城市社区医疗服务多元供给模式探究

Diversified Supply Mode of Urban Community Medical Services

随着我国城市人口的急剧增加,城市居民的医疗需求日益增长,社区医疗服务能有效缓解医疗服务需求增长与供给短缺之间的矛盾。社区医疗的运作模式在发达国家比较成熟和稳定,目前社区医疗服务的供给模式具有国际代表性的主要有三种:英国模式、美国模式、德国模式。相比发达国家,我国学者对社区医疗服务的研究还比较粗浅和表层,主要研究了社区医疗服务的现状、运行机制、医保制度、如何构建首诊和转诊制度、如何配置医疗资源等,并向政府提供决策建议。目前我国城市社区医疗服务按供给主体来划分,可以分为四种模式,分别是政府供给模式、单位制供给模式、集体经济供给模式、社会力量供给模式。四种模式既有共性又有差异,共性是均受卫生行政部门领导和监管、都是城市医疗体系的基础等,差异体现在供给主体不同、服务人群有侧重、经费管理和人事管理也有区别,这4种模式相互补充,形成了能为全体城市居民提供社区医疗服务的多元供给模式共存的格局。城市社区医疗服务多元供给模式共存的形成机制为:社区医疗服务具有准公共物品属性、处于转型体制与城乡二元体制相结合的特殊环境、人们对医疗需求的多元化、医疗供给主体的利益导向等综合因素。多元供给模式能有效缓解城市社区医疗服务供给不足与居民对社区医疗需求增长之间的矛盾,促进城市社区医疗服务的均衡发展。

With the rapid increase of urban population, urban residents＇ medical need is growing. Community health service can effectively alleviate the demand and supply contradiction of medical service. Community medical operation mode in the developed countries is more mature and stable. At present, the supply mode of community health service with international features has three kinds： 1） the British mode, 2） the American mode, 3） the German mode. Compared with the developed countries, the Chinese scholars＇ study on community medical service is relatively shallow and surface. The main research includes the current situation of community health service, operating mechanism, health care, how to build the first diagnosis and transfer treatment systems, and how to allocate the medical resources, and providing policy recommendations to governments. At present, according to the supply subject, the city community health service in China can be divided into four modes, which are the government supply mode, unit supply mode, collective economy supply mode, and social power supply mode respectively. The four modes have both commonness and difference. The commonness is under the leadership and supervision of public health administrative department and they are the foundation of urban medical system. The difference lies in different supply main body, service people having different focus, different funds management and personnel management. The four modes complement each other and form the coexistence of multivariate supply of the community medical service for urban residents. The formation mechanism of diversified urban community health service is： the community health service has a quasi-public property attribute; it is under transition and under the special environment of urban-rural dual system combination; it has the diversity of people＇s medical needs; and it has the interests orientation of medical supply subject etc.. Multivariate supply mode can effectively relieve the contradiction between urban community health service supply and the health care demand growth of residents of community and promote the balanced development of urban community health services.