政府购买服务与社区卫生服务机构的发展

Building a New Mechanism: Public Purchasing and the Development of Community-oriented Primary Health Care in China

在当代中国的城镇与乡村,社区卫生服务机构能否发展为民众的健康守门人,这是中国医疗服务体系改革与发展的重要议题之一。近年来,各级政府投入了大量公共资源,社区卫生服务机构的服务能力显著提升,但医师人均诊疗服务量基本上原地踏步,住院服务量却在萎缩。要达成"强基层"的目标,最为关键的是要"建机制",即建立一种政府购买服务的新机制,取代当前流行的行政化体制,以调动基层医疗机构的积极性。新机制的核心就是推进医保付费改革,以按人头付费为主导的新付费方式取代通行的按项目付费主导制。

The development of community health system, urban or rural, is a key issue on the agenda of China＇ s health care reforms. Over the past years, the Chinese government has channeled a great deal of public resources into community health service, so that capacities of primary care providers have been considerably upgraded. Yet the volume of service per doctor has decreased. While outpatient visits per doctor have maintained little change, the volume of inpatient services （e. g. , small surgeries） has de- Clined. To hit the target of ＂strengthening the grassroots, ＂the key is to building a new mechanism of pub- lic purchasing of service. At the core of the new mechanism is the replacement of fee - for - service with capitation - based provider - payment modes.