我国公立医疗机构落实分级诊疗制度情况分析

Analysis on the Implementation of Hierarchical Diagnosis System in Public Medical Institutions of China

目的:分析公立医疗机构中基层医疗卫生机构医疗服务量占比变化,探索公立医疗机构分级诊疗制度落实情况。方法:利用2009—2017年全国及各地卫生财务年报数据,分析公立医疗机构中基层门急诊量占比和住院量占比变化。结果:从全国层面看,2017年公立医疗机构中基层医疗卫生机构的门急诊量和住院量分别占35.13%和21.77%,较上年分别下降了0.57个和0.54个百分点,与2009—2017年平均每年降低0.85个和1.68个百分点相比,降低幅度趋缓。从省级层面看,与上年相比,2017年全国34.38%(11/32)的省份基层门急诊人次占比上升、34.40%(11/32)的省份基层出院人数占比上升,其中浙江省、吉林省和宁夏回族自治区基层门急诊量和住院量占比得到双提升。福建省基层门急诊人次占比连续5年上升4.87个百分点,广东省连续4年上升5.30个百分点,浙江连续3年上升1.15个百分点。湖北省基层出院人数占比连续3年持续提升了1.66个百分点。结论:我国分级诊疗政策实践效果并不理想,基层医疗服务量占比降低幅度有所趋缓,部分地区连续几年基层医疗服务量的上升也反映了国家针对分级诊疗制度采取一系列创新突破政策起到了一定的作用。从以下两个方面着手,助力分级诊疗制度建设,一是科学制定区域卫生规划,加强人大政协对规划刚性约束;二是完善相关机制和政策,发挥对基层医务人员和患者基层就医"双向"激励作用。

Objectives: To analyze the changes in the proportion of medical services in public primary health care institutions of China, and to explore the implementation of hierarchical diagnosis system in public medical institutions. Methods: The data of 2009 to 2017 National and Local Health Financial Yearbook was used to analyze the proportion of primary care outpatient and hospitalization in public medical institutions. Results: On a national basis, the proportion of primary care outpatient and hospitalization in public medical institutions accounted for 35.13% and 21.77% in 2017, with a decrease of 0.57% and 0.54% compared with the previous year respectively. With the average annual reduction of 0.85 and 1.69 percentage points from 2009 to 2017, the reduction slowed down. At the provincial level, the proportion of primary care outpatient increased compared with the previous year in 34.38% (11/32) of the provinces in 2017, and the proportion of primary care discharges increased in 34.38% (11/32) of the provinces in 2017. The proportion of primary care outpatient and hospitalization in primary healthcare institutions increased in Zhejiang Province, Jilin Province and Ningxia Hui Autonomous Region. The proportion of primary care outpatient in Fujian Province increased by 4.87 % for 5 consecutive years; the proportion in Guangdong Province increased by 5.30% for 4 consecutive years; and the proportion in Zhejiang Province increased by 1.05% for 3 consecutive years. The proportion of primary healthcare discharges in Hubei Province has continued to increase by 1.66% for 3 consecutive years. Conclusion: The practice effect of hierarchical diagnosis and treatment system in China was not satisfactory. The decrease of the proportion of primary medical services had slowed down. The increase of primary medical services in some areas for several consecutive years also reflected the effect of the implementation of a series of innovative breakthrough policies for hierarchical diagnosis and treatment system. The construction of the hierarchical diagnosis and treatment system would be assisted, starting from the following two aspects. First, it needed to scientifically formulate the regional health plans, strengthen the rigid constraints of the National Peolple’s Congress and the National Committee of the Chinese People’s Political Consultative Conference on planning. Second, it needed to improve relevant mechanisms and policies, and exert the two-way incentives for primary medical staff and patients.