台湾社区首诊双向转诊制度的运作及其借鉴

Experience of First Community Clinic and Two-way Referral System in Taiwan

为了解决看病难、看病贵这一世界性难题,台湾地区制定了"全民健康保险法""全民健康保险转诊实施办法""医疗法"等办法,以"分级医疗制"为核心、整合私立医院及私人诊所为医保特约单位,依托社区医疗群提高全科医生的医治水平,引导患者到基层医院就医,成为其他国家和地区解决这一难题的典范。借鉴台湾地区的经验,我们应该将所有医疗机构界定为非营利性质,将其纳入到医保定点机构,通过行政监督、行政审计及第三方监督相结合等措施限定各类医疗机构的利润率,减少各级医疗机构的赢利冲动,鼓励非公医疗机构之间、私立医院与公立医院之间开展业务协作,建立三级医院托管社区卫生服务中心制度以及三级医院医生到基层医院坐诊制度,实施住院患者转诊到社区卫生服务中心接受康复治疗制度,完善社区卫生服务中心职能,使之能够承担预防、教育、医疗、康复、护理、理疗等职能,保障社区首诊双向转诊制度的实施。

In order to solve the worldwide problem of poor access and high fee in the medical area, Taiwan has made the ＂National Health Insurance Law＂, ＂National Health Insurance Referral Implementation Measures＂, ＂Health law＂ and other measures to formulate the ＂medical classification system＂ as the core, to integrate the private hospitals and private clinics into the special unit of the medical insurance, to rely on the community＇s medical group to improve the professional level of the GPS, to guide the patients to the grass-roots hospital, which becomes a model to solve the problem of poor ac- cess and high fee for other countries and regions. Learning from the experience of Taiwan, we should define all the medical institutions as non-profit institutions. They will be incorporated into the medical insurance institutions, through the measures of combining the administrative supervision, administrative audit and the third-party supervision to restrict the profit rates in the various medical institutions, reduce the profit impulse at all levels of medical institutions at the same time; encourage the non-public medical institutions and the public hospitals to carry out the service cooperation. By setting up the system of the community health service center under the tertiary hospital trusteeship the doctors in the latter one can go to the grass- roots hospital to see the patients,. Implementing the system of making the inpatients referral to community health service center for receiving rehabilitation treatment makes the community health center bear the functions of the prevention, educa- tion, medical care, rehabilitation, nursing and physiotherapy. By integrating the various subjects like government, hospi- tal, industry associations, citizens and so on it is possible to establish a multiple supervision system to guarantee the implementation of the first community clinic and two-way referral system