分工视角下的全科与专科医学服务分化研究

Analysis on division of specialists and general practitioners in China: From the perspective of Labor Division theory

全科与专科医学服务分工形成是建立全科医生制度的重要环节,利用分工理论分析全科与专科分工演进的机理,并据此分析影响我国全科与专科医学服务分化的主要原因。结果发现,我国患者接受全科医学服务的交易费用并未远低于接受专科医疗服务的交易费用,患者更愿意在医院首诊,加之转诊交易费用较高而收益较低,均导致了全科与专科医学服务不仅无法形成分工而且存在竞争,全科医学专业化难以建立,更无法推动全科医学服务水平及效率提高;全科与专科医学服务收益差距较大,激励医学生更愿意从事专科而非全科事业,全科医学人才匮乏更加大了全科医生与专科医生技术水平的差距,从而导致患者接受全科医疗的交易费用继续上升,形成恶性循环。

The division of specialists and general practitioners is the important of the establishment of a GP system. According to the theory of labor division, the study analyzes the evolution mechanism on the division of spe-cialists and general practitioners and discusses the main factors influencing the division in China. It is found that transaction costs of general practices are not much lower than that of specialist medical care, which encourages outpa-tients to visit specialists in hospitals. Additionally, transaction costs of referral are much higher than profits. There-fore, while there is no division of specialists and general practitioners, it has been difficult to address competition between them and the quality and the efficiency of general practice care in community health centers. Moreover, the income gap does not attract medical students to work in general practices, which has worsened the quality and effi-ciency of general practices. Finally, the transaction costs of general practices have continually increased. This vicious cycle has hindered the division of specialists and general practitioners in China.