全科医疗核心特征功能、高绩效作用机制及其政策涵义

Core attributes,high-performance functional mechanism and policy implications of general practice

全科医疗是基础保健的核心,已经成为各国高价值卫生保健体系的基石。首诊、可及性、连续性、协调性和综合性五大特征构成了以功能为导向的全科医疗定义的要素。本文从全科医疗定义出发,厘清和归纳全科医疗五大特征功能的定义、内涵及其作用,探索五大特征功能对卫生体系高绩效的作用机制。并对我国全科医疗提出建议:将基层医疗卫生服务体系更名为基础保健体系;以五大核心特征功能为重点,发展强化基础保健体系,促进基层医疗卫生服务转型升级;重点从全科医生数量、薪酬制度、医保采购以及全科医生教育培训体系等方面完善全科医生制度;从组织层面建立有助于实施全科医疗特征功能的管理制度与服务流程。

General practice is the core of primary care,and it has become the fundamental part of some highvalued health care system. The function-orientated definition of primary care comprise of five core attributes,which are first-contact,accessibility,continuity,coordination and comprehensiveness of service. This paper started from the definition of general practice and sought to clarify and summarize the definitions,contents and functions of its five core attributes; meanwhile,the high-performance functional mechanism of health care system was also explored. On this basis,four suggestions are put forward： The basic medical health care system should be renamed primary care system; Five core attributes of primary care should be emphasized when strengthening the primary care system; the primary care system should be improved,and the key points are the number of general practitioners（ GPs）,payment system,primary care purchasing,educational system of GPs and etc.; The management system and service process should be developed which would benefit the implementation of the core attributes of primary care at an organizational level.