我国县域医疗卫生共同体建设问题的理论探讨与对策分析

Theoretical discussion and countermeasure analysis on the construction of county medical communities in China

目的基于文献分析我国县域医疗卫生共同体(以下简称县域医共体)建设的重要问题,为医共体可持续发展提供参考。方法选取中国知网、万方数据、维普资讯等数据库网站,以"县域医共体""县域医联体""县域医疗卫生共同体""医联体"为关键词检索期刊论文和学位论文,时间为自建库起至2021年12月。采用内容分析和社会网络分析法对文献中县域医共体建设问题进行分类整理,所有数据采用描述性分析。结果共纳入274篇文献,提炼出82条县域医共体建设进程中的高频问题,并将其划分为服务体系、运行机制、资金保障3个维度,包含整合资源、一体化管理、资源集约、信息化建设、医疗服务、医疗质量、家庭医生、公共卫生、管理体制、人事制度、薪酬制度、监管机制、医保基金、财政投入14个条目。社会网络分析结果显示,点度中心度与中介中心度排在前3位的高频问题分别为缺乏高度统一的信息交互平台(107.00,514.48)、基层医疗机构服务能力不足(61.00,238.48)和缺乏可持续利益分配机制(45.00,192.38),其为我国县域医共体建设的核心问题,起到重要中介作用。结论县域医共体建设问题涵盖医疗服务体系、运行机制和资金保障3大方面,其中基层医疗服务能力不足、缺乏高度统一的信息交互平台、基本药品供应普遍短缺、内部考核激励制度不完善、监管制度不健全和医保配套政策不完善等问题是当前我国县域医共体建设的主要问题。为促进我国县域医共体的可持续发展,笔者建议应进一步完善县域整合型医疗服务体系,健全县域医共体运行机制,以及加强县域医疗卫生投入保障力度。

Objective To provide reference for the sustainable development of county medical communities through analyzing key issues in the construction of such communities in China.Methods Such Database websites as CNKI,Wanfang Data and VIP Information were selected to retrieve journal papers and dissertations with the keywords of"county medical community""county medical alliance""county medical and health community"and"medical alliance".The time period ranged from the establishment of the database to December 2021.Content analysis and social network analysis were used to classify and sort key issues of county medical community construction in the included literature,and the descriptive analysis was used for all the data.Results 274 literatures were obtained in this study,82 high-frequency issues were extracted for the construction process of county medical communities.It was divided into 3 dimensions of service system,operation mechanism and fund guarantee,including 14 items of integration of resources,integrated management,resource intensification,information construction,medical services,medical quality,family doctors,public health,management system,personnel system,salary system,supervision mechanism,medical insurance fund and financial input.The results of social network analysis showed that the top three high-frequency issues of point centrality and intermediary centrality were lack of highly unified information exchange platform(107.00,514.48),insufficient service capacity of primary medical institutions(61.00,238.48)and lack of sustainable benefit distribution mechanism(45.00,192.38).Conclusions The construction of county medical community covered three aspects:medical service system,operation mechanism and fund guarantee.The shortage of primary medical service capacity,the lack of coordination of an information platform,the general shortage of essential drugs,the imperfect internal assessment and incentive system,the imperfect supervision system and the imperfect medical insurance supporting policy becomed the main roadblocks in building county medical communities in China.In order to promote the sustainable development of county medical community,the authors recommend to further upgrade the county integrated medical service system,perfect the operation mechanism,and strengthen the input into county health care.