文章摘要
巫 蓉,朱 亚,屠小明,周韶谷,陈家应.国内外促进分级诊疗的实践经验及启示[J].南京医科大学学报(社会科学版),2018,(3):172~175
国内外促进分级诊疗的实践经验及启示
Practice and revelation of hierarchical diagnosis and treatment at home and abroad
投稿时间:2018-05-29  
DOI:10.7655/NYDXBSS20180302
中文关键词: 分级诊疗  医联体  家庭医生  全科医师培养制度
英文关键词: hierarchical diagnosis and treatment  medical union  family doctor  general practitioner training system
基金项目:健康江苏建设与发展研究院政策研究项目“家庭医生签约服务追踪评价与对策研究”(2017JKJS007Y);南京市哲学社会科学规划项目“南京市浦口区家庭医生签约和分级诊疗体系构建策略研究”(17C06);江苏省哲学社会科学优秀创新团队
作者单位
巫 蓉 南京医科大学健康江苏建设与发展研究院江苏 南京 211166 
朱 亚 南京医科大学健康江苏建设与发展研究院江苏 南京 211166 
屠小明 南京医科大学生物医学工程与信息学院江苏 南京 211166 
周韶谷 南京市浦口区中心医院院长办公室江苏 南京 211803 
陈家应 南京医科大学医政学院江苏 南京 211166 
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中文摘要:
      目的:了解国际上分级诊疗的实践经验,为我国各地的分级诊疗制度建设提供借鉴。方法:通过文献研究,梳理国内外为实现分级诊疗所采取的政策、措施。结果:国内为实现分级诊疗所采取的措施主要有以慢性病或部分病种作为突破口,构建医联体促进优质医疗资源下沉,建立家庭医生健康守门人制度;国内推进分级诊疗存在基层医疗服务能力和意愿薄弱、居民社区首诊的依从性差、大医院缺乏转诊动力的阻力等问题;国外分级诊疗的经验主要有合理的区域卫生规划、对医患双方转诊行为的强制性约束、强大的基层卫生服务能力、全科医师掌握医保资金和专科资源、门诊和住院“双轨制”。结论: 结合国内实施现状和国外的实施经验,我国实现分级诊疗可以采取建立有效的全科医师培养制度、增强医保的杠杆作用、合理控制大医院的诊疗量和住院床日数等措施。
英文摘要:
      Objective:To grasp the international practical experience of hierarchical diagnosis and treatment, and provide reference to the development of hierarchical diagnosis and treatment throughout the country. Methods: Based on extensive literature research, the policies and measures of the hierarchical diagnosis and treatment in China and abroad were summarized. Results: The main measures to implement the hierarchical diagnosis and treatment in China were putting chronic diseases as breakthrough, structuring medical union progressing the sinking of fine medical resources and developing “family doctors as the gatekeepers of health” system. There existed obstacles to promote hierarchical diagnosis and treatment as the weakness in services capacity and willingness of primary-level health, poor compliance of the first contact care at community health service among community residents, and lack of impetus to referral. The experiences of hierarchical diagnosis and treatment at abroad were mainly a sensible regional health planning, the compulsory restraints on doctors-patients referral behavior, great capacity in primary-level health services, general practitioners’ grasp of health insurance fund and specialists resources, and “double-track system” associated with outpatient and inpatient service. Conclusion: Considering current situation in China and implementation experience at abroad, actions as enhance the ability of primary health care services, adjust medical insurance compensation policy and enhance leverage and patients’ hospital bed days in major hospitals can be taken to realize the hierarchical diagnosis and treatment in our country.
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