大医院与社区卫生机构合作模式的探索与分析——以北京安贞医院为例

The exploration and analysis on cooperation models between hospital and Community Health Services:A case from Beijing Anzhen hospital

通过介绍安贞医院在发展社区卫生服务上的多种模式做法,并定性分析不同模式的优缺点和实施条件,以及定量对比不同类别人员对不同模式的满意度差别,认为:两级医疗机构之间的利益关系越密切,越能顺利实现相互合作,双方的满意度也越高。"院办院管"模式的整体满意度最高,但实施条件要求高;"单项合作"模式深受社区卫生机构青睐,其实施需要政府充分发挥桥梁和沟通作用;"对口支援"模式的满意度最低。大医院无论采取何种模式,目前都是付出多、受益少,因此要求大医院应具有一种推进社区卫生服务发展的使命感,切实履行公益性职责,政府也应履行职责,加大政策扶持、资金支持和相关制度建设力度,尤其应理顺医院与社区卫生机构之间的经济利益关系,只有充分调动双方的积极性,才能真正实现城市两级医疗服务体系的协调和可持续发展。

This article aims to describe the multiple models of cooperation between Beijing Anzhen hospital and Community Health Services （CHSs）, and to have qualitative analysis of the advantages and disadvantages of different models and implementation conditions. It will also compare different stakeholders’ degree of satisfaction with the different cooperation models. Result： Shared interests can promote the mutual collaboration between hospitals and CHS, and improve their satisfaction with the collaboration. The model of ＂hospital managed community health services＂ receives the highest satisfaction, but requires the more implementation conditions. The model of ＂single project cooperation＂ is favored by the CHS, and needs sufficient communication in the implementation process. The model of ＂partner assistance＂ receives the lowest satisfaction. Regardless of the different models, hospitals have limited benefit from the collaboration, comparing to their input. Therefore, it requires that the hospitals should commit to their public service responsibility and missions to support CHS. The government should also fulfill its responsibility to strengthen policy and financial support. Proper attention should be paid to financial incentives of both sides, in order to develop a concordant and sustainable two-level urban health service system.