推进分级诊疗,构建连续健康服务

Promoting Hierarchical Medical System to Achieve Continuing Health Services Delivery in China

本文从《国务院办公厅关于推进分级诊疗制度建设的指导意见》深入解读、全国分级诊疗工作开展情况、下一步工作安排三个方面,对推进分级诊疗、构建连续健康服务进行论述。在文件深入解读中指出:分级诊疗的核心是建立以患者为中心的医疗机构之间的分工合作机制;分级诊疗的精髓是以患者为中心的整合式医疗,医疗机构提供连续性的医疗服务,医疗服务的资源布局围绕患者服务需求来配置,医疗服务的流程围绕方便患者来设计;分级诊疗的目标是方便群众看病就医,为群众提供优质、高效、便捷、连续的健康服务。目前全国各地开展分级诊疗工作的主要做法包括:优化医疗资源配置,构建分级诊疗基础;组建医疗联合体或医疗集团,构建分级诊疗载体;不断完善医保、价格等配套政策,为分级诊疗提供重要支撑;提升基层服务能力,方便群众就近就医;探索创新分级诊疗服务模式,加大信息化建设力度;以病种为突破口,以点带面推进分级诊疗;加强宣传,引导患者建立科学就医理念。下一步工作安排总结为:抓住六个环节,实现四个分开,解决四个问题。抓住六个环节即:政府主导是根本;群众自愿是基础;医疗联合体是载体;信息化是前提;配套政策是关键;高血压、糖尿病等慢性病管理是突破口。实现四个分开即:区域分开;城乡分开;上下分开;急慢分开。解决四个问题即:患者"愿意去";基层医疗卫生机构"接得住";大医院"舍得放";政策制度要配套。希望本文能为推进形成分级诊疗格局、为群众提供连续健康服务提供思路和借鉴。

This article addressed the promotion of hierarchical medical system in China for the construction of continuing heath services from the respects of in-depth interpretation of the General Office of the State Council of the People＇ s Republic of China： Guiding Opinions on Promoting the Construction of Hierarchical Medical System（ hereinafter referred to as the Guiding Opinions）,current development of hierarchical medical system in China,and the following work schedule of 3aspects.In the part of in-depth interpretation of the Guiding Opinions,the following were put forward： the core of hierarchical medical system is building patient-centered division and cooperation mechanism between medical institutions; the essence of hierarchical medical system is patient-centered integrated medical services,medical institutions at all levels provide continuing medical services,medical resources are allocated based on demands,the procedure of medical services is designed to make it much more convenient for patients to see the doctor; the goal of hierarchical medical system is to make medical services be easily available,and to offer high-quality,highly effective,convenient and continuing heath services.The main measures adopted for the development of hierarchical medical system around China currently cover the aspects as follows： building the basis of hierarchical medical system by optimizing the allocation of medical resources; setting up the carriers of hierarchical medical system based on organizing medical association or group; providing important support by continuously perfecting the matched policies of medical insurances and prices; improving the service capabilities of primary medical institutions to make people be access to the medical services nearby; exploring and innovating service models of hierarchical medical system and strengthening informationization construction; promoting the development of hierarchical medical system from point to surface by taking the disease management as a breakthrough; strengthening propaganda in order to guide patients to establish the concept of seeing a doctor in a scientific way.The following work schedule for promoting the development of hierarchical medical system was summarized in the following： Six focused aspects： the root is governmental dominance; the basis is that patients have their first contact at primary medical institutions should be voluntarily; the carrier is medical association; the prerequisite is informatization; the key is matched polices; the breakthrough is chronic disease management,such as hypertension and diabetes.Four separations： region separations; urban and rural areas separations; hospitals and primary health care institutions separations; acute diseases and chronic diseases separations.Solving 4 problems： making patients voluntarily to go to see a doctor in primary medical institutions; strengthening the services capabilities of primary medical institutions in order to meet the needs of treating the patients; guiding tertiary-level hospitals to actively make lower-referrals; formulating and enacting the relevant matched policies.It is hoped this article can offer ideas and reference for promoting the formation of hierarchical medical pattern in order that continuing health services can be provided for the people in China.