强力建设首诊制 纠正医疗资源误配置

Establishing Primary Care to Correct Misallocation of Health care Resource

在过去20年左右的医疗服务市场化改革和医疗保障制度改革过程中,我国医疗资源配置及利用"倒金字塔"的问题逐步产生和积累,并成为"看病贵、看病难"的部分原因。基于人人享有基本医疗服务的价值取向,政府必须反转"倒金字塔"、纠正资源的误配。参考国际经验,并行展开基层医疗服务能力建设和参保者就医行为管理工作是反转"倒金字塔"的保证,其中的首诊制(守门人制度)是核心。建设首诊制是一项艰难的系统工程,政府要采取由上而下、整体推进的管理方法。

The evolution of health care system and medical security in China during the past two decades gradually caused the allocation of healthcare resource been characterized by ＂Inverted Pyramid＂, and became parts of the reasons of ＂too expensive and difficult in seeing doctors＂. This misallocation has been suspected to be a reason to unaffordability and inaccessibility of the health care services. Abide by the principle of ＂universal coverage to basic health care＂, government should correct this misallocation. Two institutional infrastructures have to be established in parallel： Service capacity of basic health care institutions and management of patients＇ referral system. For which, primary care is the core. The paper proposes that primary care is a systematic project with tremendous challenges; therefore, the government has to enforce it from up to bottom, as well in a systematic approach.