强制首诊和双向转诊——神木“全民免费医疗”的下一步

Compulsive Initial Diagnosis and Dual Referral:The Next Step of “Free Health Care Project” in Shenmu County

在＂强县扩权＂背景下,2009年3月神木县启动＂全民免费医疗＂政策,实现了基本医疗服务的城乡一体化。这一制度与其在教育、就业、养老等方面的新政一样,不断探索着资源型城市实现基本公共服务均等化的新思路。本文通过对神木县＂全民免费医疗＂实施以来的居民满意度及制度运行状况的调研,指出神木医改中存在的主要问题：（1）神木县农村三级卫生服务网络不健全,乡镇卫生院作用发挥有限,医疗资源浪费与短缺并存;（2）为解决过度医疗问题而出台的控制医疗费用的细则在实际运行中效果欠佳。基于此,我们建议实行＂守门人＂制度,引入强制首诊和双向转诊制度,并设计出双向转诊和费用报销的程序及其配套制度,以期为神木医改出现的问题提供解决方案,同时为其它地区实现基本公共卫生服务均等化目标,提供一个有益的借鉴。

Under the background of ＂Powerful County to expand their powers＂,Shenmu County start the policy of ＂Free health care project to local residents＂ to realize the combination of healthy security between county and city.This policy will help resources cities to search for a new thought to realize the equalization of public service with other new policies in education,working and old-age security.Through the survey on resident satisfaction and current situation about the implementation of ＂Free health care project to local residents＂,the paper figures out that：（1） Shenmu existing three level rural health service network is incomplete,township hospitals play a limited role,waste and short of medical resources coexist;（2） The rules of controlling medical costs doesn＇t perform well in the practical operation.Based on that,we consult ＂gate-keeper＂ rules from the western medical system and take in compulsive initial diagnosis and dual referral system.Through the designing of referral and other systems,we expect to give a case to solve the problem in Shenmu County medical reform and make a good model for other areas to realize the equalization of public service.