治理视阈下分级诊疗的反思与展望

Reflections and Prospects of Hierarchical Medical Care from the Perspective of Governance

治理理论为完善分级诊疗制度建设和实践提供了思路。分级诊疗和治理具有逻辑上的内在自洽性和利益关系处理上的一致性。治理视阈下,反思分级诊疗存在的不足包括:分级诊疗制度体系内部协调性不足;医疗机构参与分级诊疗的动力不足;医保机构引导分级诊疗的合力不足;患者诊疗就医的理性认知能力不足。治理视阈下,健全分级诊疗的对策包括:协调并发挥不同层面分级诊疗制度的合力;协调形成不同医疗机构利益共享的合作格局;协调形成医保患之间良性互动的治理格局;引导居民积极参与分级诊疗治理过程。

Governance theory provides ideas and opportunities for improving the development and practice of hierarchical medical care.Hierarchical medical care and governance have both logical internal self-consistency and consistency in the treatment of interest relations.From the perspective of governance,the shortcomings of hierarchical medical care include:insufficient coordination within the hierarchical medical system;lack of motivation for medical institutions to participate in hierarchical medical care;the joint efforts of medical insurance institutions to guide hierarchical medical care are insufficient;The rational cognitive ability of patients in hierarchical medical care is insufficient.From the perspective of governance,countermeasures for improving hierarchical medical care include:coordinating and exerting the synergy of hierarchical medical system at different levels;coordinating the formation of a cooperative pattern of benefit sharing between different medical institutions;coordinating the formation of a governance pattern of benign interaction between doctors,medical insurance and patients;guiding residents to actively participate process of hierarchical medical care.