我国目前分级诊疗工作中的几个关键环节探讨

Key Elements of Building Coordinated Health Care Delivery System in China

本文依据"知信行"行为改变理论,探讨分级诊疗体系建设中政府管医、医生行医、患者就医行为改变的关键要素,并探讨实现"大医院愿意放、基层愿意接、患者愿意去"的政策支撑和制度环境。本文提出:在认知上,分级诊疗是区域医疗服务体系规划的核心,是医改工作的风向标,是一项复杂的长期任务。在意愿上,若要大医院愿意放,需同步推进传统的财政补助方式、当前医疗服务定价机制的改革;若要基层愿意接,应设立财政专项补助、拉大绩效工资差;若要患者愿意去,应鼓励大医院专科医生坐诊基层、正确宣传基层首诊内涵、完善医保管理方式。在行动上,实行机构差异化考核、设立大医院基层部、打通药物目录等管理措施必须兼顾,协同推进分级诊疗体系建设。

According to the behavior changing theory of knowledge-attitude-practice,we explored the key elements regarding how government manages medical services,how doctors practice medicine,and how patients have medical services in the coordinated health care delivery system in China,and also explored the supporting polices and institutional environment to encourage major hospitals to make patient referral down to primary-level medical settings,primary-level medical settings to receive referral patients, and patients to have medical services in primary-level medical settings. This paper came up with following suggestions. In terms of cognition,we should realize that the coordinated health care delivery system is the core of planning for regional health care delivery system and benchmark of health care system reform, and is a complex long-term task. In terms of willingness,given the willingness of major hospitals to make patient referral down to primary-level medical settings,the reform of traditional financial aid mode and the current pricing mechanism of medical services should be carried out at the same time; given the willingness of primary-level medical settings to receive referral patients,special subsidies should be established and the gap of performance pay should be widened; given the willingness of patients to have medical services in primary-level medical settings,specialist doctors of major hospitals should be encouraged to provide medical consultation in primary medical settings,the concept of first diagnosis in primary-level medical settings should be publicized in a right way,and medical insurance management should be improved. In terms of action,while advancing the coordinated health care delivery system,other measures should be implemented at the same time,including differentiated assessment systems,establishment of primary-level departments in major hospitals and consistent drug lists.