| This article is wrote to discuss the role of community health center in Shanghai playing during the first-treatment system operation process.In 1978, Primary Health Care was first put forward by World Health Organization for the sake of a global health strategy:achieve health for all. Since then,more and more countries treat national health strategy as a part of national develpment strategies by transfering medical health service from hospital-oriented to community-oriented and family-oriented. Facing the global tredency, to meet the needs of social development, establishing first-treatment system at community and developing community health care had been a critical part of health care system reform in 2009 in China, thus the role of community health center becoming a heated issue both acdemically and pratically.I use related policy literatures and data got from the study of XHCQ community health center as two basic materials to do analysis. According to role theory, I try to study the role of health care center during the operation process of two main components of first-treatment system: Medical Associations system and General Practioners system at community level, from the perspective of ideal role and real role.This thesis consists of five parts. The first part is introduction. In this part, the study proposition and its meaning, research route and the approach and a brief introduction regarding the case are involved. Literature review of community health care, first-treatment system at community and the role of the clinics at basic level are also included in this part. The second part is a descriptive study under desk research of each period of Shanghai community health center’s establishment and development,and the construction process of two main components of first-treatment system at community level, medical association system and general practitioners system, as well.The third and fourth parts show the role of community health center in medical association system operation and general practitioner system operation respectively.The discussions are extented at four level: ideal role set and real role status; how real role status approach to ideal role set; the disparities and its formation reason between ideal role set and real role status; the countermeasures and suggestions to reduce the disparities. The last part is summary to make a conclusion and an evaluation of thisthesis.My viewpoint could be concluded mainly as the following:Firstly, the ideal role of community health center during the operation process of first-treatment system has a dual nature which are policy sets and residents’ requirements. These two factors may not be the same because some policies have hysteretic nature compared with residents’ requirements and some residents’ requirements seem to be not that reasonable.Secondly, the existence of the discrepancy above impact the real role of community health center during the operation process of first-treatment system objectively. The negtive effection is that community health center may has an incorrect role orientation. However, there also has some positive effections. On one hand, community health center has its responsibility to submit residents’ requirements to a higher level as the first place of the connection between national health system and the national and their families. Under good feedback, policies and their operations could be improved to fufill residents’ requirements, and residents’ requirements could be more reasonable. On the other hand, community health center should try to create roles to satisfy residents’ personalized and multiple requirements within the scope of the policy allows.Thirdly, community health center should make the first diagnosis responsibility and the two-way referral system into practice tangibly in the medical association system operation. The real role should be kept the same to the ideal role for community health center in this aspect. However, because of the lack of the supporting system, community health center doesn’t operate as well as it is required.Fourthly, during the general practitioner system operation process, policies could highly meet residents’ requirements. But the quantity of general practitioner is too small to complete the work the policies stipulate and the residents require. So that community health center has a discrepancy between ideal role and real role in this aspect.Last but not least, from the above, there are two urgent measures should be put into practice as objective neccessary conditions to reduce the discrepancy between ideal role and real role of community health center during the operation process of first-treatment system at community. One is improve and perfect the supporting system of two-way referral system. The other one is to enhance general practitioner orientation.In summary, the innovation point and academic meaning of this thesis is that I found the dual nature and its potential contradiction of the ideal role of community health center during the construction process of Shanghai first-treatment system at community, and the analysis to the contradiction’s effection to community health center’s real role. In addition, the analytical framework and the conclusion may offer a new perspective and some first-hand materials that are helpful to further study regarding first-treatment system at community and urban primary health care.However, due to the limitation of my capability and study time, there still has some shortages in reading policy literature, in the scope of case study and data analysis and so forth which are expected to made perfect in further study.
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