多元化医联体模式下分级诊疗的探索与思考
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摘要
总结直管式、紧密型和松散型三种医联体模式下分级诊疗的工作经验,分析三种模式下分级诊疗的实践效果,直管模式双向转诊效果最好,紧密型和松散型疑难病人上转较好、康复病人下转不畅。据此,从政策、机构和患者三个方面剖析了影响分级诊疗的制约因素,提出构建医联体和医共体相衔接的分级诊疗新体系、明确不同等级医院功能定位、制定可操作的分级诊疗流程、完善基本药物目录、协同推进医疗医保物价改革和信息化互联互通等合理性建议,有效推动分级诊疗的落地,让人民群众共享健康成果。
To sum up the experiences of hierarchical diagnosis under three types of medical alliance modes:the vertical,close or loose type;analyze the practical effects of hierarchical diagnosis system. The two-way referral effect was the best in vertical type. The complicated patients transferred treatment to superior hospitals were better,and the rehabilitation patients transferred treatment to lower hospitals were poor in close or loose type. It analyzed the constraints of the hierarchical diagnosis system from policies,institutions and patients. It put forward reasonable suggestions,such as construct a new hierarchical treatment system connecting medical alliance and medical community, define the functional orientation of different levels of hospitals, establish the process of hierarchical diagnosis, refine national essential medicine list,promote the medical reform,price reform and medical insurance reform in a cooperative way,interconnect the information system,to effectively implement the hierarchical medical system. Let the people share the health achievements.
To sum up the experiences of hierarchical diagnosis under three types of medical alliance modes:the vertical,close or loose type;analyze the practical effects of hierarchical diagnosis system. The two-way referral effect was the best in vertical type. The complicated patients transferred treatment to superior hospitals were better,and the rehabilitation patients transferred treatment to lower hospitals were poor in close or loose type. It analyzed the constraints of the hierarchical diagnosis system from policies,institutions and patients. It put forward reasonable suggestions,such as construct a new hierarchical treatment system connecting medical alliance and medical community, define the functional orientation of different levels of hospitals, establish the process of hierarchical diagnosis, refine national essential medicine list,promote the medical reform,price reform and medical insurance reform in a cooperative way,interconnect the information system,to effectively implement the hierarchical medical system. Let the people share the health achievements.
引文
[1]东振彩.天津市儿科医联体建设的实践与探索[J].中国初级卫生保健,2018,32(2):8-10.
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[5]张慧林,孙超,张克新,等.搭建三级四联一体化智慧医学平台,探索建立新型分级诊疗制度[J].中国医疗管理科学,2015,5(2):5-8.
[2]马继龙,陆方,陈雯,等.医生对分级诊疗制度的认知和评价[J],中国卫生质量管理,2016,23(5):99-101.
[3]秦敬柱,黄思桂.青岛市家庭医生联系人和门诊统筹制度对居民就医行为的影响[J].中华医院管理,2014,30(2):147-149.
[4]江一峰,段茗玉,周磊,等.上海市松江区居民对分级诊疗认识状况的调查与分析[J].中国卫生质量管理,2016,23(5):102-104.
[5]张慧林,孙超,张克新,等.搭建三级四联一体化智慧医学平台,探索建立新型分级诊疗制度[J].中国医疗管理科学,2015,5(2):5-8.