医疗卫生服务体系整合:国际视角与中国实践

Integrated healthcare system:International perspective and Chinese practices

为应对老龄化和医疗卫生服务体系碎片化等挑战,许多国家和地区开展了不同内容和形式的医疗卫生服务体系整合改革,内容上主要包括服务提供、治理机制、组织管理和筹资支付等方面,形式上可分为水平和垂直整合、虚拟和实体整合等模式。新医改以来,我国一些地方,尤其是公立医院改革试点城市,在医疗卫生服务体系整合方面进行了改革实践。这些做法各有特点,主要有政府主导是目前整合的主要改革动因;以技术为纽带的虚拟整合简便易行,形式灵活;委托管理或联合体式的整合涉及资产的管理,一体化程度较高;联合兼并式的实体整合具有更强的资源配置能力。但目前我国医疗卫生服务体系整合还存在诸多障碍,如政府分级管理体制、公立医院单体扩张需求、公立医院与基层医疗卫生服务机构衔接、患者自由流动意愿与医保自由就医政策等。应对的主要策略有,注重发挥政府行政调控与市场机制结合的双重作用,因地制宜、循序渐进推动整合,通过改革支付制度等多种方式建立激励机制,有赖于公立医院改革的进一步深化等。

To confront the challenges of aging, health services fragmentation, and so on, most countries and regions have developed integration reform of healthcare system that includes the contents of health service delivery, governance mechanism, organization and management, financial and payment, and the forms of horizontal and vertical integration, real and virtual integration. After health system reform, some reforms have been implemented in several cities of China, especially in public hospitals pilot cities. These practices have different characteristics： ⅰ）the drive of government is the main reform motive.ⅱ） virtual integrations through medical technique are more operable and flexible.ⅲ） The integration degree of Hospital trusteeship and contract-type medical association have higher because of referring to asset management.ⅳ） The real integration of medical conglomeration merger has more abilities to allocate health resources. However, there are some drawbacks to integrate the health system, such as hierarchical management, the hospitals expansion need, the link-up between hospitals and primary-level institutions, the patients’ free flow will and free visits policies of health insurance, etc. The possible strategies include： ⅰ） Combining government and market regulation.ⅱ）The integration should suit local conditions and be developed step by step. ⅲ）Developing payment and other reforms to establish the incentive mechanism of integration.ⅳ）The integration should be got to public hospital management and mechanism reform.