某市社区卫生机构与大中型综合医院的关系模式研究

Research on relationship between Community Health Services facilities and hosptials in uran area

目的:了解某城市社区卫生服务机构与大中型综合医院之间关系现状,探讨建立两者之间合理关系的策略。方法:文献研究、案例研究和关键知情人访谈。发现:我国医疗机构与行政管理级别对应,使得大医院和基层卫生服务机构之间关系松散,缺少联系;在发展和改革过程中,大医院和社区卫生服务机构之间的服务提供内容界定并不清楚;虽然出台了不少加强两者之间联系的政策措施,但这些新政策尚没有抓住关键环节。某市两类机构的关系主要有三种类型:大医院办社区、契约或托管、松散关系。研究表明,两者之间自身利益关系越密切,越能够顺利地实现相互联系,此外,还有很多方面会影响二者之间的关系。结论:需要明确两类机构的角色与功能,加大社区卫生服务的发展力度,特别是人才培养,在一定程度上限制大医院的规模;对于大医院办社区的模式,需要谨慎对待。

Objectives:The research aims to understand the relationship between Community Health Services facilities and hospitals in the sample city. Methods:Literature review,case study and key informant interview were applied. Main findings:The health care facilities located in and administered by different administrative levels. It resulted in loose relationship between hospitals and community health care providers. The functions and roles for these two kinds of providers have not been clearly defined. A number of new policies were developed to guide the two providers establishing a harmonious relationship. However,it seems that these new policies have not touch the key problems. There are three types of relationships between these two providers:1) hospital managed community health care,2) hospital contracted community health centers,3)hospital doesn't have any relationship with Community Health Services. Therefore,a close relationship between these two providers depends on whether they can benefit to each other. However,the government needs to determine carefully on whether it should support this type of relationship. Conclusions:Roles and functions of different providers should be defined. The development of the Community Health Services should be focused,especially the human resource development. It is urgent to regulate and restrict the scale of the large hospitals.