基于全科医疗的“社区首诊和双向转诊责任制”政策框架及要素

Policy framework and components for general practice-based gatekeeping and referral system

社区首诊和双向转诊制度是合理配置卫生资源的核心制度之一,本质是关于病人在医疗服务体系中的进入点和流向的规则,背后隐含着众多利益相关方,其中各方权利、责任与利益分配复杂。因此,构建一个系统的政策框架,对顺利推进和不断完善社区首诊和双向转诊制度具有重要意义。本文给出以全科医疗为基础的社区首诊和双向转诊责任制(下简称"社区双诊责任制")的定义与内涵,揭示该政策的价值基础。建立包括十大要素在内的"社区双诊责任制"政策框架。描述了每一个要素所涵盖的组织,界定了政府、市场、社会和个人在其中的责任义务以及他们之间的互动关系模式,最终形成一个较为系统完整的政策框架。

Gatekeeping and referral system are core institutional arrangements in health resource allocation which regulate the consumers’ entry points and their fluxion in the healthcare service delivery system. Hiding behind such arrangements are numerous stakeholders and their sophisticated interactions of obligation, responsibility and ben-efits. For this reason, it is of great importance to build a more systematic and integrated policy framework to promote and impoverish the gatekeeping and referral system. This paper puts forward the definition of“general practice-based gatekeeping and referral system” and revealed the political values embedded in it. We then identified the ten essen-tial components for policy implementation based on this definition. For each component, we recognized the involved actors, and elaborated their obligations, boundaries and interactions. This ten-component policy framework could be used in the international comparison research as a map, guiding the implementation of gatekeeping and referral system.