基于国际经验的整合卫生服务体系关键路径探索
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摘要
整合卫生服务是实现全方位、全周期健康服务的有效路径,我国目前还处于初步阶段。文章在综述了英国、法国、日本等国家整合卫生实践的基础上,梳理了国际上整合卫生体系关键环节及主要举措,分析了我国实践探索与国际经验的差距及存在的问题,最后提出完善整合卫生服务的6个关键环节,即分层、统筹、整合、转变、考核、激励,并总结了推进整合卫生服务体系的4个建议路径,包括:统筹与协作,部门机构协同、资源有效配置;分层与整合,需求合理分层、服务内容整合;人员多学科能力培养、设置联络员;考核与激励,整体评价体系、有效经济激励。
Integrated health services system is an effective way to deliver comprehensive lifecycle health services. China is still in the early stage of integrated health services. This paper analyzed the international key points and main measures on integrated health services system based on reviewing practice experiences from Britain,France,Japan,etc. The gap between China's practice and international experience and the problems in China's practice were analyzed. Finally,six key points of integrated care were put forward,including stratification,coordination,integration,transformation,evaluation and incentive. The suggested pathway to put forward integrated health service system was also summarized. That involved coordination and cooperation,the collaborative work of different departments,effective resource allocation;stratification and integration,reasonable stratification of needs and integration of services;cultivation of multidisciplinary abilities,introduction of liaison;and evaluation and incentive,overall evaluation system and effective economic incentive.
Integrated health services system is an effective way to deliver comprehensive lifecycle health services. China is still in the early stage of integrated health services. This paper analyzed the international key points and main measures on integrated health services system based on reviewing practice experiences from Britain,France,Japan,etc. The gap between China's practice and international experience and the problems in China's practice were analyzed. Finally,six key points of integrated care were put forward,including stratification,coordination,integration,transformation,evaluation and incentive. The suggested pathway to put forward integrated health service system was also summarized. That involved coordination and cooperation,the collaborative work of different departments,effective resource allocation;stratification and integration,reasonable stratification of needs and integration of services;cultivation of multidisciplinary abilities,introduction of liaison;and evaluation and incentive,overall evaluation system and effective economic incentive.
引文
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[2] MUR-VEEMAN I, HARDY B, STEENBERGEN M, et al.Development of integrated care in England and the Netherlands:managing across public-private boundaries[J]. Health Policy,2003, 65(3):227-241.
[3] WORLD HEALTH ORGANIZATION. Framework on integrated,people-centred health services[R]. Geneva:World Health Organization, 2016.
[4] FULOP N, MOWLEM A, EDWARDS N. Building integrated care:lessons from the UK and elsewhere[R]. London:the NHS Confederation, 2005.
[5]代涛,陈瑶,韦潇.医疗卫生服务体系整合:国际视角与中国实践[J].中国卫生政策研究, 2012, 5(9):1-9.
[6] KONGSTVEDT R R. Essentials of managed health care[M].5th ed. Reston:Jones and Bartlett Publishers, 2007.
[7]匡莉,甘远洪,吴颖芳.“纵向整合”的医疗服务提供体系及其整合机制研究[J].中国卫生事业管理, 2012, 29(8):564-566.
[8]匡莉,马远珠,甘远洪.整合的卫生服务:来自WHO的定义与阐释[J].医学与哲学, 2011, 32(13):1-3.
[9]于广军.英国国家卫生服务体系新一轮改革及其对我国的启示[J].中国卫生资源, 2015, 18(5):371-373.
[10]谢春艳,金春林,王贤吉.英国国民健康服务体系新一轮改革解析[J].中国医院管理, 2015, 35(2):78-80.
[11]谢春艳,金春林,王贤吉.英国整合型保健发展经验及启示[J].中国卫生资源,2015, 18(1):71-74.
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[15]张莹,邵静,丁海云.日本整合型医疗卫生服务体系构建的经验与启示[C]//中国医学科学院.第二届中国卫生政策研究论坛论文集.北京:中国医学科学院, 2012.
[16]顾亚明.日本分级诊疗制度及其对我国的启示[J].卫生经济研究, 2015(3):8-12.
[17]孟开.从日本第四次医疗法的修改看医院病床分类[J].国外医学(社会医学分册), 2004, 21(3):120-126.
[18] WILLIAMS P. The competent boundary spanner[J]. Public Admin, 2002, 80(1):103-124.
[19] HAMC,ALDERWICKH,DUNNP,etal.Delivering sustainability and transformation plans from ambitious proposals to credible plans[R]. London:The King’s Fund,2017.
[20] BIENKOWSKA-GIBBS T, KING S, SAUNDERS C, et al.New organisational models of primary care to meet the future needs of the NHS:a brief overview of recent reports[R/OL].[2018-02-22]. https://www.rand.org/pubs/research_reports/RR1181.html.
[21] DRENNAN V M, HALTER M, JOLY L, et al. Physician associates and GPs in primary care:a comparison[J]. Brit J Gen Pract, 2015, 65(634):e344-e350.
[22]孙皎.介绍日本出院计划发展的近况[J].吉林医学, 2006,27(4):398-400.
[23] ANDERSON G, HORVATH J. The growing burden of chronic disease in America[J]. Public Health Rep, 2004, 119(3):263-270.
[24] GAYNOR M, LAUDICELLA M, PROPPER C, et al. Can governments do it better? Merger mania and hospital outcomes in the English NHS[J]. J Health Econ, 2012, 31(3):528-543.
[25]谢春艳,何江江,胡善联.英国初级卫生保健质量与结果框架解析[J].中国医院管理, 2015, 35(7):78-80.
[26]张莹.日本医疗机构双向转诊补偿制度的经验与启示[J].中国卫生经济, 2013, 32(4):93-94.
[27]厚生労働省.医療法[EB/OL].(2017-07-03)[2018-02-22].http://wwwhourei.mhlw.go.jp/cgi-bin/t_docframe.cgi?MODE=h ourei&DMODE=CONTENTS&SMODE=NORMAL&KEYWO RD=&EFSNO=200.
[28]孟开,张玲.日本医疗法的五次修改与医院管理[J].中华医院管理杂志, 2010, 26(5):397-400.
[29]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴2017[M].北京:中国协和医科大学出版社, 2017.
[30]吴秋兰,曾广民,王谏珠,等.社区高血压的转诊现状及分析[J].中国医药指南, 2012, 10(30):676-677.
[31]潘景业,徐长恩,全世超.双向转诊下转难原因的“冰山角”分析[J].中国卫生事业管理, 2009, 26(5):300-301.
[32]王珩,冯占春,李鹏.双向转诊中向下转诊的影响因素分析[J].中华医院管理杂志, 2012, 28(4):268-270.
[33]张亮,张研,唐文熙,等.健康整合:引领卫生系统变革[M].北京:科学出版社, 2014:137-146.
[2] MUR-VEEMAN I, HARDY B, STEENBERGEN M, et al.Development of integrated care in England and the Netherlands:managing across public-private boundaries[J]. Health Policy,2003, 65(3):227-241.
[3] WORLD HEALTH ORGANIZATION. Framework on integrated,people-centred health services[R]. Geneva:World Health Organization, 2016.
[4] FULOP N, MOWLEM A, EDWARDS N. Building integrated care:lessons from the UK and elsewhere[R]. London:the NHS Confederation, 2005.
[5]代涛,陈瑶,韦潇.医疗卫生服务体系整合:国际视角与中国实践[J].中国卫生政策研究, 2012, 5(9):1-9.
[6] KONGSTVEDT R R. Essentials of managed health care[M].5th ed. Reston:Jones and Bartlett Publishers, 2007.
[7]匡莉,甘远洪,吴颖芳.“纵向整合”的医疗服务提供体系及其整合机制研究[J].中国卫生事业管理, 2012, 29(8):564-566.
[8]匡莉,马远珠,甘远洪.整合的卫生服务:来自WHO的定义与阐释[J].医学与哲学, 2011, 32(13):1-3.
[9]于广军.英国国家卫生服务体系新一轮改革及其对我国的启示[J].中国卫生资源, 2015, 18(5):371-373.
[10]谢春艳,金春林,王贤吉.英国国民健康服务体系新一轮改革解析[J].中国医院管理, 2015, 35(2):78-80.
[11]谢春艳,金春林,王贤吉.英国整合型保健发展经验及启示[J].中国卫生资源,2015, 18(1):71-74.
[12] BIRMINGHAM CITY COUNCIL. Our plan to improve the health and wellbeing of people living in Birmingham and Solihull[EB/OL].[2018-02-24]. https://www.birmingham.gov.uk/stp.
[13] CAMBRIDGESHIREANDPETERBOROUGHCCG.Cambridgeshire and Peterborough health and care system sustainability and transformation plan[R]. Cambridgeshire:Cambridgeshire and Peterborough CCG, 2016.
[14] NATIONAL HEALTH SYSTEM CUMBRIA CCG.STPs[EB/OL].[2018-02-22]. http://www.northcumbriaccg.nhs.uk/about-us/STP/STPs.aspx.
[15]张莹,邵静,丁海云.日本整合型医疗卫生服务体系构建的经验与启示[C]//中国医学科学院.第二届中国卫生政策研究论坛论文集.北京:中国医学科学院, 2012.
[16]顾亚明.日本分级诊疗制度及其对我国的启示[J].卫生经济研究, 2015(3):8-12.
[17]孟开.从日本第四次医疗法的修改看医院病床分类[J].国外医学(社会医学分册), 2004, 21(3):120-126.
[18] WILLIAMS P. The competent boundary spanner[J]. Public Admin, 2002, 80(1):103-124.
[19] HAMC,ALDERWICKH,DUNNP,etal.Delivering sustainability and transformation plans from ambitious proposals to credible plans[R]. London:The King’s Fund,2017.
[20] BIENKOWSKA-GIBBS T, KING S, SAUNDERS C, et al.New organisational models of primary care to meet the future needs of the NHS:a brief overview of recent reports[R/OL].[2018-02-22]. https://www.rand.org/pubs/research_reports/RR1181.html.
[21] DRENNAN V M, HALTER M, JOLY L, et al. Physician associates and GPs in primary care:a comparison[J]. Brit J Gen Pract, 2015, 65(634):e344-e350.
[22]孙皎.介绍日本出院计划发展的近况[J].吉林医学, 2006,27(4):398-400.
[23] ANDERSON G, HORVATH J. The growing burden of chronic disease in America[J]. Public Health Rep, 2004, 119(3):263-270.
[24] GAYNOR M, LAUDICELLA M, PROPPER C, et al. Can governments do it better? Merger mania and hospital outcomes in the English NHS[J]. J Health Econ, 2012, 31(3):528-543.
[25]谢春艳,何江江,胡善联.英国初级卫生保健质量与结果框架解析[J].中国医院管理, 2015, 35(7):78-80.
[26]张莹.日本医疗机构双向转诊补偿制度的经验与启示[J].中国卫生经济, 2013, 32(4):93-94.
[27]厚生労働省.医療法[EB/OL].(2017-07-03)[2018-02-22].http://wwwhourei.mhlw.go.jp/cgi-bin/t_docframe.cgi?MODE=h ourei&DMODE=CONTENTS&SMODE=NORMAL&KEYWO RD=&EFSNO=200.
[28]孟开,张玲.日本医疗法的五次修改与医院管理[J].中华医院管理杂志, 2010, 26(5):397-400.
[29]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴2017[M].北京:中国协和医科大学出版社, 2017.
[30]吴秋兰,曾广民,王谏珠,等.社区高血压的转诊现状及分析[J].中国医药指南, 2012, 10(30):676-677.
[31]潘景业,徐长恩,全世超.双向转诊下转难原因的“冰山角”分析[J].中国卫生事业管理, 2009, 26(5):300-301.
[32]王珩,冯占春,李鹏.双向转诊中向下转诊的影响因素分析[J].中华医院管理杂志, 2012, 28(4):268-270.
[33]张亮,张研,唐文熙,等.健康整合:引领卫生系统变革[M].北京:科学出版社, 2014:137-146.