安徽省天长市和福建省尤溪县县域医联体建设研究

Study of the construction of medical alliances in Tianchang city of Anhui province and Youxi county of Fujian province

本研究选取安徽省天长市和福建省尤溪县作为典型案例,从服务提供方式、筹资支付、治理规制、协作机制、资源共享等方面,对其县域医联体建设实践进行系统梳理和比较分析。研究发现,天长市和尤溪县医联体建设均比较重视政策措施的综合性、协同性和系统性,以医保支付方式为重点建立相容的激励约束机制,多措并举提升基层服务能力,但一些具体措施和资源整合程度有所差异,面临共性和个性问题。建议持续推动服务体系由"金字塔型"向"网络型"转变;在医联体内建立相容的激励约束机制;以提升基层服务能力为重点,强化人才、药品、信息等共享机制建设;针对特定问题,在措施执行层面不断调整完善、持续探索创新。

This paper systematically summarizes and compares the reform measures of medical alliances in Tianchang city of Anhui province and Youxi county of Fujian province from five different aspects, namely service delivery model, financing and payment, governance and regulation, organizational collaboration, and resources sharing.The research findings are as follows:1) the reform measures of medical alliances in the two counties are all comprehensive, synergetic and systematic;2) the incentive and constraint mechanisms are established centered on the payment model of medical insurance;3) various measures have been taken to improve the service capacity of primary health care;4) however, there are some differences in some specific reform measures and the degree of resource integration,and thus the two counties are all facing some collective and individual problems. In conclusion, the policy implications are as follows:1) the health care system should be transformed from "pyramid" hierarchical system to "network" parallel one;2) compatible incentive and constraint mechanisms within medical alliances should be established;3) sharing mechanism of resources such as workforce, medical assets and information should be strengthened, focusing on the improvement of the service capacity of primary health care;and 4) the specific measures against individual problems should be adjusted,improved,explored and innovated constantly.