基于校政协同与医防融合的“全科医学+”医共体的构建与探索
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摘要
目的本文旨在探索基层医共体建设与可持续发展的新路径,为医共体的建设提供可复制的参考经验。方法通过文献分析、理论研究的方法,结合实地调研、专家论证对问题解析,同时进行面向区域基层的实践,探索构建新型医共体。结果对国内部分城市医共体运行现状与发展进行了深入的分析,经过一年多的实践,首次提出并建立了医科大学与政府协同下的以三级医院为区域龙头医院,以省级公共卫生研究机构、乡镇社区卫生服务机构、功能社区紧密联合,以全科医学为抓手的医防融合型"全科医学+"医共体。该医共体以校政协同解决优质医疗资源缺乏和资源合理利用问题;以"五个统一"解决深层次体制机制矛盾问题;以全科医学为抓手推进区域医共体建设,解决基层服务能力不足的问题。通过"全科医学+"为实现普及健康生活、优化健康服务、完善健康保障、建设健康环境、发展健康产业的战略目标探索一条可实施、可持续的改革新路径。结论 "全科医学+"医共体在多方协同下为医药卫生体制改革提供新思路,为我国其他县级公立医院改革和医共体试点工作提供参考。
Objective This study aims to explore a new path for the construction and sustainable development of primary medical communities and to provide a replicable reference experience. Methods The methods adopted in this study were the literature review and theoretical research methods, combined with field research and expert argumentation as well as the grassroots-oriented practice of constructing the new medical community. Results Based on the in-depth analysis of the current status and development of the medical communities in China, here we proposed the concept of "General Practice+" medical community which had been practiced in Foshan, China for more than one year. Combined with the provincial-level public health research institutions, community health service centers, and functional communities, "General Practice+" medical community emphasizes on the integration of treatment and prevention, takes the tertiary hospital as the leading regional hospital and focus on the general medicine. It was noticeable that this new pattern of the medical community was constructed under the cooperation between medical university and government. This medical community was expected to solve the problem of lacking high-quality medical resources by the cooperation between university and government, resolve the underlying contradictions in system and mechanism by "five unity principles", and promote the construction of regional medical communities by taking the general medicine as the starting point. The new pattern of the medical community uses the "General Practice+" to explore a new path of applicable and sustainable reform for popularizing healthy living, optimizing health services, improving health care, building a healthy environment, and developing a healthy industry. Conclusion The "General Practice+" medical community provides new ideas for the medical and health system reform under multi-cooperation and presents evidence for the other county-level public hospitals reform and the other medical community pilot project.
Objective This study aims to explore a new path for the construction and sustainable development of primary medical communities and to provide a replicable reference experience. Methods The methods adopted in this study were the literature review and theoretical research methods, combined with field research and expert argumentation as well as the grassroots-oriented practice of constructing the new medical community. Results Based on the in-depth analysis of the current status and development of the medical communities in China, here we proposed the concept of "General Practice+" medical community which had been practiced in Foshan, China for more than one year. Combined with the provincial-level public health research institutions, community health service centers, and functional communities, "General Practice+" medical community emphasizes on the integration of treatment and prevention, takes the tertiary hospital as the leading regional hospital and focus on the general medicine. It was noticeable that this new pattern of the medical community was constructed under the cooperation between medical university and government. This medical community was expected to solve the problem of lacking high-quality medical resources by the cooperation between university and government, resolve the underlying contradictions in system and mechanism by "five unity principles", and promote the construction of regional medical communities by taking the general medicine as the starting point. The new pattern of the medical community uses the "General Practice+" to explore a new path of applicable and sustainable reform for popularizing healthy living, optimizing health services, improving health care, building a healthy environment, and developing a healthy industry. Conclusion The "General Practice+" medical community provides new ideas for the medical and health system reform under multi-cooperation and presents evidence for the other county-level public hospitals reform and the other medical community pilot project.
引文
[1] 中共中央国务院.国务院关于印发“十三五”卫生与健康规划的通知(国发[2016]77号)[R].http://www.gov.cn/zhengce/content/2017-01/10/content_5158488.htm.
[2] 中共中央国务院.“健康中国2030”规划纲要[R].http://www.mohrss.gov.cn/SYrlzyhshbzb/zwgk/ghcw/ghjh/201612/t20161230_263500.html.
[3] 国务院办公厅.关于推进医疗联合体建设和发展的指导意见[国办发[2017]32号][R].http://www.gov.cn/zhengce/content/2017-04/26/content_5189071.htm.
[4] 程念,汪早立.典型地区医联体模式与成效对比研究[J].中国卫生经济,2018,37(7):12-15.
[5] 甄诚,毛羽.医联体框架下各省市关于强基层举措的现状分析[J].北京医学,2017,39(1):93-96.
[6] 申丽君,黄成凤,李乐乐,等.县域医共体模式的探索与实践——以安徽省天长市为例[J].卫生经济研究,2018(12):7-11.
[7] 刘文生.解剖县域医共体“阜南样板”[J].中国医院院长,2018(11):68-71.
[8] 宫芳芳,孙喜琢,林锦春,等.提升基层医疗服务能力的探索与实践[J].中国医院,2017,21(11):13-15.
[9] 刘婷婷,林琳,夏令国,等.国内区域医疗联合体的研究现况与述评[J].卫生软科学,2016,30(6):5-9.
[10] 熊茂友.我国医共体建设的亮点、难点与切入点[J].中国财政,2018(3):58-60.
[11] 陈丽芬,马力,陈超,等.三级医院设置全科医疗科的实践与思考[J].中国社会医学杂志,2018,35(5):439-442.
[12] 周炜.英国全科医学体系对我国全科医学工作的启示和思考[J].浙江医学教育,2019,18(1):16-18,22.
[13] 徐建德.医联体的模式及未来发展趋向研究[J].中国卫生标准管理,2019,10(2):29-32.
[14] 张洽,王春光,刘永立.“深化医改,分级诊疗”政策下全科医学人才培养的探讨[J].全科医学临床与教育,2019,17(2):97-99.
[15] 刘红梅,杨纲.多点执业背景下医生集团发展战略研究[J].卫生经济研究,2017,(9):8-11.
[2] 中共中央国务院.“健康中国2030”规划纲要[R].http://www.mohrss.gov.cn/SYrlzyhshbzb/zwgk/ghcw/ghjh/201612/t20161230_263500.html.
[3] 国务院办公厅.关于推进医疗联合体建设和发展的指导意见[国办发[2017]32号][R].http://www.gov.cn/zhengce/content/2017-04/26/content_5189071.htm.
[4] 程念,汪早立.典型地区医联体模式与成效对比研究[J].中国卫生经济,2018,37(7):12-15.
[5] 甄诚,毛羽.医联体框架下各省市关于强基层举措的现状分析[J].北京医学,2017,39(1):93-96.
[6] 申丽君,黄成凤,李乐乐,等.县域医共体模式的探索与实践——以安徽省天长市为例[J].卫生经济研究,2018(12):7-11.
[7] 刘文生.解剖县域医共体“阜南样板”[J].中国医院院长,2018(11):68-71.
[8] 宫芳芳,孙喜琢,林锦春,等.提升基层医疗服务能力的探索与实践[J].中国医院,2017,21(11):13-15.
[9] 刘婷婷,林琳,夏令国,等.国内区域医疗联合体的研究现况与述评[J].卫生软科学,2016,30(6):5-9.
[10] 熊茂友.我国医共体建设的亮点、难点与切入点[J].中国财政,2018(3):58-60.
[11] 陈丽芬,马力,陈超,等.三级医院设置全科医疗科的实践与思考[J].中国社会医学杂志,2018,35(5):439-442.
[12] 周炜.英国全科医学体系对我国全科医学工作的启示和思考[J].浙江医学教育,2019,18(1):16-18,22.
[13] 徐建德.医联体的模式及未来发展趋向研究[J].中国卫生标准管理,2019,10(2):29-32.
[14] 张洽,王春光,刘永立.“深化医改,分级诊疗”政策下全科医学人才培养的探讨[J].全科医学临床与教育,2019,17(2):97-99.
[15] 刘红梅,杨纲.多点执业背景下医生集团发展战略研究[J].卫生经济研究,2017,(9):8-11.