The key and difficulty in building a compact county medical community lies in grassroots medical and health institutions. Currently, research on grassroots medical and health institutions under the compact county medical community mainly uses discontinuous time series models and DEA models to analyze their operational efficiency. There is a lack of comprehensive evaluation of the service performance of grassroots medical and health institutions from multiple dimensions, Therefore, it is of great significance to conduct research on the service performance of grassroots medical and health institutions under the tight county medical community.

Evaluate the service performance of grassroots medical and health institutions in 39 pilot counties (cities, districts) of Guangxi's tightly knit county-level medical communities, in order to provide a basis for deepening the high-quality development of Guangxi and nationwide tightly knit county-level medical communities.

Collect operational data of grassroots medical and health institutions in 39 pilot counties (cities, districts) from 2018 to 2021, and evaluate them using descriptive analysis, entropy weighted TOPSIS and RSR.

From 2018 to 2021, the C_i values of the service performance of grassroots medical and health institutions were 0.311 2, 0.363 2, 0.579 1, and 0.674 2, respectively. Ranked first in 2021 and last in 2018; In 2021, a total of 7 pilot counties (cities, districts) were evaluated as "excellent" in the service performance of grassroots medical and health institutions, accounting for 17.95%. A total of 6 individuals were rated as "poor", accounting for 15.38%. The remaining 26 were rated as "medium", accounting for 66.67%.

The sinking of resources has been improved, capacity building has been further strengthened, access to health equity has increased, the efficiency of medical insurance fund utilization has improved, and overall service performance is showing an upward trend. However, the two-way referral system needs to be strengthened, resource utilization efficiency needs to be strengthened, and the benefit sharing mechanism needs to be further improved. There are significant differences in the service performance of grassroots medical and health institutions among pilot counties (cities, districts). We need to improve and leverage the role of the county-level medical community management committee, improve the annual total budget system of the medical community, establish a comprehensive benefit distribution mechanism, and focus on supporting pilot counties (cities, districts) with relatively poor economic development.

紧密型县域医共体能否建设好，重点和难点都在基层医疗卫生机构，目前针对紧密型县域医共体下基层医疗卫生机构的研究主要运用间断时间序列模型及数据包络分析（DEA）模型对其运行效率进行分析，缺乏从多个维度对基层医疗卫生机构的服务绩效进行综合评价，因此开展紧密型县域医共体下基层医疗卫生机构服务绩效研究具有重要意义。

对广西壮族自治区（以下简称广西）39个紧密型县域医共体试点县（市、区）的基层医疗卫生机构服务绩效进行评价，以期为深化广西和全国紧密型县域医共体高质量发展提供依据。

2018—2021年收集39个试点县（市、区）基层医疗卫生机构2018—2021年运行数据，采用描述性分析和熵权逼近理想解排序法（TOPSIS）结合秩和比法（RSR）对其进行评价。

2018—2021年，基层医疗卫生机构服务绩效的C_i值依次为0.311 2、0.363 2、0.579 1、0.674 2。2021年排在第一，2018年排在最后；2021年，基层医疗卫生机构服务绩效被评定为"优"的试点县（市、区）共7个，占17.95%。被评定为"差"的共6个，占15.38%。其余26个被评定为"中"，占66.67%。

资源下沉得到改善，能力建设进一步加强，卫生健康公平可及性增加，医保资金使用效能提升，服务绩效总体呈上升趋势。但双向转诊制度有待加强，资源利用效率有待提高，利益共享机制需进一步健全，各试点县（市、区）间基层医疗卫生机构服务绩效存在明显差异。要发挥县域医共体管理委员会作用，完善医共体年度总额预算制度，健全利益分配机制，重点支持经济发展相对较差的试点县（市、区）。