我国各省市自治区的分级诊疗政策比较研究

Policies Associated with the Implementation of Hierarchical Medical System across Different Provinces of the Mainland of China:a Comparative Study

目的比较我国各省(自治区、直辖市)分级诊疗政策的主要内容,从而为分级诊疗建设的进一步推进提供参考。方法访问我国各省(自治区、直辖市)政府、卫生计生委的官方网站和人民网、新浪网等官方媒体网站,以获取与分级诊疗政策相关的文件和新闻报道;同时检索中国知网(CNKI)和万方数据知识服务平台,检索式为"分级诊疗and(措施or政策)"。检索时间均为建库(网站)至2017-03-31。从纳入的文献中提取各省(自治区、直辖市)建设分级诊疗的政策措施和具体内容,并采用分类归纳法进行分析。结果共获得分级诊疗政策相关文件和新闻报道38篇、数据库文献12篇,有完整分级诊疗政策文件的省(自治区、直辖市)29个。各省(自治区、直辖市)分级诊疗制度建设的主要内容包括定位建设、基层首诊建设、双向转诊建设、医疗资源建设、信息化建设5个方面,共12项具体措施。其中,19个省(自治区、直辖市)明确了各级医疗机构的服务功能定位,5个省(自治区、直辖市)提出要确定分级诊疗病种;26个省(自治区、直辖市)明确了基层医疗卫生服务能力建设内容,28个省(自治区、直辖市)明确了基层签约服务制度建设内容,3个省(自治区、直辖市)提出要完善基层医疗卫生机构运行机制;19个省(自治区、直辖市)明确了关于转诊流程的建设内容,29个省(自治区、直辖市)提出要推进医保支付制度改革,25个省(自治区、直辖市)提出要健全医疗服务价格形成机制,8个省(自治区、直辖市)明确了建立完善利益分配机制的内容;15个省(自治区、直辖市)提出要整合推进区域医疗资源共享,17个省(自治区、直辖市)提出要完善医疗资源合理配置机制;28个省(自治区、直辖市)明确了推进医疗卫生信息化建设的内容。结论我国分级诊疗制度虽未建立,但各省(自治区、直辖市)的分级诊疗建设正在有序推进。各省(自治区、直辖市)的建设思路和方法基本一致,提示可基于当地特色建立符合本地区具体情况的分级诊疗模式。

Objective To compare the policies associated with the implementation of hierarchical medical system across different provinces(autonomous regions/municipalities)in the mainland of China,providing a reference for further development of hierarchical medical system.Methods By visiting the websites of the government and health and family planning commission of 31 provinces(autonomous regions/municipalities)in the mainland of China,people.cn,sina.com.cn and other official media websites,we collected the documents and news reports associated with the contents and implementation of hierarchical medical system.Moreover,by searching the databases of CNKI and Wanfang Data Knowledge Service Platform using the terms"hierarchical medical system and measure/policy",we enrolled the articles collected as of March 31,2017 in which policies and measures related to the implementation of hierarchical medical system across the 31 provinces(autonomous regions/municipalities)were studied in detail.Then the enrolled data were classified and summarized.Results Totaled 38 official policy documents and news reports,and 12 articles from databases were included.29 provinces(autonomous regions/municipalities)were found with a complete set of relevant policy documents.5 tasks(determination of the responsibilities of medical institutions at all levels,initial treatment in grassroots medical institutions,dual referral system development,reasonable medical resource allocation and sharing,healthcare informatization)and 12 measures were identified for the implementation of hierarchical medical system across different provinces.To be specific,the number of provinces(autonomous regions/municipalities)that determined the functions of medical intuitions at all levels,kinds of diseases should be managed by medical intuitions at all levels,details for improving the service capabilities of grassroots medical institutions,details for the development of contractual service system in grassroots medical institutions,details for referral procedure,details for perfecting the mechanism of interest distribution,details for accelerating the medical informatization was 19,5,26,28,19,8,28,respectively.Moreover,the number of provinces(autonomous regions/municipalities)that proposed to perfect the operation mechanism of grassroots medical institutions,facilitate the reform of medical insurance reimbursement patterns,improve the formation mechanism of medical service price,promote the integration and sharing of the regional medical resources,and improve the reasonable medical resource allocation mechanism was 3,29,25,15,17,respectively.Conclusion Although the prefect hierarchical medical system has not been developed in China,the implementation of this system is under way orderly in the 31 provinces(autonomous regions/municipalities).All the provinces(autonomous regions/municipalities)have basically similar ideas and methods for implementation of this system,which suggests that the pattern for implementation of hierarchical medical system can be developed based on the local conditions.