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中文摘要: 目的：通过对广东省中山市某镇医共体内社区卫生服务中心和同市未加入医共体的社区卫生服务机构的运营效应进行比较，探讨医共体对社区卫生服务中心应用效果的影响。方法：收集2014年1月-2016年12月中山市某镇22家社区卫生服务机构的运营数据，运用数据包络分析（Data Envelopment Analysis，DEA）和广义估计方程（Generalized Estimating Equations，GEE），比较医共体和非医共体单位的综合效率值，并分析社区卫生服务中心运行效果的影响因素。结果：（1）运用DEA分析得出医共体社区卫生服务中心2014-2016年的综合效率值均为1，达到最佳产值，均达到有效状态；并且2014-2016年综合效率（均为1）、纯技术效率（均为1）、规模效率（均为1）、全要素生产率（两家医共体社区卫生服务中心2014-2016年均值分别为1.079、1.065），均高于未加入医共体的社区卫生服务中心。（2）GEE结果显示，在控制了镇区区域因素影响后，医共体社区卫生服务中心DEA综合效率均值（1.046）依然高于非医共体社区卫生服务中心（0.912），并且总人口数、人均GDP、抚养比、女性人口占总人口比例、人均可支配收入与社区卫生服务中心综合效率值呈相关性。结论：中山市某镇医共体模式具有政府投入大、镇农村合作医疗提供有力支撑、上下级医疗机构的医生之间协作紧密等优点，对社区卫生服务机构的发展具有一定促进作用，但该模式依然有医院和社区卫生服务机构之间存在竞争、社区诊疗能力不强等不足。
Abstract:Objective：By comparing the operation effect of community health service institutions in the county medical alliance and the community health service institutions that have not joined the county medical alliance in the same city，and to explore the influence of the community health service institutions on the county medical alliance. Methods：The operation data of 22 community health service institutions in a town of Zhongshan city from January 2014 to December 2016 were collected. Data Envelopment Analysis and Generalized Estimating Equations were used to compare the comprehensive efficiency values of the medical and non-medical alliances，and the influencing factors of the operation effect of the community health service institutions were analyzed. Results：（1）According to the DEA analysis，the comprehensive efficiency value of the community health service center of the Medical Community during 2014-2016 is 1，reaching the best output value and reaching the effective state. Moreover，The comprehensive efficiency（1 for all），pure technical efficiency（1 for all），scale efficiency（1 for all）and total factor productivity（the mean values of the two community health service centers were 1.079 and 1.065，respectively）from 2014 to 2016，which were all higher than those of the community health service centers that have not joined the community health service centers. （2）The results of GEE show that after controlling the influence of township regional factors，the average DEA comprehensive efficiency of the community health service center of the medical community（1.046）is still higher than that of the non-community health service center（0.912）. And then，the total population，per capita GDP，dependency ratio，female population in total population，per capita disposable income were correlated with the overall efficiency of community health service centers. Conclusion：With strong support of rural cooperative medical care in Zhongshan city，the medical mode has large government spending and close collaboration between doctors in different medical institutions，therefore helps the development of community health service institutions. However，there are still some deficiencies in this model，such as hospitals competes with community health service institutions，and the weak capacity of community diagnosis and treatment.
keywords: County Medical Alliance Community Health ServiceInstitution Operation Efficiency Data Envelopment Analysis Generalized Estimating Equations
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曹水和,陈钰心,钱庆文,邓昭信.医共体对社区卫生服务中心运行效益影响研究[J].江苏卫生事业管理,2021,32(6):701-706.
CAO Shuihe,CHEN Yuxin,QIAN Qingwen,DENG Zhaoxin.Study on the Influence of “County Medical Alliance” of Community Health Service In Stitutions[J].Jiangsu Health System Management,2021,32(6):701-706.
曹水和,陈钰心,钱庆文,邓昭信.医共体对社区卫生服务中心运行效益影响研究[J].江苏卫生事业管理,2021,32(6):701-706.
CAO Shuihe,CHEN Yuxin,QIAN Qingwen,DENG Zhaoxin.Study on the Influence of “County Medical Alliance” of Community Health Service In Stitutions[J].Jiangsu Health System Management,2021,32(6):701-706.
