疫情后推进分级诊疗面临的挑战和对策

Challenges and Countermeasures for Setting up a Tiered Healthcare System After the COVID-19 Epidemic

新一轮医改2009年启动以来,中国的分级诊疗状况没有得到根本改善,大医院看病拥挤状况未见好转。这不仅使“看病贵”问题进一步恶化,而且就目前而言,也不利于新冠肺炎疫情防控。分级诊疗状况日益恶化的根本原因是,中国的公立医疗体系施行行政等级化管理制度,给等级越高的医疗机构分配更好的资源。大型公立医院在抗击新冠肺炎疫情中的出色表现,使得各地纷纷新建大型公立医院,民营医疗不可靠的错误观念再次兴起,给推进分级诊疗带来巨大挑战。促进分级诊疗有必要大力发展民营医疗。疫情后推进分级诊疗可从几个方面入手:建立医保定点医生制度和强制性信息披露机制,取消新进医生的事业单位编制,废止社区卫生服务中心和卫生院的收支两条线制度。

Since 2009, the functioning of China’s tiered healthcare system has been deteriorating year by year, and it has not witnessed improvement in the congestion in big hospitals. This not only worsens the problem of “expensive healthcare”, but also accelerates the spread of the COVID-19. The fundamental reason for the deteriorating status of tiered healthcare system is that China’s public medical system implements a hierarchical administrative management regime, which allocates better resource to medical institutions with higher levels. The outstanding performance of large public hospitals in the fight against the COVID-19 epidemic has made many cities plan to build large public hospitals and the recurrence of the misconception that private medical care is unreliable, which bring huge challenges to set up a well-functioning tiered healthcare system. To set up a tiered healthcare system calls for developing private medical care. We propose the following policy recommendations for setting up a tiered healthcare system: establish a doctor-based social insurance reimbursement system and a mandatory information disclosure mechanism, abolish new doctors’ identity of Shiyedanwei, and terminate Two-line System of Revenue and Expenditure practiced in urban healthcare center and township hospital.