国家医学中心和国家区域医疗中心功能任务落实情况与关键问题探讨

Research on implementation status and key issues of function fulfillment in China national medical centers and national regional medical centers

国家医学中心和国家区域医疗中心是推动优质医疗资源扩容和区域均衡布局的重要载体,评估其功能任务落实情况,了解建设发展中面临的关键问题,对推进中心高质量发展具有重要意义。本研究根据"结构-过程-结果"评估理论逻辑框架进行评估框架设计,分为中心自评估、数据上报和现场调研评估3个阶段,对截至2020年10月完成批复设置的6个国家医学中心和5个国家区域医疗中心的15家主体医院功能任务落实情况进行评估。结果显示,各级政府对中心的投入和政策保障力度加大,中心内外部管理运行机制初步建立,承担的职责任务有效落实,辐射带动作用逐步显现。影响中心功能任务落实的关键问题包括,对主体医院的财政投入和政策保障不足、中心内外部的管理和运行机制尚不健全、高层次人才培养使用机制还需完善、有利于突破"卡脖子"和"临门一脚"关键技术的科研创新和成果转化机制相对滞后,与中心高质量发展的目标不相匹配。建议要进一步健全"委省共建"机制,加强对中心的政策引导与财政投入保障;完善各中心内部组织管理机制;加快医学高层次人才培养和使用相关制度的改革创新;建立健全以健康需求为导向的科研创新和成果转化机制,推进中心高效落实功能任务。

China national medical centers and national regional medical centers are the key entities to expand the availability of quality medical resources and ensure they are better distributed among regions.It is of great significance for the centers′high-quality development to understand the key issues in the construction and progression of centers by evaluating the performance of their function fulfillment.The evaluation framework of this study was based on the"structure-process-outcome"model.The study was divided into three stages,including centers′self-evaluation,data reporting,and on-site investigation and evaluation.The team conducted the evaluation on 15 entity hospitals supporting 6 national medical centers and 5 national regional medical centers that had been approved by October 2020.As the results showed,the funding and policy support for these centers from governments at all levels were increased,the internal and external management mechanism of the centers were preliminarily set up,the functions of the centers were executed properly,and the"radiation effect"of the centers was in place gradually.The key problems hindering the fulfillment of functions concern the mechanisms that were not sound and need to be further refined,which included the field of financial investment and policy guarantee for the entity hospitals,internal and external management of centers,introduction and cultivaton of the talented,and the innovation and transformation of scientific achievements which facilitates breakthroughs in core technologies.To promote the efficient implementation of functional tasks of the centers,the authors proposed four suggestions.First,the"commission and province co-construction"mechanism should be further improved to augment investment and policy guarantee from the government.Second,the internal organization and management mechanism of each centers should be optimized.Third,the reform and innovation in the training and management system of the talented medical personnel should be accelerated.Last,the health needs oriented mechanism for scientific research innovation and achievements transformation should be established.