我国基层医疗体系的发展与展望

The development and prospect of primary care system in China

基层医疗作为整个医疗体系的基础,在医疗卫生服务体系的改革转型中经历了一系列变迁。在当前医疗改革深入推进的历史趋势下,基层医疗体系的构建和发展更是决定未来整个医疗体系服务效能的基石。以农村乡镇卫生院和城镇社区卫生服务中心为核心的我国基层医疗卫生体系建设成为我国新医改关注的重点,也是实现"健康中国"的重要阵地。本文通过回顾基层医疗体系的发展历史,剖析近年来基层医疗在服务内容、目标人群、支付方式等方面随着社会经济发展而发生的变迁。梳理了我国基层医疗由农村起步,重心逐渐向城市转移,新医改后经历了整体重构而实现一体化协调发展的历程。通过对医联体的建设和发展的回顾,指出在当前"健康中国"战略指引下,我国基层医疗体系所承担的任务正由疾病诊疗向健康维护拓展;以"医联体"为主的整合医疗,即将逐渐转型升级为以健康为目标的"健联体"。本文从:目标和任务的转变、服务内容的拓展、加强服务能力建设、技术革新改善医疗服务供给这4个方面分析了当前我国基层医疗体系发展的新动向,从而为我国基层医疗体系未来的发展趋势做出展望。指出未来分级诊疗下的整合医疗是大势所趋,需要多方共同努力,从供给结构、人才培养、绩效激励、政策保障、技术支撑等多方面进行提升和改善,以期真正实现"健康中国"。

As the foundation of the whole health system, primary care has experienced a series of changes in the reform and transformation of the health system. In the trend of deepening medical reform, the construction and development of primary care system is the cornerstone of determining the service efficiency of the whole medical system. The construction of primary care system, mostly in form of rural township hospitals and urban community health centers, has become the focus of new medical reform in China, and also an important aspect to realize "healthy China". We review the development history of the primary care system, and analyze the changes of the primary care in recent years with the development of social economy, such as service content, target population and payment method. The primary care in China started from countryside and gradually shifted its focus to city. After the new medical reform, it has experienced the overall reconstruction and realized the integrated and coordinated development. Based on the review of the construction and development of medical consortia, this paper points out that under the "healthy China" strategy, the tasks of the primary care system in China are expanding from disease diagnosis and treatment to health maintenance. The integrated medical system based on "medical association" will gradually transform into "health association". We analyze the new trend of the development of the current primary care system in China from four aspects: transformation of objectives and tasks, expansion of service content, enhancement of service capacity building and improvement of medical service supply through technological innovation, so as to make a prospect for the future development trend. It is pointed out that integrated care is the trend in the future, which needs the joint efforts of many parties, such as supply structure, personnel training, performance incentive, policy guarantee, technical support and so on, so as to truly realize "Healthy China".