Abstract: Since 1997,China has vigorously developed community health service for 20 years.Through systematically reviewing the developing framework of community health service,it was found that before the new medical reform,though comparatively complete network system of community health has been built up,there still lacks many talents of general practice so that the community health service is still passive and requires much follow-up measurements.Meanwhile,in the new general era after the new medical reform,despite the fact that the community health is developing towards the direction of the medical path of general practice,the functional localization cannot manifest the advantages of community health,accompanied by the problems that part of the functions were not implemented deeply,as well as the working modes of general practitioners were not explicit,etc.Facing the new challenges of developing general practice,this study concludes lessons from the foreign community health practices involving organizational structure and service function construction,based on which we put forward that the future community health organizations should stick to the principle to cooperate with large hospitals in order to realize the concept of general practice "with precision".

Key words: Community health services, Functional localization, General practice

摘要： 自1997年大力发展社区卫生服务以来，我国社区卫生服务已经荏苒20年。本研究系统审视社区卫生服务发展脉络，发现新医改前社区卫生服务尚处于被动跟进阶段，虽然建立了较为完备的社区卫生网络体系，但全科人才缺口较大；新医改后的新全科时代，尽管社区卫生朝全科医学轨道主动迈进，但却存在功能定位并未突出社区卫生服务优势、部分功能落实不深入、全科医生工作模式不明晰等问题。面对新一轮全科发展的挑战，本研究借鉴国外社区卫生服务在组织结构和服务功能建设方面的经验，提出未来发展社区卫生应秉持与大医院协同合作、“精准化”全科医疗的理念。

关键词: 社区卫生服务, 功能定位, 全科医疗