关于我国分级诊疗制度实施路径选择的探讨
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摘要
对国内外实施分级诊疗的主要措施和实施效果的分析表明,政府在分级诊疗制度实施过程中要承担主体责任,主导对患者(疾病)和医疗机构进行分级,加强基层首诊刚性约束,通过行政和经济手段约束各级医疗机构的诊疗行为,通过医疗保险报销比例等经济手段引导患者的就医行为,通过医疗保险捆绑支付实现医联体内经济利益的捆绑和风险共担。从而,建立起强制性分级诊疗制度,实现就医秩序的有序进行。
The main measures and effect of hierarchical medical system at home and abroad showed that the government should take the main responsibility, and lead to the classification of patients(disease) and medical institutions, strengthen the rigid restraint of primary medical treatment, and restrict the diagnosis and treatment of hospitals at all levels through administrative and economic measures. The patient's medical behavior was guided by the medical insurance reimbursement ratio. The binding and risk sharing of the economic interests in the Medical Union was realized by the medical insurance bundled payment. Therefore, a mandatory hierarchical medical system was established to keep medical order.
The main measures and effect of hierarchical medical system at home and abroad showed that the government should take the main responsibility, and lead to the classification of patients(disease) and medical institutions, strengthen the rigid restraint of primary medical treatment, and restrict the diagnosis and treatment of hospitals at all levels through administrative and economic measures. The patient's medical behavior was guided by the medical insurance reimbursement ratio. The binding and risk sharing of the economic interests in the Medical Union was realized by the medical insurance bundled payment. Therefore, a mandatory hierarchical medical system was established to keep medical order.
引文
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[4]夏俊杰,卢祖洵,王家骥,等."医保经费总额包干,节余奖励"框架下的罗湖医改模式[J].中国全科医学,2017, 20(19):2299-2302.
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[13]司明舒,李士雪.基于文献研究的我国分级诊疗服务模式现状分析[J].中国初级卫生保健,2016,30(10):1-4.
[14]宋奎勐,韩志琰,宋燕,等.分级诊疗发展策略探讨[J].卫生软科学,2016,30(7):3-6.
[15]吕键.论深化医改进程中分级诊疗体系的完善[J].中国医院管理,2014,34(6):1-3.
[16]吴伟旋,向前.捆绑支付对我国医疗卫生领域供给侧改革的启示[J].中国卫生经济,2017,36(7):22-24.
[17]辛沁玲,苏敏,方鹏骞,等.我国医疗联合体激励约束机制的关键问题与路径分析[J].中华医院管理杂志,2017,33(12):889-892.
[2]孙晓凡,陈旻杰,闻大翔,等.英、美、荷、澳、日分级诊疗实践的启示[J].中国卫生质量管理,2016,23(5):105-108.
[3]梁朝金,胡志,秦侠,等.德国分级诊疗实践和经验及其对我国的启示[J].中国医院管理,2016,36(8):76-77.
[4]夏俊杰,卢祖洵,王家骥,等."医保经费总额包干,节余奖励"框架下的罗湖医改模式[J].中国全科医学,2017, 20(19):2299-2302.
[5]陈方超.青岛市依托医联体构建分级诊疗体系[J].山东卫生计生,2015(4):23.
[6]黄汉明,刘跃华,卜亚丽.南京市医保差异化支付与分级诊疗的实证分析[J].中国医疗保险,2015(6):41-44,48.
[7]邬惊雷.“1+1+1”签约分级诊疗上海之路[J].中国卫生,2017(7):38-39.
[8]刘远立.重心下沉分级诊疗——厦门市的“三师共管”模式(节选)[J].现代医院管理,2016,14(4):14-15.
[9]姜洁,李幼平.我国分级诊疗模式的演进及改革路径探讨[J].四川大学学报(哲学社会科学版),2017(4):29-35.
[10]李婷,郭帅,马天翼,等.“互联网+”视角下的分级诊疗体系构建[J].中国卫生经济,2016,35(12):38-40.
[11]石龙.广西分级诊疗制度的政策演进、实践悖论、构建困境及实现路径[J].广西医学,2017,40(7):864-866.
[12]张慧林,成昌慧,马效恩.分级诊疗制度的现状分析及对策思考[J].中国医院管理,2015,35(11):8-9.
[13]司明舒,李士雪.基于文献研究的我国分级诊疗服务模式现状分析[J].中国初级卫生保健,2016,30(10):1-4.
[14]宋奎勐,韩志琰,宋燕,等.分级诊疗发展策略探讨[J].卫生软科学,2016,30(7):3-6.
[15]吕键.论深化医改进程中分级诊疗体系的完善[J].中国医院管理,2014,34(6):1-3.
[16]吴伟旋,向前.捆绑支付对我国医疗卫生领域供给侧改革的启示[J].中国卫生经济,2017,36(7):22-24.
[17]辛沁玲,苏敏,方鹏骞,等.我国医疗联合体激励约束机制的关键问题与路径分析[J].中华医院管理杂志,2017,33(12):889-892.