从疾病治疗转向疾病管理——兼论慢病治疗方式转变

From Disease Treatment to Disease Management——The Changes of the Way to Treat Chronic Diseases

医疗保险如何响应"健康中国"战略,体现预防为主和健康管理理念,着力于提高医疗服务质量和基金效用,促进医疗卫生体制改革深化,更好发挥医保的基础性作用?选择患者多、费用高、有完整治疗方案的慢性病作为疾病管理项目,从注重疾病治疗转向注重疾病管理,是当下制度改革和管理创新的突破口之一。推行疾病管理对于提高治疗质量降低费用,促进分级诊疗体系和守门人制度形成,优化医疗资源向基层配置,宣传践行健康文明生活方式均有积极意义。文章提出了在三医联动下实施疾病管理项目的具体路径。

How do the medical insurance response to the strategy of ＂Healthy China＂, express the idea of prevention fi rst and health management, improve the quality of medical service and fund effi cacy, promote the deepening of health system reform, and make itself playing better basic role？ Choosing chronic diseases, which are highly prevalent, cost and has completive treatment scheme, to conduct disease management, which switch the emphasis from treatment to management, is one of the key points of system reform and management innovation. Disease management has positive impact on improving the quality of service while reducing cost, promoting the forming of diagnosis and treatment classification and gate-keeper, optimizing the medical resource shifting to primary health care, and increasing the building of healthy life style. The specifi c road to implement diseases management under the situation of co-action of medical service, insurance, medicine is suggested.