分级诊疗的本质、制度性障碍与对策建议

The Nature of the THCS,Institutional Obstacles and Suggestions

通过比较国内外对分级诊疗的定义与实践探究分级诊疗的本质,认为分级诊疗是医疗机构之间"明分实合"的专业诊疗模式,该模式的实现有赖于各项医疗管理制度的良性运转与协调。通过对当前我国相关制度的剖析,发现当前分级诊疗模式构建困难的主要原因是行政等级制度导致优质医疗资源向高端富集;双向转诊制度不完善;良好就医文化尚未形成。因此,必须通过改革医疗机构的薪酬制度、管理制度、转诊制度及培育合理就医文化等来实现"明分实合"的诊疗模式。

Based on the domestic and foreign classification of the tiered health care system（THCS）, it studied the nature of the THCS. THCS was regarded as a professional mode of diagnosis and treatment, which was divided on the surface, but combined in practice. The mode depended on the benign operation and coordination of the medical management system. Then, the current THCS in China was analyzed. The main reason for the difficulty in establishing the current grading system was that administrative hierarchy system led excellent medical resources to be aggregated in the higher level hospital; two- way referral system was not perfect; good medi- cal culture had not been yet formed. Therefore, it needed to reform the salary system and management system, transfer system and cul- tivating the culture of medical treatment of medical institutions so as to realize the diagnosis and treatment mode.