基于WHO分析框架,从结构和过程两个层次及多重维度,考察欧洲初级卫生保健的改革状况及趋向可以发现,嵌于初级卫生保健背景的守门人制度,是衡量初级卫生保健强弱程度的重要指标和显著特征。因此,建立何种状态的守门人制度,是中国初级卫生保健体制改革的关键所在。鉴于无守门人制度不利于卫生费用的控制以及卫生服务的连续性、协调性和一体化,而强制性守门人制度会牺牲病人的自由选择权从而导致较低的满意度,所以建立尊重病人需求和愿望的“中间状态”的守门人制度,是中国走向强初级卫生保健体制的不二选择。 Based on the WHO analytical framework, the status and trends of reforms in primary health care in Europe are examined at two levels and in multiple dimensions, both in structure and in process. It is found that the gatekeeper system embedded in primary health care is an important measure of the strength of primary health care Indicators and salient features. Therefore, what kind of state gatekeeper system should be established is the key to the reform of China’s primary health care system. In view of the fact that the gatekeepers system is not conducive to the control of health costs and the continuity, coordination and integration of health services, and the mandatory gatekeeper system sacrifices the patient’s freedom of choice and thus leads to lower satisfaction, the establishment of respect for patient needs And the “gatekeeper” system of “intermediate status” aspirations are the only alternative China has to move toward a strong primary health care system.