分级诊疗的基本理论及国际经验

The basic Theory and international experience of graded diagnosis and treatment system

新医改以来,我国公立医院发展迅猛,基层医改成效平平,医疗服务市场靠价格机制解决不了患者就医趋高、"要命不要钱"的问题。因此,需要建立一种组织协调机制——分级诊疗制度,实现医疗资源的有效配置。分级诊疗的核心不在于"分",而在于"合"。本文基于科斯的企业理论和交易成本理论,以及医疗服务领域具有显著的规模经济和范围经济特征,认为整合医疗服务体系可以发挥优势,降低交易成本,将传统的治病模式转化为健康保障模式。同时,借鉴国际经验,提出分级诊疗的推进策略。

Since the new medical reform,the public hospitals in our country have developed rapidly,the effect of primary health institutes reform is not good,and the medical service market cannot solve the problem of patients seeking medical treatment in high-level hospitals by price mechanism.Therefore,it is necessary to establish graded diagnosis and treatment system to realize the effective allocation of medical resources.The core of graded diagnosis and treatment is not division but combination.Based on Coase＇s enterprise theory and transaction cost theory,as well as the obvious characteristics of scale economy and scope economy in the field of medical service,this paper holds that the integration of medical service system can give full play to advantages,reduce transaction costs,and transform traditional treatment mode into health insurance mode.At the same time,using international experience for reference,the paper puts forward the promotion strategy of classified diagnosis and treatment.