以广州市统计局提供的第六次人口普查数据作为人口统计数据源,以天河区卫生局提供的社区医疗机构数据作为社区医疗服务研究数据源,以广州市天河区作为研究案例,总结出社区医疗服务存在政府供给、单位制供给、集体经济供给、社会力量供给4种模式。各供给模式均具有受卫生局领导、政府部门监管和作为城市医疗体系的基础等一系列共性,同时在供给主体、服务对象、筹资与财务管理和人事管理等方面存在差异性,形成相互补充的多元模式共存体系,社区医疗服务的准公共物品属性、社会经济体制转型与城乡二元体制、居民的多元化需求和不同供给主体的利益诉求综合作用是多元模式共存的机制。只有充分利用多元模式供给主体、全方位协调机制要素、进行合理的制度设计,才能更好地促进社区医疗服务均等化,同时为其他城市公共服务供给提供参考借鉴。
Community health service is one of the key elements of basic public service that is community-oriented and to solve the basic medical needs of primary health service. The main structure and operation system of public service provision change because of China's social and economic transition. Community health service at the present stage has dual properties, the market mechanism is introduced into on the one hand, and traditional institutional characteristics still exist on the other hand. The paper uses the sixth census data provided by the Guangzhou Municipal Bureau of Statistics as a source of demographic data, community health care institutions provided by the Health Bureau of Tianhe District as the source of community health service, and takes Tianhe District in Guangzhou as a case to be studied. In the paper four types of supply models in community health services in Tianhe district in Guangzhou are summed up: government supply, work unit supply, collective economy supply and market supply. They are all under the leadership of the Health Bureau, supervised by the government and serve as the basis of the urban health care system. At the same time they have differences in the main supply, service targets, financing and financial management and personnel management. Both the common and different features of the various modes of supply form a complementary system of coexisting multivariate models. Based on the analysis of the coexistence of the multi-mode system, we draw the conclusion that the quasi-public properties of the community health services, the transformation of social and economic system and urban-rural dual system, the diverse needs of the residents and the interests of the different supply and their combined effects make the mechanism of multi-mode coexistence. Only taking full advantage of multi-mode supply, full range of coordination mechanisms and reasonable system design can gain access to equalization of community health services.