基于文献分析的我国分级诊疗系统问题严重性变迁研究

Seriousness changes in the issues for hierarchical diagnosis and treatment system in China based on literature analysis

目的分析我国分级诊疗系统存在问题的严重程度变迁,为政策优化提供参考。方法通过对2002—2019年三大中文期刊数据库文献的评阅建立问题清单,计算问题严重性指数,分析问题严重性序位及其变化。结果分级诊疗系统内存在32类问题,而问题严重性序位高且稳定、序位高且上升、序位不高但快速上升的问题分别有2个、6个、5个。重点关注的问题主要聚焦于在基层服务资源短缺与能力不足、上下级医疗机构资源和利益共享机制不规范、居民基层诊疗意愿低、医保引导力度不足、政府支撑政策不到位等方面。结论建议未来分级诊疗的重点工作应该是通过政府支撑政策的配套与落地,实现基层服务能力提升与上下级医疗机构利益共享并举。

Objective To analyze the seriousness changes in the issues existing in the hierarchical diagnosis and treatment system in China, and to provide reference for policy optimization. Methods The literature published from 2002 to 2019 was retrieved and reviewed to identify all the issues. Andthe seriousness of all issues and their orders were calculated and analyzed. Results Among 32 issuesidentified, 2 problems were continuously in higher position, 6 problems were very serious with a constantly rising of order, and 5 were of low ordinal positionwitha clearlyrising of order. The results showed that five key problems shouldbe focused on, namely, shortage of resources and service capacity in primary health institutions, lack of sharing mechanism in resources and interests between the upper and lower health institutions, weak willingness of residents for diagnosis and treatment at the grassroots healthinstitutions, insufficientguidance for medical insurance and inadequate government policy supports.Conclusions In the future, the key work forgovernmentwill be optimizingand implementing the supporting policies to improve the service capability of grassroots health institutions and to share the interests betweenupper and lower health institutions.