我国部分地区分级诊疗政策实践的比较分析

A comparative study on different policy practices of domestic tiered health care system

为了解我国部分典型地区分级诊疗政策的特点与实践中存在的问题,通过梳理上海市、浙江省杭州市、福建省厦门市、陕西省延安市、甘肃省平凉市、宁夏自治区盐池县、广东省东莞市等地区分级诊疗相关政策内容,将其分级诊疗的做法分为综合网络、医疗集团推动、医保主导和需方引导等类型,对其服务提供方式、筹资支付机制、管理考核机制、人才培养机制、药品供应机制、信息共享机制等方面进行了深入分析。研究发现,不同地区分级诊疗政策的切入点和侧重有所差异;普遍重视改革医保支付方式,发挥其引导和制约作用;部分地区重视完善与服务模式相适应的基层卫生人才保障和药品供应制度;政策措施的综合性、联动性有待加强;与国际成熟做法仍存在一定差距。建议以完善医疗卫生服务体系为抓手,因地制宜、循序渐进地推进分级诊疗;建立与政策目标一致、相容的激励约束机制;加强政策措施的综合性、联动性;健全基层卫生人才保障和药品供应机制,提升基层服务能力。

In order to understand features and existing problems in practice of tiered health care system in par- tial priority areas, this article sorted through what and how tiered health care policy had been put into effect in Shanghai, of G Hangzhou of Zhejiang, Xiamen of Fujian, Yan＇an of Shaanxi, Pingliang of Gansu, Yanchi of Ningxia, Dongguan uangdong, formed their practice as integrated network, medical group driven, health insurance dominant and consumer-usher four types, and also developed in-depth analysis on means of service delivery, mechanism of finan- cing and payment, mechanism of management and evaluation, mechanism of heath manpower resource cultivation, mechanism of drugs supply, and mechanism of information sharing. Research findings were ： different area has different policy entry point and priorities for tiered health care system policy, whoever involved in pays attention to reform health insurance payment which would make full play of guidance and restrict functions becomes a commonplace; in partial area grass-roots medical personnel and drug supply mechanism are stressed on improvement corresponding with health care delivery ; the measures of policies should be more integrated and joint-robust; and comparing with mature international practice, there is still big disparity. In conclusions, the policy implications were as follows： improving health care delivery system should be policy grip, considering local conditions gradually put forward hierarchic health care policy. Incentive and restrict mechanism should be established in according with policy goals. Policy measures should be more integrated and joint-robust. The grass-roots health manpower resource should be ensured and a sound drug supply mechanism should be improved, aiming to promote grass-roots health service delivery capability