深圳市劳务工社区医疗服务购买的“三棱锥”模型构建及相关利益分析

Establishment of Triangular Pyramid Mode of Governmental Purchase for Labor Workers' Community Medical Service in Shenzhen and Its Stakeholder Analysis

目的构建深圳市劳务工社区医疗服务购买的"三棱锥"模型并探讨各相关方的利益。方法构建由主导者(政府)、支付者(社保机构)、提供者(社区医疗服务机构)、使用者(劳务工)四方组成的深圳市劳务工社区医疗服务购买的"三棱锥"模型,分析各相关方的利益。结果 (1)劳务工可以低廉高质地获得社区基本医疗服务,但存在过度使用医疗资源的现象;(2)劳务工社区医疗服务可增加社区医疗服务机构的业务量,但面临"服务越多亏损越大"的风险;(3)医疗保险机构为增大劳务工社区医疗服务的政策影响,导致社区医疗服务机构收不抵支,最终损害劳务工的利益;(4)劳务工社区医疗服务为政府解决劳务工"看病难、看病贵"问题的有效途径,但需要完善相关政策,消解负面影响。结论现阶段深圳市劳务工社区医疗服务购买必须发挥政府的主导作用,完善相关政策,协调和平衡各方的利益。

Objective To build up the triangular pyramid mode of governmental purchase for labor workers＇ community medical service （LWCMS） in Shenzhen and study the benefits of all relevant circles.Methods The triangular pyramid mode of governmental purchase for LWCMS in Shenzhen was built.It was composed of leading force （government）,payer （social security organization）,provider （community medical service organization） and user （labor workers）.The benefits of all relevant circles were analyzed.Results ⑴The LWCMS was low price and high quality,but there existed phenomenon of excessive using medicai resources.⑵Providing LWCMS could expand business volume of community medical service organization,but there were the risks of ＂the more the service,the more the loss＂.⑶The social security organization modified the policy in order to increase the influence of the LWCMS,which brought about financial insolvency for community medical service organizations,and finally harmed the interests of the labor workers.⑷The LWCMS policy was an effective measure for government to solve the problem of ＂ high expense and difficulties in medical care＂,but the relative policies should be improved to dispel the negative effect.Conclusion It is necessary for the government to play the leading role of purchase for LWCMS.The policy needs improving to coordinate and the interests of all parties.