我们需要什么样的分级诊疗？

What Kind of Hierarchical Medical System Do We Need?

实施分级诊疗是深化我国医药卫生体制改革的战略要求,是关乎医改工作成败的关键内容。近年我国的分级诊疗实施取得了一定的成效,但总体上困难多、阻力大,进展缓慢,甚至在多个方面陷入了困境。这既是政策和实施中的问题所致,亦有理论认识误区和体制掣肘的原因。本文以医疗机构与居民医疗服务供需矛盾的分析为起点,从理论和实际两个层面梳理和阐述分级诊疗的源起,分析其理论内涵和实际发展,在此基础上系统剖析我国分级诊疗实施面临的困境并探究其原因,最后提出我国分级诊疗未来发展的方向。

The implementation of the hierarchical medical system is the core strategic requirement for deepening the reform of China’s medicine and health care system, and the key to the success of health care reform. In recent years, China has made some headway in implementing the hierarchical medical system, but overall, the reform is slow and even stalled in some areas, with many difficulties and obstacles ahead. There exist problems in terms of policies and their implementation, as well as theoretical misunderstandings and institutional constraints. This paper takes the analysis of the contradiction between supply and demand of medical facilities and services as the starting point, and then clarifies the origin, implications and realities of the hierarchical medical system from both theoretical and practical aspects. On this basis, this paper systematically analyzes the difficulties in the implementation of the hierarchical medical system in China and explores the underlying reasons, and finally puts forward some suggestions for the future development of the system.