Focusing on primary care is the primary content of health care policies, however, there is a lack of effective measurement tools in practice.

To construct a index system for county health system development focusing on primary care, provide a reference for its monitoring approaches, and perform analysis and presentation with application cases.

In the study conducted from 2021 to 2022, the index system, weights and percentage conversion methods were constructed based on literature review and Delphi method, case application and analysis were conducted based on the data of questionnaire survey, institutional survey and medical insurance collected by baseline survey among residents, patients and medical workers, as well as data of key informant interview, in 2 experimental counties of county health system reform in Guangxi Zhuang Autonomous Region from 2020 to 2022.

The results of Delphi method showed that the authority coefficient of experts was 0.91, the coefficients of variation of two rounds of consultation were 0.14 and 0.13, respectively. The final constructed index system contains 3 domains, 15 dimensions, and 36 indicators, with a comprehensive index calculation method. The results showed that the overall scores for the two counties in Guangxi Zhuang Autonomous Region were 58.62 and 52.57, respectively, both of which were below the current national benchmark (60.00 points) .

Based on the data availability, the index system constructed in this study can be applied to monitor and evaluate county health system to achieve the goal of focusing on primary care, its application may improve visibility and priority of primary care development, facilitate the publish and implementation policies strengthening primary care.

"以基层为重点"是新时期卫生健康工作方针的首要内容，但实践中缺乏有效的测量工具。

本研究旨在构建"以基层为重点"的县域卫生体系发展指数，为监测县域卫生体系"以基层为重点"发展情况提供方法参考，并结合应用案例展开分析演示。

本研究的开展时间为2021—2022年，首先基于文献综述和德尔菲法建立指标体系、确定指标权重和各项指标的百分制转化方法，其次利用2020—2022年在广西壮族自治区两个县域卫生体系综合改革试点县开展的基线调查收集的居民/患者/医务人员问卷调查、机构调查、医保数据及关键知情人访谈数据等开展案例应用与分析。

德尔菲结果显示，专家的权威系数为0.91，两轮咨询的平均变异系数分别为0.14和0.13。最终构建的指标体系包含3个层次、15个维度、36个指标，并附有综合指数计算方法。案例分析结果显示，广西壮族自治区两县的总体得分分别为58.62分和52.57分，均低于当前全国层面基准（60.00分）。两个案例县的主要"短板"集中在：人力资源质量和数量、糖尿病用药、信息互联互通等投入相关指标，基层医疗卫生可及性、协调性和连续性等过程相关维度指标，灾难性卫生支出、可避免的住院等结果相关指标。

在保证数据可得性前提下，本研究构建的指数可用于监测和评价县域卫生体系实现"以基层为重点"的程度，其应用或将有助于提升基层医疗卫生发展的"能见度"和优先度，促进有效强化基层的政策措施的出台和落实。