健康治理与中国分级诊疗制度

Health Management and Graded Treatment System in China

分级诊疗制度是实现健康中国战略目标的重要举措及必然要求,该制度在实践过程中逐渐形成了五种模式类型。通过文献研究及实地调研发现,这一制度在试点中存在着基本药物目录种类少、剂型不全,全科医生数量少、器械配备不全,基层医疗机构门诊量低、重复就诊以及向下转诊难以执行等问题。研究表明,该项政策的制定与推动简单地采取经济手段而忽视民众的就医心理,进而忽视了三级医院的虹吸效应,同时无法解决医疗机构的利益驱动及基层医疗机构能力不足等问题。为此,要综合运用政策工具,引导群众转变就医观念,实行上级医院全面托管基层医疗机构,减少财政投入三级医院,实行财政向基层医疗机构倾斜,取消三级医院门诊政策,使得患者到基层医疗机构首诊,推动分级诊疗政策目标的实现。

The objective of this paper is to illustrate and examine the current graded treatment system in implementation,which is an important measure and requirement of achieving the strategic goal of health China.The system has gradually formed five kinds of patterns in the process of practice.Through the methodology of literature research and field investigation,the findings of the paper is that graded treatment system lacks of essential drugs list and dosage form,has a small number of general practioners and medical equipment.The amount of outpatient service is low in the primary health care institutions,there are repeated visits and difficult to downward referral and other issues in the pilot process.The study shows that the key lies in ignoring the people's medical psychology to simply take economic measures to develop and promote the policy,thus ignoring the Siphon effect of the tertiary hospitals,and cannot be able to solve the problems of driving interests in the medical institutions and lack of capacity of primary medical institutions.The conclusion is that we ought to use the integrated policy tools to guide the masses to change the concept of medical treatment,build the trusteeship between a higher overall hospital and the basic medical institutions,reduce the financial investment in the third-level hospitals to fulfill the implementation of fiscal tilt to the grassroots medical institutions,and cancel the outpatient service policy in the third-grade hospital.Only doing these above can we fulfill the value of making the patients to take the first diagnosis to the grassroots medical institutions,and promote the implementation of graded treatment policy.