深度贫困地区健康扶贫研究:以四川凉山州分级诊疗为例
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摘要
深度贫困地区健康扶贫是脱贫攻坚的难点和重点之一,尤其是连片特困的少数民族地区。分级诊疗能够有效提高医疗卫生资源配置效率,缓解贫困地区医疗服务供给的不足,是健康扶贫的有效途径。凉山州由于自然地理环境、民族文化、生活习惯等特殊性,医疗卫生服务发展"不充分、不均衡"问题较为突出,医疗卫生资源分布密度和服务半径不匹配,传统就医文化和习惯与合理就医存在内在冲突等。虽然近年来凉山州医疗卫生事业发展取得了较大成效,但分级诊疗发展仍面临不少问题,如医疗卫生政策的变动性,医疗服务连续性不足,病人上转容易下转难等。结合凉山州特点,应充分利用健康扶贫政策优势,按服务半径进行资源配置,明确不同医院之间的分工,减少同质竞争,发挥医保杠杆作用,促进家庭医生本土化等,提高凉山州居民的健康水平。
Poverty alleviation through providing better health care in deeply poverty-stricken areas is a difficult task and the key point in poverty alleviation,especially in concentrated poverty-stricken ethnic areas.Graded diagnosis and treatment can effectively improve the allocation efficiency of medical and health resources and alleviate the shortage of medical services in poor areas.Due to specific natural geographical environment,ethnic culture and living habits,the problem of insufficient and unbalanced development of medical and health service is more prominent in Liangshan Prefecture,such as unmatched distribution and service radius of medical and health resources,as well as inherent conflict between traditional medical culture and habit and reasonable medical treatment.Although remarkable success has been achieved in the development of medical and health service in recent years in Liangshan Prefecture,the grading diagnosis development still faces many problems,such as volatility in health care policy,lack of medical service continuity,and difficulties in transferring patients to better hospitals.According to the characteristics of Liangshan Prefecture,we should make full use of the policy advantage of poverty alleviation through providing better health care,allocate resources according to service radius,make a clear division of different hospitals,reduce competition among similar hospitals,give full play to the leverage of medical insurance and promote family doctor localization in order to improve health level and the sense of well-being of the residents in Liangshan Prefecture.
Poverty alleviation through providing better health care in deeply poverty-stricken areas is a difficult task and the key point in poverty alleviation,especially in concentrated poverty-stricken ethnic areas.Graded diagnosis and treatment can effectively improve the allocation efficiency of medical and health resources and alleviate the shortage of medical services in poor areas.Due to specific natural geographical environment,ethnic culture and living habits,the problem of insufficient and unbalanced development of medical and health service is more prominent in Liangshan Prefecture,such as unmatched distribution and service radius of medical and health resources,as well as inherent conflict between traditional medical culture and habit and reasonable medical treatment.Although remarkable success has been achieved in the development of medical and health service in recent years in Liangshan Prefecture,the grading diagnosis development still faces many problems,such as volatility in health care policy,lack of medical service continuity,and difficulties in transferring patients to better hospitals.According to the characteristics of Liangshan Prefecture,we should make full use of the policy advantage of poverty alleviation through providing better health care,allocate resources according to service radius,make a clear division of different hospitals,reduce competition among similar hospitals,give full play to the leverage of medical insurance and promote family doctor localization in order to improve health level and the sense of well-being of the residents in Liangshan Prefecture.
引文
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[7]王大平,许金红.深圳市分级诊疗制度建设研究[J].中国卫生人才,2016,(9):56-59.
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[11]陈滨涛.分级诊疗医保联动机制研究背景、主要发现及政策建议[J].中国农村卫生事业管理,2017,(2):121-123.
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[13]姚泽麟.政府职能与分级诊疗:制度嵌入性视角的历史总结[J].公共管理学报,2016,(3):61-70.
[14]吕国营.分级诊疗成功的关键在于供给侧改革[J].中国医疗保险,2017,(5):22.
[15]高和荣.健康治理与中国分级诊疗制度[J].公共管理学报,2017,(2):139-144.
[16]王东进.分级诊疗须闯过五道关[J].中国医疗保险,2016,(10):5-8.
[17]朱恒鹏.分级诊疗难形成根源在医疗不在医保[J].中国医疗保险,2017,(5):20-22.
[18]张伟,孙瑞玲.基于患者需求视角下的分级诊疗制度研究[J].中国全科医学,2017,(12):1410-1414.
[19]梁鸿.推进分级诊疗制度的关键是建立和完善家庭医生制度[J].中国卫生政策研究,2016,(8):1-2.
[20]刘国恩,官海静.分级诊疗与全科诊所:中国医疗供给侧改革的关键[J].中国全科医学,2016,(8):2619-2624.
[21]仇雨临.家庭医生签约制是分级诊疗施行的保证[J].中国医疗保险,2017,(5):23.
[22]郭燕红.推进分级诊疗,构建连续健康服务[J].中国全科医学,2017,(1):1-5.
[23]朱留宝,刘跃华,杨燕绥.广州红山街试点分级诊疗成效的实证分析[J].中国医疗保险,2017,(1):26-30.
[24]黄柳.分级诊疗的厦门“样本”[J].中国医院院长,2017,(1):74-77.
[25]谷小丽,殷璇,钱东福.分级诊疗的国内外经验与实施策略分析[J].中国全科医学,2016,(10):3404-3408.
[26]刘伦皓,刘莉,余刚等.凉山州2005-2016年新发现HIV感染者的流行特征及趋势分析[J].中国艾滋病性病,2018,(4):345-356.
[27]冯敏,罗凉昭.从居住环境文化透视妇女的健康发展:以凉山彝族的田野考察为例[J].妇女研究论丛,2001,(3):16-20.
[28]曲比阿果,陈雄飞.当下凉山医疗体系的人类学解读[J].西南民族大学学报(人文社会科学版),2012,(11):52-56.
[29]周如南.四川凉山彝族地区的健康认知与治疗模式:以昭觉县竹核坝为例[J].西南民族大学学报(人文社会科学版),2014,(2):42-47.
[30]四川省地方志编撰委员会.四川省志医药卫生志[M].成都:四川辞书出版社,1995:241.
[31]韩艳丽,郑文,那霄雯.非物质文化遗产视野下彝族医药研究综述[J].云南中医中药杂志.2017,(3):93-95.
(1)据《四川卫生和计划生育年鉴2016》计算整理所得。
[2]王清波,胡佳,代涛.建立分级诊疗制度的动力与阻力分析:基于利益相关者理论[J].中国卫生政策研究,2016,(4):9-15.
[3]余红星等.基于分级诊疗的医疗机构分工协作机制探究[J].中国医院管理,2014,(7):1-3.
[4]方鹏骞等.我国分级诊疗制度实施的关键问题与对策探讨[J].中国医院管理,2016,(11):1-3.
[5]张录法.分级诊疗实践模式探究[J].中国社会保障,2016,(5):70-72.
[6]赵斌,李蔚.社会医疗保险背景下的分级诊疗制度国际借鉴及中国困境[J].中国医疗保险,2017,(5):14-19.
[7]王大平,许金红.深圳市分级诊疗制度建设研究[J].中国卫生人才,2016,(9):56-59.
[8]申曙光,张勃.分级诊疗、基层首诊与基层医疗卫生机构建设[J].学海,2016,(2):48-57.
[9]姚进文等.甘肃省会宁县分级诊疗试点模式即效果评价[J].中国全科医学,2016,(22):2632-2635.
[10]王雪云,姚峥嵘,田侃.基于供给侧视角的我国分级诊疗相关问题思考[J].中国医院管理,2017,(3):21-23.
[11]陈滨涛.分级诊疗医保联动机制研究背景、主要发现及政策建议[J].中国农村卫生事业管理,2017,(2):121-123.
[12]唐绍洪,崔垚,刘屹.分级诊疗制度关涉主体的利益冲突与协调[J].中州学刊,2017,(2):70-75.
[13]姚泽麟.政府职能与分级诊疗:制度嵌入性视角的历史总结[J].公共管理学报,2016,(3):61-70.
[14]吕国营.分级诊疗成功的关键在于供给侧改革[J].中国医疗保险,2017,(5):22.
[15]高和荣.健康治理与中国分级诊疗制度[J].公共管理学报,2017,(2):139-144.
[16]王东进.分级诊疗须闯过五道关[J].中国医疗保险,2016,(10):5-8.
[17]朱恒鹏.分级诊疗难形成根源在医疗不在医保[J].中国医疗保险,2017,(5):20-22.
[18]张伟,孙瑞玲.基于患者需求视角下的分级诊疗制度研究[J].中国全科医学,2017,(12):1410-1414.
[19]梁鸿.推进分级诊疗制度的关键是建立和完善家庭医生制度[J].中国卫生政策研究,2016,(8):1-2.
[20]刘国恩,官海静.分级诊疗与全科诊所:中国医疗供给侧改革的关键[J].中国全科医学,2016,(8):2619-2624.
[21]仇雨临.家庭医生签约制是分级诊疗施行的保证[J].中国医疗保险,2017,(5):23.
[22]郭燕红.推进分级诊疗,构建连续健康服务[J].中国全科医学,2017,(1):1-5.
[23]朱留宝,刘跃华,杨燕绥.广州红山街试点分级诊疗成效的实证分析[J].中国医疗保险,2017,(1):26-30.
[24]黄柳.分级诊疗的厦门“样本”[J].中国医院院长,2017,(1):74-77.
[25]谷小丽,殷璇,钱东福.分级诊疗的国内外经验与实施策略分析[J].中国全科医学,2016,(10):3404-3408.
[26]刘伦皓,刘莉,余刚等.凉山州2005-2016年新发现HIV感染者的流行特征及趋势分析[J].中国艾滋病性病,2018,(4):345-356.
[27]冯敏,罗凉昭.从居住环境文化透视妇女的健康发展:以凉山彝族的田野考察为例[J].妇女研究论丛,2001,(3):16-20.
[28]曲比阿果,陈雄飞.当下凉山医疗体系的人类学解读[J].西南民族大学学报(人文社会科学版),2012,(11):52-56.
[29]周如南.四川凉山彝族地区的健康认知与治疗模式:以昭觉县竹核坝为例[J].西南民族大学学报(人文社会科学版),2014,(2):42-47.
[30]四川省地方志编撰委员会.四川省志医药卫生志[M].成都:四川辞书出版社,1995:241.
[31]韩艳丽,郑文,那霄雯.非物质文化遗产视野下彝族医药研究综述[J].云南中医中药杂志.2017,(3):93-95.
(1)据《四川卫生和计划生育年鉴2016》计算整理所得。