公共卫生是以推动公众健康的改善为使命的一项公共事业，提升公共卫生服务绩效是贯彻“以人为本”核心理念的具体表现。社区公共卫生服务是促使我国基本公共卫生服务均等化、深化医疗卫生体制改革的重要交会点，同时也是“人人享有卫生保健”目标的主要内容。而社区公共卫生服务绩效，尤其是欠发达地区的绩效高低则与国家基本公共卫生服务均等化进程的深入推进密不可分，对于深化国家医疗卫生体制改革的影响作用更不容忽视。在此背景下，本书定位于欠发达地区，以社区公共卫生服务绩效与其影响因素为研究对象，通过定量剖析绩效与其影响因素之间的关系，并围绕影响因素，审视、归纳欠发达地区社区公共卫生服务绩效问题之关键所在，从而为我国欠发达地区有针对性地提升社区公共卫生服务绩效管理的政策启示提供经实证检验的数据支持和现实依据。本书的主要内容是：首先，系统性地梳理、总结相关研究成果，在借鉴其理论基础之上，运用结构方程模型（SEM）工具，构建我国欠发达地区社区公共卫生服务绩效结构概念模型、社区公共卫生服务绩效与影响因素关系概念模型，继而提出研究假设。其次，基于样本地区的数据调查，借助SPSS和AMOS数据分析工具验证所构建的概念模型与研究假设，并对实证检验结果进行分析、讨论和解释，为后续的绩效问题审视和管理启示提供实证检验后的数据支持。再次，以实证检验的结果，围绕影响因素，审视当前欠发达地区社区公共卫生服务绩效问题关键点，为绩效管理启示提供现实依据。最后，结合实证检验的数据支持和现实依据双重证据，归纳得出我国欠发达地区社区公共卫生服务绩效管理的政策启示，从而在为欠发达地区社区公共卫生服务绩效改善赋予一种基本分析思维框架的同时，对于针对性地促进其影响因素发挥出正向、积极的作用亦有非常明显的意义。本书的研究创新主要体现在以下三点。第一，以量化的方式展现欠发达地区社区公共卫生服务绩效和各个构成要素之间的内在关系，并具体测算出各个构成要素对我国欠发达地区社区公共卫生服务绩效的贡献情况，为欠发达地区提升社区公共卫生服务绩效提供基准与思路，且研究对全面理解和认识社区公共卫生服务绩效理论在不同区域背景下的应用也是一种非常有益的尝试，因而本书具有一定的拓展性。本书从绩效管理视角入手，将其理论应用于社区公共卫生服务研究，定位于欠发达地区，从投入、运行、效果三个要素，构建了欠发达地区社区公共卫生服务绩效结构模型，测算出三个构成要素对欠发达地区社区公共卫生服务绩效的贡献情况。结果显示，运行要素对欠发达地区社区公共卫生服务绩效的贡献最大，而投入对其的贡献最小。因而欠发达地区在面对经济落后、投入有限而公共卫生问题比较突出的困境下，应首先对其运行要素予以关注。第二，从社区公共卫生服务绩效的宏观研究向更具有可操作性的微观领域聚焦，从实证分析的视角寻找影响因素对绩效产生影响的新的数据证据和现实依据，从而使得欠发达地区社区公共卫生服务绩效管理的政策启示更具科学性和针对性，因而本书在一定程度上丰富和发展了社区公共卫生服务绩效研究框架。具体实施时，使用世界银行与哈佛大学有关卫生服务绩效诊断框架做基础，构建欠发达地区社区公共卫生服务绩效与影响因素关系模型，提出欠发达地区社区公共卫生服务绩效受组织管理、资源配置、支付方式、监督约束与行为改变五个变量的影响。基于样本地区的数据调查，具体量化各个影响因素对三个绩效构成要素的影响程度。结果显示，五个影响因素对欠发达地区社区公共卫生服务运行要素产生的总影响效应最大，支付方式对投入要素的影响效应最大，而行为改变对欠发达地区社区公共卫生服务效果要素是最大的影响因素。同时，五个影响因素中，组织管理对其他四个影响因素均直接产生正向作用，且对支付方式产生的直接影响最大。继而围绕五个影响因素，从实践中寻找并归纳出绩效问题的关键点，为欠发达地区社区公共卫生服务绩效管理的政策启示提供现实依据，从而对于欠发达地区更清楚地认识并有针对性地促进这些影响因素发挥正向、积极的作用具有非常明显的意义。第三，本书在构建模型与检验模型时，使用了融合回归和路径分析、确定性因素分析的结构方程模型（SEM）法作为本书的实证检验工具，避开了以往回归模型的方法只能同时解释单个因变量和单个或者几个自变量间关系的约束，从定量的角度揭示欠发达地区社区公共卫生服务绩效构成要素间、绩效与各个影响因素之间的关系，使得本书的最终分析结果更具科学性、合理性和系统性，从而实现了用新工具解决新问题的恰当运用。关键词：欠发达地区 社区公共卫生服务绩效 影响因素 关系效应 实证研究

Public health is a public utility targeting on pushing forward the development of public health and improving its performance is the embodiment of the implementation of “people-orientated” concept. Community public health service is not only the junction point of equalizing basic public health service and deepening the reform of medical and health care system of China，but also the main content of “everyone enjoying medical and health care” target. Community public health service takes an important mission in respects of the purpose and function of public health as well as the mission of national reform on medical and health care system. Especially in areas with underdevelopment，the performance of local community public health service is closely connected to the implementation of equalizing basic public health service，and has an explicit effect on deepening the reform of medical and health care system of China.Given the situation above，with the focus on underdeveloped areas，targeting on the performance and influential factors of community public health service，by quantitative analysis on the relation between performance and its influential factors，this work reviewed and generalized the key points of the performance issues in underdeveloped area to offer enlightenment to improve the performance management of community public health service in underdeveloped area，also provided empirical test data and practical supports.The main work is as followings：First，with systematic organizing and summarizing previous works，basing on their theories，Structural Equation Modeling （SEM） was used to build the structural concept model for the performance and the relation between performance and its influential factors of the community public health service in underdeveloped area，with which the research hypothesis was proposed. Second，basing on the data from sample areas，with SPSS and AMOS data analyzing，the concept models and hypothesis were testified，and the empirical testing results were analyzed，discussed and explained to offer testified supportive data for further review and enlightenment on performance management. Third，basing on the testified empirical results，the key points of current performance issues of the community public health service in underdeveloped area were reviewed with influential factors to provide practical solutions to performance management. Last，with the support from both empirically testified data and actual evidence，the enlightenment on the performance management of the community public health service in underdeveloped area was concluded.Therefore，this study is given a basic frame of mind to improve the performance of the community public health service in underdeveloped area at the same time，also targeted to promote its influential factors that play a positive and active role have very obvious significance.The three major innovations of this work are：First，the inner relation of the influential factors of performance in the community public health service in underdeveloped area are presented in a quantitative way，and each factor’s contributions to the performance in the community public health service in underdeveloped area are calculated to provide a reference and an idea for improving the performance of the community public health service in underdeveloped area. Also，this research is a beneficial trial to comprehensively understand the theoretical application of the performance in the community public health service in different underdeveloped areas with different backgrounds. Therefore，this research itself is extensible itself. This work，starting from the perspective of government performance management，putting the theories into public heath service，focusing on underdeveloped area，built a structural model for the performance of the community public health service in underdeveloped area with factors of investment，operation and effect，and calculated each factor’s contribution to the performance of the community public health service in underdeveloped area. The result shows that operation makes the greatest contribution to the performance of the community public health service in underdeveloped area，investment the least. Therefore，with the difficulties of insufficient economic development，limited investment and serious public health problems，the factor of operation should be concerned first.Second，with the shifting of its focus from the macro-search of community public health service performance to the more operative micro-level，this work attempted to find out new data and actual evidence which reflect the factor’s influence on the performance in a empirical perspective to make sure that the enlightenment of the management on the performance of the community public health service in underdeveloped area would be more scientific and targeted. Thus，this work has enriched and developed the frame of the research on the performance of the community public health service in underdeveloped area. When implementing，this research followed the basis of area performance diagnostic frame of the World Bank and Harvard University，built the relation model for the performance and its influential factors of the community public health service in underdeveloped area，proposed that the performance of the community public health service in underdeveloped area was influenced by five variables：organization management，resources allocation，payment method，supervision and behavior change. In addition，the impacts of each variable on the three performance factors were specifically quantified basing on the data from sampling areas.The result showed that the five influential variables have the strongest total effect on the factor of operation of the community public health service in underdeveloped area，payment method have the strongest effect on investment，and behavior change influences the most on the factor of effect of the community public health service in underdeveloped area. Meanwhile，among the five influential variables，organization management has positive effect on the other four and the most direct effect on payment method. The conclusion of this empirical result provided data evidence for the enlightenment of the performance management of the community public health in underdeveloped area. Around the five influential variables，this research found and concluded the key points of the issue and offered practical evidence for the enlightenment of the performance management of the community public health service in underdeveloped area，which has a significant meaning on helping the underdeveloped areas clearly realize the issue and improving the positive and active of these influential variables in a targeted way.Third，while building and testing the models，with integration regression and path analysis as well as structural equation modeling （SEM） of confirmatory factor analysis as testing tools，this work avoided the usual restriction that regression model can only explain the relation between one dependent variable and one or several arguments，and revealed the relations between structural factors and between performance and influential variables. Therefore，this research has more scientific，reasonable and systematic analyzing results，and is an innovative application of new tools into new problems.Key Words：Underdeveloped Area the Performance of Community Public Health Service Influential Factors Relationship Effect Empirical Research

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