Thailand is a developing country. Although the per capita GNP exceeded 2000 dollars in the early 1990s, the national economy is still in the process of recovery and the overall social economic level is not high due to the unfair distribution of social income, the low living standards of the majority of low-and middle-income classes and the financial crisis around 1998. At present, the development of community health service is carried out under the condition of limited health resources and low level, and the basic conditions are similar to those of middle-level economic regions in China. Therefore, Thailand's experience can be used for reference for China. The similarities and differences between urban and rural community health services are 1. If the rural community health service in Thailand is earlier than that in cities, some hygienists will hold different opinions: that is, the rural community health service in Thailand is only the primary health care model promoted by Pa. However, let's not talk about the close relationship between primary health care and community health services. Judging from the continuous and comprehensive health service brought by the health card project, rural health care in Thailand has the characteristics of modern community health service. In fact, both developed and developing countries lack the practice and experience of rural community health service. While developing urban community health services in China, a problem naturally arises: What about rural community health services? China is a country with a large population, mainly in rural areas. Should community health services be developed in rural areas? Do rural areas have the conditions to develop community health services? To answer these questions, it is difficult to find perfect answers only by Thailand's experience, but at least it can make us think and even get some enlightenment. The development of rural community health services in Thailand has played a great role in the health card project, and the continuous expansion of the population covered by health cards cannot be separated from the government's financial input. Most of the card purchase fees of 30 million card-holding farmers come from the state. Of course, farmers with cards only enjoy low-level basic medical care, but this is an important goal of rural community health services in Thailand. The concept of modern community health service was introduced to Thailand in the early 1990s, because Thai medical staff said that "continuous, comprehensive and comprehensive health service" was a legendary word around 1989. The development of urban community health service in Thailand is not "rural encircling the city", but imitating the community health service model of developed countries, and many template projects have been established with the financial and technical support of some developed countries and international organizations. The pilot work of urban community health service in Thailand started from 1989, but it did not develop as fast as that in China. So far, the national urban community health service network has not yet been formed. The operation mode of urban community health service in Thailand is similar to that in China, only 5-7 years ahead of China, but its successful experience and social benefits are positive, which increases our confidence in developing community health service. 2 Benefits and Effects of Community Health Service Although the community health service in Thailand has a history of more than 65,438+00 years, especially the rural community health service plays an important role in the whole national health service system, it is still difficult to evaluate the effect. However, we can evaluate the function and benefit of community health service from the mutual relationship and interaction between community health service and the whole health work, as well as the development and change of community health service itself. 2. 1 patient flow change: One of the important purposes of community health service is to keep patients with common diseases in the community. Therefore, the change of the number of patients in different levels of medical institutions, that is, the change of patient flow direction, is an important index to evaluate the function of community health institutions. As can be seen from the table 1, the patient flow in Thailand changed rapidly in the 1990s, mainly because the number of patients in high-level medical institutions decreased. The basic (community) medical insurance policy stipulates that patients must go to community health institutions first, and some medical insurance in Thailand also has the same regulations. We don't need to know whether the change of patient flow in Thailand is because the quality service of community health institutions attracts patients, and we don't need to evaluate the quality of community health service in Thailand, but the change of patient flow shows that the focus of Thai health service system has shifted to the community. The enlightenment to us is that medical insurance is the key and community health service is the condition to realize this transfer. 2.2 Changes in efficiency and benefits: It is difficult to evaluate the efficiency and benefits of community health services in a short time, but the changes in service indicators of some pilot institutions show that the efficiency and benefits of community health services are constantly improving. 2.3 Impact on the health system and policies: The development of community health services has accelerated the reform of the medical insurance system and the national health resource allocation policy. Since 1997, the Thai government has stipulated that employees of state-owned departments must register in community health service institutions, and the amount of financial subsidies that community health service institutions can obtain depends on the number of residents registered in the institutions. 3 Community Awareness and Community Participation When discussing Wan Fang data and community health services in Thailand, community health workers often refer to a relatively new concept-community awareness. Community awareness is a concept that both providers and demanders of community health services must strengthen, and it has an important influence and function on many links of community health services. The community awareness of suppliers is not only conducive to making scientific community health planning and work programs, but more importantly, it attaches importance to mobilizing community residents to participate in community health services and making full use of community resources to develop community health services. Thailand attaches importance to the demand-side community awareness and its role in the development of community health services is reflected in two aspects: strengthening residents' community economic awareness, so that people without medical insurance can accept unified payment, thus ensuring basic medical needs to a certain extent; Recruit a large number of community health volunteers (especially rural community health service personnel) to strengthen the extensive contact between health personnel and community residents; Community residents participate in the decision-making and management of community health services, which improves the feasibility and efficiency of community health services. With the development of community health service and the increase of beneficiary residents, the demand side's community awareness is also constantly strengthening. In Thailand, due to the limited number of practicing doctors, the number of practicing doctors in primary medical institutions is very small, and the cost of seeing a doctor in large hospitals and private clinics is expensive. In the community health service center, patients not only get the diagnosis and treatment of medical practitioners at low prices, but also are a kind of continuous service, forming a familiar and harmonious relationship with medical staff. In the community where community health developed earlier and better, residents realized the benefits of community health service and took the initiative to use their social relations and advantages to donate or raise funds and equipment for community health service centers, hoping to reduce costs, improve the treatment of medical staff and retain medical practitioners. It is precisely because of these measures that the operating costs of some community health service centers are declining, so that the charging standards are decreasing year by year. The Importance of Community Health Financing Thailand attaches great importance to community health financing. First of all, the state has invested a lot of money in community health services, mainly including the salaries of some staff in community health service institutions and the construction and configuration of some facilities. This form is an investment for community health service providers. Investment in the demand side is mainly achieved through health card and low-income health card projects. Demand-side investment, as a guiding fund, drives residents' investment in health insurance. That is, from the supplier's input, guide the buyer's input and form * * * financing. The health card system is a voluntary health insurance system. The source of funds for health cards is not entirely from the government, nor only from residents, but from both sides. The basic operation mode is to purchase cards voluntarily on a family basis. Families with less than five people pay 500 baht (40 baht 1 USD) every year, and the Ministry of Health pays 500 baht. Families with more than five people need to buy extra cards. Card buyers are mainly residents above the poverty line but with low income, especially farmers. If you want to get more extensive medical insurance, you can buy private medical insurance, that is, supplementary medical insurance. Thailand's medical card system is called by the World Health Organization as "a new idea to realize universal medical reform under the condition of market economy". From the experience of developing community health services in Thailand and other countries, one of the important conditions for the sustainable development of community health services is a stable financing channel. Thailand, on the other hand, has its own characteristics in the way that state investment drives the demand side to raise funds. China has determined the policy of "subsidizing community health services", but how to subsidize it is worth further study and discussion. In fact, a simple "subsidy" is unscientific, and it is difficult to obtain an ideal investment benefit. National and local financial input (subsidies) will also be limited. Moreover, the goal of this investment should not only be to maintain the survival of community health service institutions, but also to guide extensive community financing and improve the quality of community health services. At present, the international strategy of health investment is also changing from supplier input to demand input, and the role of demand input is to improve the service quality and efficiency of suppliers. Therefore, in China, the investment of national and local finance in community health services needs to be seriously considered. For example, some "subsidies" are used as guiding funds to guide residents to buy community health services with high health care value. According to Thailand's experience, the prospect of community health financing will be better if the strategy of community health financing is combined with the reform of medical security system. 5 Quality of Community Health Services The main goal of developing community health services in Thailand (especially urban community health services) is to improve the quality of primary health services, improve the service delivery capacity of primary health institutions, and meet the health needs of residents. Looking at the whole operation process of community health service, there are three main aspects that play an important role in improving the quality of community health service. 5. 1 Hire and retain medical practitioners to work in community health service institutions. The vast majority of medical practitioners in Thailand have received medical education for more than 6 years and hold doctoral degrees, with a high level, but a small number. Practitioners work in community health service institutions, which in itself is a major change in primary health services in Thailand and provides technical support for primary health institutions. 5.2 Referral system and hospital technical support. The referral between community health service institutions and hospitals in Thailand is well coordinated, and community health workers can use hospital equipment to enter the hospital to participate in diagnosis and treatment. This is not only conducive to improving the quality of medical services, but also conducive to the continuous improvement of the professional level of community health personnel. 5.3 relatively complete and systematic community information work. The records and management of residents' health records and community health service processes are relatively standardized, which can make better use of information to promote medical quality. The development of urban community health services in China emphasizes the standardization of functions, services and management, such as the high standard requirements for general practitioner qualifications, which is conducive to improving the quality of community health services. However, there are problems in two-way referral, information management and utilization, standardized management and so on. It will not be conducive to improving the quality of community health services. In a word, the rural community health service in Thailand has its own characteristics, especially the ways and practices of community health financing have attracted the attention of the international health community. The urban community health service in Thailand is still in the pilot stage, so it is unrealistic to ask for the successful experience of other places, and more attention should be paid to their strategies and measures to solve problems.