多元化医联体模式下分级诊疗的探索与思考

Exploration and Review on Hierarchical Medical System under the Pluralistic Medical Alliance Modes

总结直管式、紧密型和松散型三种医联体模式下分级诊疗的工作经验,分析三种模式下分级诊疗的实践效果,直管模式双向转诊效果最好,紧密型和松散型疑难病人上转较好、康复病人下转不畅。据此,从政策、机构和患者三个方面剖析了影响分级诊疗的制约因素,提出构建医联体和医共体相衔接的分级诊疗新体系、明确不同等级医院功能定位、制定可操作的分级诊疗流程、完善基本药物目录、协同推进医疗医保物价改革和信息化互联互通等合理性建议,有效推动分级诊疗的落地,让人民群众共享健康成果。

To sum up the experiences of hierarchical diagnosis under three types of medical alliance modes:the vertical,close or loose type;analyze the practical effects of hierarchical diagnosis system. The two-way referral effect was the best in vertical type. The compli. cated patients transferred treatment to superior hospitals were better,and the rehabilitation patients transferred treatment to lower hospi. tals were poor in close or loose type. It analyzed the constraints of the hierarchical diagnosis system from policies,institutions and pa. tients. It put forward reasonable suggestions,such as construct a new hierarchical treatment system connecting medical alliance and medi. cal community, define the functional orientation of different levels of hospitals, establish the process of hierarchical diagnosis, re. fine national essential medicine list,promote the medical reform,price reform and medical insurance reform in a cooperative way,in. terconnect the information system, to effectively implement the hierarchical medical system. Let the people share the health achieve. ments.