1.School of Health Management，Anhui Medical University;2.the First Affiliated Hospital of Anhui Medical University
Research on performance-based salary distribution mechanism for doctors in county level public hospitals based on the RBRVS methodology
摘 要： 目前我国紧密型县域医共体政策运行面临困境，为深度剖析紧密型县域医共体政策运行中存在的困境，以米特―霍恩模型的六大因素：政策目标与标准、政策资源、组织沟通与运行活动、运行机构特征、运行环境以及运行者价值取向为框架进行分析，得出政策运行的困境包括：政策目标涉及范围较广，政策标准落实时间较长，卫生资源配置效率较低，医保支付指挥棒作用弱，分级诊疗上下转诊不畅，信息化建设契合度不高，基层医疗机构能力不足，“三医”联动协调程度低等。为解决紧密型县域医共体政策运行困境，提出建议：制定具体可行政策，优化配置医疗资源，实现信息互通共享，提高基层医疗能力，加强医保改革力度，从而推进紧密型县域医共体稳固建设与长效发展。
Abstract: At present, the policy operation of compact county medical community in our country is facing difficulties. In order to deeply analyze the difficulties existing in the policy operation of compact county medical community, the six factors of Meter–Horn model are used: policy objectives and standards, policy resources, organization communication and operation activities, operating organization characteristics, operating environment and operator value orientation are analyzed as a framework. Dilemmas of policy operation include: a wide range of policy objectives, a long time for implementation of policy standards, low efficiency in the allocation of health resources, medical insurance payment baton is weak, graded diagnosis and treatment are not smoothly referred up and down, information construction is not well suited, grassroots medical institutions have insufficient capacity, and the coordination of the " medical, medical insurance, medicine " linkages is low. It is necessary to solve the dilemma of the policy operation of compact county medical community. Making recommendations: formulate specific and feasible policies, optimize the allocation of medical resources, realize information exchange and sharing, improve the primary medical capacity, strengthen medical insurance reform, to promote compact county medical community stable construction and long-term development.