分级诊疗体系建设动力机制与路径选择

The Dynamic Mechanism and Path Selection in the Construction of Hierarchical Medical System

分级诊疗体系建设是社会各界重点关注的民生问题;行政主导下的医疗联合体及县域医疗卫生一体化建设构成现阶段分级诊疗体系建设政策实践。文章以广西S县为个案,对健康治理逻辑框架下政府、医疗卫生服务递送者与患者之间的主体关系进行演绎分析,探讨县域分级诊疗体系建设进程中政府角色定位、医疗卫生服务递送者运作逻辑与基层民众的策略选择揭示出以满足民众健康需求为导向、多元主体共商共建共享的动力机制;提出将健康融入分级诊疗政策进程、集中区域医疗卫生服务主体的整合优势、维护患者健康权益的对策建议。

The construction of Hierarchical Medical System is the major focus concerning people’s well-being in the current society.At present,the medical treatment combination and the integrated healthcare system in county level is the policy practice under the background of the Hierarchical Medical System.Based on the case study of a county in Guangxi,this paper deductively analyzes the relationship between government,health service deliverers and patients under the logical framework of health governance.The discussion on role orientation of government,operation logic of health service deliverers and strategic choice of grassroots people in the process of Hierarchical Medical System construction reveals the dynamic mechanism of joint construction and sharing by multiple subjects guided by the needs of the people.The results indicates that we should integrate health-care into the policy process of Hierarchical Medical System,centralize integrated advantage of regional health service delivers,protect patient’s health rights and meet patient’s medical demands.