,23：30—34.
[18]陈艳,程晓明,许伟,等.沈阳市社区卫生服务的需求和利用影响因素分析[J].中国卫生经济,2003,22：52-53.
[19]肖峰,马军,荣湘江,等.北京市亚运村社区卫生服务利用现状调查,中国公共卫生管理,2007：5(23)523—524
[20]夏挺松,彭绩,周指明,等.深圳市居民社区卫生服务知晓程度与利用程度关系及其印象因素[J].中国全科医学,2005,1(2)：541—543
[21]李向红,黎燕宁,汤泽群,等.居民就医行为的影响因素和医疗体制改革[J].广医科大学学报,2004,21(3)：453—456.
[22]刑海燕,沈毅,赵华娟,等.农村居民就医行为及影响因素的对应分[J].中国农村卫生事业管理,2002,22(5)：12—15.
[23]冉志成.谈社区卫生服务.卫生行政管理,2005,8(23)：43—45
[24]刘岱富.广元市中区社区卫生服务工作“三到位”
[25]姜黎明,白雅敏,邵瑞太.发达国家以社区为基础的慢性病综合干预经验.中国慢性病预防与控制,2002；10(5)235：—237
[26]李立明,胡永华,曹卫华,等.原发性高血压的社区综合防治研究.北京大学学报(医学版),2002；34(5)：519—524
[27]陈文力,黄庭标,蔡成活,等.中山市古镇以慢性病综合防治为切入点开展社区卫生服务的理论和实践.中国全科医学,2004：7(23)：1764—1766
[28]罗桂华.试论我国城市社区卫生服务的发展.国外医学,2009,2(26)：94—96
[29]中国中医药报,9月13日.
[30]JolveyB.Assuring the health of the public in the 21st century:Advancing health population:The Pfizer guide to careers in public health [M].New York:Pfizer Pharmaceuticals Group,2002:4.
[1]高强.发展医疗卫生事业构建社会主义和谐社会.产经.高端,2005,9(2)13—15
[2]龚幼龙.卫生服务研究[M].上海：复旦大学出版社,2002.
[3]汪凯,王国庆,李朴,等.黑水县居民医疗需要和卫生服务利用研究[J].中国卫生事业管理,1999,15(7)：376—379.
[4]曹宇环,刘险峰,郑建中,等.包头市城区居民医疗服务需求利用及影响因素研究[J].中国卫生事业管理,2003,12：746—748.
[5]刘亚玲,徐勇勇,王汉民,等.陕西省城乡不同地区居民两周患病情况的比较.第四军医大学学报,2004,25：2297—2299.
[6]刘新奎,雷卫河,田庆丰.河南省农村卫生服务需求与利用影响因素分析[J].河南医学研究,2005,9：271—274.
[7]中华人民共和国卫生部.第三次国家卫生服务调查方案及调查指导手册,2003,8：13—14.
[8付云,全晓燕,梅树珍,等.包头市老年人卫生服务需要利用及影响因素[J].调查研究,2006,3：11—13.
[9]叶恒波.国内外卫生服务需要利用模式研究进展.国外医学社会医学分册,9(2)：53—57.
[10]第三次国家卫生服务调查主要结果,国家卫生部卫生政策与管理。
[11]李瑞光,方子节.中国农村卫生事业要有新起点.中国农村卫生事业管理,2005,2：3—5
[12]胡志,汤质如,秦侠,等.安徽省肥西县新型农村合作医疗研究(一)农村 居民医疗服务需要与利用状况.中国卫生经济,2004,12：12—14.
[13]刘丽娜,徐凌中.威海市城乡居民住院服务利用研究.中国卫生统计,2007,2：60—62
[14]刘亚玲,徐勇勇,刘丹红,等.陕西农业人口的门诊医疗需要、需求及影响因素分析.现代医学,2005,4：88—91.
[15]左惠娟,邓利群,姚崇华。北京农村居民健康状况及卫生服务需求调查.中国全科医学,2004,7：187—189.
[16]包士峰,张雷.城市居民卫生服务状况纵向分析[J].中国全科医学,2006,10：1650—1652
[17]Volmink J,Craner P.Drectly observed therapy for treating tuberculous. Orchrane Database Syst Rev,2003,(1):CD003343.
[18]崔丹,杜玉开.贫困地区农村家庭卫生状况及影响因素研究.中国初级卫生保健,2004(6)：3—4.
[19]王洵.城乡老人健康和医疗状况分析.中国初级卫生保健,1997,11(2)：45
[20]贺国平,周杏元.社区慢性病防工作的和政策保障.中华医院管理,1999,8：398—400
[21]史雅翼,谢隆化.浙江农村15岁以上居民两周患病及就诊影响因素分析.中国卫生事业管理,2001,4：231—233
[22]2009年中国卫生统计提要
[23]刘梅,陈金华.社区卫生服务机构与医院实施双向转诊的意义及建议.中国社区卫生服务,2004,7(11)：38—39
[24]张宇,’肖十力,张拓红,等.社区卫生服务机构与医院双向转诊实现途径和管理办法的研究[J].中国全科医学,2002,2(5)：123—125
[25]宁黎霞.江西省第三次卫生服务调查—医疗服务的需要和利用[J].中国医院统计,2004,9(11)：248—249.
[26]李向红,黎燕宁,林江.农村居民卫生服务需要、利用现状及影响因素分析[J].广西医科大学学报,2004,21(3)：453—456.
[27]邢海燕,沈毅,赵华娟,等.农村居民就医行为及影响因素的对应分析[J]. 浙江大学硕士学位论文 综述中国农村卫生事业管理,2002,22(5)：12—15.
[28]刘晓强,周世观.江苏省卫生服务需求现状及变化研究.卫生软科学,2002,16(6)35—36.
[29]魏新刚,孟群.黑龙江省家庭健康询问调查分析及卫生服务综合评价.中国卫生经济,2007,4(4)：19—21.
[30]李孜,金新政,李道萍.城市贫弱人群健康问题及卫生服务利用研究.卫生事业管理,2003,19(6)：359—363。
[31]黄焕峰,王维夫.农村地区慢性病防治网络建设现状与出路.中国初级卫生保健,2008,11：5—6
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