上海市长宁区社区卫生服务综合改革的制度设计

System design of comprehensive reform of community health service in Changning district

作为国家和上海市社区卫生服务综合改革试验田，长宁区围绕政府基层卫生综合改革要求，以问题为导向，着力解决社区卫生服务的“能力、动力和引力”问题，从内部赋能、借力上级医疗资源、集约化措施引入助力等方面强化基层能力建设，以服务外包卸除编制压力，设计符合行业特点的薪酬体系，实施有效的绩效考核制度，出台贴合需方配药和绿色转诊需求的政策，通过制度设计、机制突破，在引导就医下沉、实现梯度就诊、发挥家庭医生守健康守费用“双守门人”作用上获得初步进展。

Changning district is a pilot site for community health reform of China as well as of Shanghai municipality. According to the requirement of comprehensive reform, the system is designed on the problem-oriented basis focusing on solving the ＂ capability, vitality and attraction＂ problems of the community health service system. The reform fully uses the internal capacity and external medical resources, and implements the policies of outsourcing services, rational salary and performance appraisal system, convenient drug dispensing and quick referral. The comprehensive reform has gained preliminary achievements in enhancing grass-root capacity, implementing tiered referral and playing ＂double gatekeeper＂ role of family doctors.