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该文通过省市县乡村五个层次 ,卫生服务组织者、提供者和消费者三方 ,以及医疗、预防和保健服务三大职能的提供者与管理者的意向调查 ,得出了与文献论证一致的结论。综合各方意向论证结果 ,下列状况已经成为农村卫生服务的组织者、提供者和消费者普遍认同的现实 :原有的我国农村县乡村三级网虽然网络形式依然存在 ,随着我国宏观经济体制改革的进程 ,计划经济时代的农村三级卫生网固有特征逐渐消失 ,基本上为下列状况所替代 :(1)协调变成了围绕各自经济利益的无序竞争 ;(2 )寻求更多一点的经济收益成为县乡村三级卫生组织的行为原动力 ,替代了社会效益和经济利益一致的“共同目标” ;(3)医疗、预防、保健三大功能定位发生混乱 ,“重医轻防、重有偿轻无偿、重收益多轻收益少”状况成为县乡村三级卫生组织的普遍现实 ;(4 )预防保健职能难以切实落实到位或流于形式成为农村地区卫生事业发展的焦点问题。这些状况在乡镇卫生院表现得尤为突出。
This article has reached a consensus with the literature on the basis of the five-level survey of villages, counties, villages, health service providers, providers and consumers, as well as the intentions of providers and managers of the three major functions of medical care, prevention and health care services. The conclusion. As a result of the comprehensive intentions of all parties, the following conditions have become a reality shared by the organizers, providers, and consumers of rural health services: The original rural network of rural counties in China still exists despite its macroeconomic system. In the process of reform, the inherent characteristics of the rural three-tiered health network in the era of planned economy have gradually disappeared and are basically replaced by the following conditions: (1) coordination becomes disorderly competition around their respective economic interests; (2) seeks more Economic benefits have become the primary motive force of the county’s rural and tertiary health organizations, replacing the “common goal” of social benefits and economic interests; (3) confusion in the positioning of the three major functions of medical care, prevention, and health care. The condition of being light, graver, light, and less profitable has become a universal reality in the county-level rural health organizations; (4) The preventive health care function cannot be effectively implemented or become a form of focus in the development of health services in rural areas. These conditions are particularly prominent in township health centers.