目的：了解海口市社区卫生服务（CHS）体系发展状况，并探讨其优势、潜力和困境。方法以海口市4个区的所有 CHS 中心和 CHS 站为调查对象，采用卫生部妇社司下发的《社区卫生服务站常规监测调查表》和《社区卫生服务中心常规监测调查表》，对2007—2010年海口市 CHS 机构的总体规模、卫生人力资源、财务收支及卫生服务提供情况等进行调查。抽取部分 CHS 机构的处方，采用卫生部妇社司下发的《社区卫生服务机构合理用药及处方费用常规监测调查表》，对2008—2010年 CHS 机构处方的用药个数、抗生素和激素使用情况及费用进行调查。随机拦截部分就诊 CHS 机构的社区居民，采用卫生部妇社司下发的《社区卫生服务利用者满意度调查表》，对2009—2010年社区居民的 CHS 知晓、利用及满意情况进行调查。结果2010年建成并投入运行的 CHS 中心已有11家，完成规划数的55.0％（11/20）；CHS 站74家，完成规划任务。到2010年底，全市 CHS 中心的平均固定资产额为300.51万元， CHS 站为44.66万元。2010年底，CHS 机构卫生技术人员总数已达到1180人，医师403人，护士548人，医护比为1∶1.36。CHS 站和 CHS 中心分别于2009年和2010年实现了收支基本持平，并略有盈余；在收入方面，业务收入是 CHS机构收入的主要来源，占总收入的70％以上；在支出方面，业务支出和人力支出是 CHS 机构支出的主要部分，CHS 中心药品支出占业务支出的60％以上，CHS 站则高达78％以上，在人力支出方面，人员的工资支出占绝大部分。2010年，海口市 CHS 机构的门急诊总量为1633913人次，占当年全市所有各级医疗机构门急诊总量6151781人次的26.6％；2007年 CHS 机构的急诊量为36041人次，到2010年达到257282人次，为2007年的7.1倍；双向转诊始终表现为上转多于下转的不对等态势。2008—2010年，2/3的处方中使用了抗生素，而且使用二联抗生素和激素的处方数均占抽查总数的20％以上。2010年，全市 CHS 机构共登记管理高血压患者35634人，糖尿病患者10550人。满意度较高的是 CHS 机构医务人员的服务态度，其次为等候时间和医务人员的解释和交流，最低的是就诊机构的设施和设备。结论以社会力量为主体的海口市 CHS 体系的优势在于资金筹措范围广，运作灵活，较短的时间内在机构的布局上实现了地域上的医疗服务可及性。其潜力首先在于成本控制相对容易，从而使药品价格下调有很大的空间；其次在高血压、糖尿病等慢性病管理方面，CHS 机构逐渐积累起来的资料，为心脑血管疾病的人群防控奠定基础。目前所面临的发展困境主要是难以获得综合医院的技术支持及其私有制属性而引发的对其公益性的质疑。%Objective To investigate the development status,advantages,potential and predicaments of Haikou community health service( CHS)system. Methods We enrolled all CHS centers and CHS stations in the four districts of Haikou,We investigated the general scale,health human resources,financial revenue and expenditure and the delivery of health services from 2007 to 2010 of the CHS settings in Haikou using the Conventional Monitoring Questionnaire for CHS stations and the Conventional Monitoring Questionnaire for CHS Centers issued by the Women and Social Division of the Ministry of Health. We selected prescriptions from some CHS settings in Haikou,and used the CHS Conventional Monitoring Questionnaire of Reasonable Drug Administration and Prescription Expense to investigate the number of medications,the use of antibiotics and hormone and expenses from 2008 to 2010 of the selected CHS settings. We also enrolled community residents from some of the CHS settings and investigated their awareness,utilization and satisfaction degree about CHS from 2009 to 2010. Results In 2010,11 CHS centers were established and put into operation,accounting for 55. 0% of the planned amount,and 74 CHS stations were established,reaching the planned amount. By the end of 2010,the average fixed asset of the CHS centers in Haikou was 300 510 000 yuan,and that of the CHS stations was 446 600 yuan. By the end of 2010,the number of health workers,clinicians and nurses were 1 180,403 and 548,with a doctor - to - nurse ratio of 1∶ 1. 36. The CHS stations and centers first achieved approximate balance between revenue and expenditure and made profit slightly;in the aspect of revenue, operating revenue was the major resource of the revenue of CHS settings,accounting for 70% of the total revenue;in the aspect of expenditure,operating expenditure and manpower expenditure were the major part of the expenditure of the CHS settings;the medicine expenditure took up more than 60% of the operating expenditure of the CHS centers,and that proportion for the CHS stations was 78% ;in the aspect of manpower expense,the wages of staff took up the majority. In 2010,the total number of outpatients was 1 633 913 in the CHS settings in Haikou,accounting for 26. 6% of the total number of outpatients in all medical settings in Haikou which was 6 151 781;the number of outpatients in CHS settings was 36 041 in 2007,and that was 257 282 in 2010,7. 1 times that of 2007;the two - way referral system showed an nonequivalent state in which upward referrals were more than downward referrals. From 2008 to 2010,antibiotics were used in 2 / 3 of the prescriptions,and the number of prescriptions that included duplex antibiotics and hormone took up more than 20% . In 2010,35 634 hypertensive patients and 10 550 diabetic patients were registered and treated in the CHS settings in Haikou. The selected community residents held the highest satisfaction rate toward the service attitude of medical staff of the CHS setting,and the items with the secondary and third highest satisfaction rates were waiting time and the interpretation and communication of medical staff,and the lowest item was the facility and equipment of the CHS settings. Conclusion The CHS system of Haikou with social forces as the main body has several advantages including the wide range of financing,flexible operation and the realization of regional accessibility of medical services by setting layout in a short period of time. Its primary potential is that the cost control is relatively easier,which provides space for the down regulation of medicine price;what's more,the relevant documents of hypertension,diabetes mellitus and other chronic disease management filed by CHS settings lay a foundation for the prevention and treatment of cardiovascular and cerebrovascular diseases. The predicaments facing CHS settings are mainly the difficulty to get technological support from general hospitals and the query of its public welfare due to its private ownership.
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