吉林省某医院集团双向转诊现状及对策研究
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摘要
我国医疗资源短缺,区域配置不均衡等问题严重阻碍了我国卫生事业的发展。为科学的配置卫生资源,促进卫生资源的合理使用,党和政府采取积极的改革措施,明确建立双向转诊制度的重要性和必要性。医院集团作为一种新的医院组织形式和新的管理模式,能更有效的整合各区域、各层次和各类别医院的卫生资源,发挥大医院的技术辐射功能,提升下级医院的管理能力,培养医院技术人才。同时,通过在集团内建立有效的双向转诊机制,合理分流患者、优化卫生资源配置,提高医疗服务的效率和质量,使医疗资源得以合理、充分的使用。
本课题主要是针对新的区域医疗服务模式——医院集团内的双向转诊制度进行研究,通过医院集团内、外医护人员和患者对医院集团、双向转诊的认知度及实施情况的调查,分析医院集团和集团内双向转诊制度存在的问题；并有针对性地提出对策与建议。论文开始部分主要包括研究背景、医院集团、双向转诊和研究意义等四个方面,对医院集团和双向转诊制度的发展史和研究现状进行了详细的介绍。本论文的数据是根据设计的技术路线,通过问卷调查的形式,在医院集团内外分别选取两家医疗机构,针对医院集团内外医护人员和患者对医院集团的认知程度、对双向转诊的认知程度,以及集团内外双向转诊制度的实施情况进行调查。通过文献归纳法、专家访谈法、实证分析法、统计分析等多种研究方法分析医院集团双向转诊制度中存在的问题。主要通过对吉林省A医院集团概况描述,并对医院集团的认知情况、双向转诊制度的认知情况、双向转诊制度在医院集团内外医疗机构的实施情况等三个部分的数据情况进行统计分析。结合吉林省A医院集团的现状和调查结果,进一步分析吉林省A医院集团和集团内双向转诊制度存在的问题。具体包括：一是医护人员和患者对医院集团和双向转诊的了解程度较低,缺乏专门的责任机构,宣传力度不足；二是医院集团组织机构和运行模式不完善,阻碍了医院集团的发展。三是医院集团保持原有经营形式,集团管理不规范、不统一；四是转诊标准未建立,转诊流程不完善,患者信息流转不通畅；五是医院集团内医疗技术水平参差不齐,医疗服务配套制度缺失,引导患者选择集团成员医院的动力不足。针对发现的问题,提出相应的对策、建议。主要包括五个方面：扩大宣传,提高认识；完善组织结构,优化运行模式；引入企业管理机制,控制运行成本；制定转诊标准,完善转诊流程,建立患者转诊信息平台；提高医疗技术水平,引导患者选择集团内的成员医院就诊。
The shortage and imbalance of medical resources has seriously hindered the development of our health care. Focus on configuring and promoting legitimately of health resources, the party and government take a variety of positive reform measures. A clear establish is two-way referral system is importance and necessity. As a new form of hospital organization and a new management, Hospital Group can integrate effectively the advantages of hospital resources at different regional, levels and types. It also can improve the management capacity of lower-level hospitals and train hospital technicians. Meanwhile, establishing effective two-way referral mechanisms within the group is to regulate the rational triage of patients, to optimize health resources, to improve efficiency and quality of medical services, so that medical resources can be reasonable, use adequately and reduce health care costs of patients. It effectively mitigates the issue that medical treatment is difficult and expensive.
This topic is mainly to study the two-way referral system of hospital group, a new model of regional medical services. Through investigating to medical staff and patients inside and outside the hospital group on awareness and present situation of hospital group and two-way referral, the topic analyze the problems of hospital group and two-way referral system; and put forward solutions and prevention mechanisms. The beginning of papers include research background and significance, hospital groups, two-way referral. The development history and the current research situation of hospital groups and two-way referral are introducted in detail. The data of this thesis is based on the design of technical routes and is investigated through the questionnaire. Four hospitals were selected from inside and outside of hospital group. The awareness level of the hospital group, two-way referral cognitive Level and the implementation of two-way referral system is investigated to the hospital staff and patients groups both inside and outside the hospital group. Through the literature induction, empirical analysis, statistical analysis, this part elaborate shortcomings of two-way referral system in the hospital group. By analyzing to the profile of A hospital Group of Jilin Province, the statistics on hospital group cognition, the cognition of two-way referral system and the implementation of two-way referral system in medical institutions within and outside the hospital group,we get the result. With the status and findings of A hospital group in Jilin Province, this part analysis further the development of hospital group and the problem of two-way referral system in the hospital group. First, health care workers and patients have low level of understanding to the hospital group and two-way referral; Secondly, organization and operation mode is imperfect, hindering the development of the hospital group. Thirdly, the hospital group maintain the original form of management. The management is not standardized and uniform; Fourthly, referral criteria are not established, referral process is imperfect and permission is complex, the patient information flow is not smooth; fifthly, the different of medical skill levels and the lack of health care support system lead to patients do not choose the members of the Group hospitals.The corresponding countermeasures and suggestions are proposed to the analysis results and the problems, including five areas:expand advocacy, rais awareness; improve the organizational structure, optimal operation mode; separat management from operation, introduct corporate management, control operating costs; develope referral criteria, improve the referral process, establish the patient referral information platform; increase the level of medical technology, and guide patients to choose the members of the hospital within the group.
本课题主要是针对新的区域医疗服务模式——医院集团内的双向转诊制度进行研究,通过医院集团内、外医护人员和患者对医院集团、双向转诊的认知度及实施情况的调查,分析医院集团和集团内双向转诊制度存在的问题；并有针对性地提出对策与建议。论文开始部分主要包括研究背景、医院集团、双向转诊和研究意义等四个方面,对医院集团和双向转诊制度的发展史和研究现状进行了详细的介绍。本论文的数据是根据设计的技术路线,通过问卷调查的形式,在医院集团内外分别选取两家医疗机构,针对医院集团内外医护人员和患者对医院集团的认知程度、对双向转诊的认知程度,以及集团内外双向转诊制度的实施情况进行调查。通过文献归纳法、专家访谈法、实证分析法、统计分析等多种研究方法分析医院集团双向转诊制度中存在的问题。主要通过对吉林省A医院集团概况描述,并对医院集团的认知情况、双向转诊制度的认知情况、双向转诊制度在医院集团内外医疗机构的实施情况等三个部分的数据情况进行统计分析。结合吉林省A医院集团的现状和调查结果,进一步分析吉林省A医院集团和集团内双向转诊制度存在的问题。具体包括：一是医护人员和患者对医院集团和双向转诊的了解程度较低,缺乏专门的责任机构,宣传力度不足；二是医院集团组织机构和运行模式不完善,阻碍了医院集团的发展。三是医院集团保持原有经营形式,集团管理不规范、不统一；四是转诊标准未建立,转诊流程不完善,患者信息流转不通畅；五是医院集团内医疗技术水平参差不齐,医疗服务配套制度缺失,引导患者选择集团成员医院的动力不足。针对发现的问题,提出相应的对策、建议。主要包括五个方面：扩大宣传,提高认识；完善组织结构,优化运行模式；引入企业管理机制,控制运行成本；制定转诊标准,完善转诊流程,建立患者转诊信息平台；提高医疗技术水平,引导患者选择集团内的成员医院就诊。
The shortage and imbalance of medical resources has seriously hindered the development of our health care. Focus on configuring and promoting legitimately of health resources, the party and government take a variety of positive reform measures. A clear establish is two-way referral system is importance and necessity. As a new form of hospital organization and a new management, Hospital Group can integrate effectively the advantages of hospital resources at different regional, levels and types. It also can improve the management capacity of lower-level hospitals and train hospital technicians. Meanwhile, establishing effective two-way referral mechanisms within the group is to regulate the rational triage of patients, to optimize health resources, to improve efficiency and quality of medical services, so that medical resources can be reasonable, use adequately and reduce health care costs of patients. It effectively mitigates the issue that medical treatment is difficult and expensive.
This topic is mainly to study the two-way referral system of hospital group, a new model of regional medical services. Through investigating to medical staff and patients inside and outside the hospital group on awareness and present situation of hospital group and two-way referral, the topic analyze the problems of hospital group and two-way referral system; and put forward solutions and prevention mechanisms. The beginning of papers include research background and significance, hospital groups, two-way referral. The development history and the current research situation of hospital groups and two-way referral are introducted in detail. The data of this thesis is based on the design of technical routes and is investigated through the questionnaire. Four hospitals were selected from inside and outside of hospital group. The awareness level of the hospital group, two-way referral cognitive Level and the implementation of two-way referral system is investigated to the hospital staff and patients groups both inside and outside the hospital group. Through the literature induction, empirical analysis, statistical analysis, this part elaborate shortcomings of two-way referral system in the hospital group. By analyzing to the profile of A hospital Group of Jilin Province, the statistics on hospital group cognition, the cognition of two-way referral system and the implementation of two-way referral system in medical institutions within and outside the hospital group,we get the result. With the status and findings of A hospital group in Jilin Province, this part analysis further the development of hospital group and the problem of two-way referral system in the hospital group. First, health care workers and patients have low level of understanding to the hospital group and two-way referral; Secondly, organization and operation mode is imperfect, hindering the development of the hospital group. Thirdly, the hospital group maintain the original form of management. The management is not standardized and uniform; Fourthly, referral criteria are not established, referral process is imperfect and permission is complex, the patient information flow is not smooth; fifthly, the different of medical skill levels and the lack of health care support system lead to patients do not choose the members of the Group hospitals.The corresponding countermeasures and suggestions are proposed to the analysis results and the problems, including five areas:expand advocacy, rais awareness; improve the organizational structure, optimal operation mode; separat management from operation, introduct corporate management, control operating costs; develope referral criteria, improve the referral process, establish the patient referral information platform; increase the level of medical technology, and guide patients to choose the members of the hospital within the group.
引文
[1]中共中央国务院.关于深化医药卫生体制改革的意见.2009.
[2]国务院.关于印发医药卫生体制改革近期重点实施方案(2009-2011年)的通知.2009.
[3]国家工商管理总局.企业集团登记管理暂行规定.1998.
[4]李永秋,李士雪,张英洁.关于医院集团发展的问题和建议[J].中国卫生事业管理.2006,01：19-20.
[5]蒋蕊.新加坡公立医疗机构体制的借鉴[J].医院领导决策参考.2002,23：34-36.
[6]全继凤.论英国撒切尔—梅杰政府的国民医疗保健制度[D].中国优秀硕士论文全文数据库.2007,06.
[7]王晓明,姚永浮.英国的公立医院管理制度改革及启示[J].医院领导决策参考.2005,08：46-49.
[8]宋文舸,赵郁馨.英国卫生改革与医院组织的重建(下)[J].卫生软科学.1996,06：41-43.
[9]宋文舸,赵郁馨.英国卫生改革与医院组织的重建(上)[J].卫生软科学.1996,05：42-44.
[10]彼得·弗里德里希,郭小沙.社会保险改革中的立法与利益平衡：2007年德国医疗卫生改革[J].社会保障研究(北京).2007,06：25-34.
[11]陈翔,王小丽.德国社会医疗保险筹资、支付机制及其启示[J].卫生经济研究.2009,12(268)：20-22.
[12]王丙毅,尹音频.德国医疗管制模式的特点、改革取向及借鉴意义[J].理论学刊.2008,07(137)：58-61.
[13]Marion Caspers-Merk. The Medical System in Germany:Characteristics, Problems and Resolutions[R]北京：中国人民大学,2006.
[14]侯建林,刘金峰,雷海潮,胡善联,王吉善,董德刚,陈卫国,焦云智.德国公立医院近期改革动态及对我国的启示[J].中国医院.2002,03：57-59.
[15]胡善联,龚向光.新加坡医院体制改革[J].卫生经济研究.2001,11：10-12.
[16]郝兵.新加坡医院改革良方——医院公司化[J].国际医药卫生导报.2005, 02：83-84.
[17]常修泽.新加坡医疗卫生体制的四点启示[J].学习月刊.2007,04：38-40.
[18]陈志兴,龚宇.医院重组的基本模式和政策向导[J].中国医院管理.2001,20(01)：15-17.
[19]邹俐爱,丘金彩,冯丽仪,刘琳,喻星、呈许军.公立医院集团化运营模式剖析[J].现代医院.2002,10(12)：106-107.
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[21]Department of health. Delivering health and social Care. http://www.dh.gov.uk
[22]郝晓宁,李士雪,李湘江.美国社区卫生服务运行机制和管理模式研究.医学与哲学(人文社会医学版).2006,27(8)：22-23.
[23]高大林.德国卫生保健制度[J].《国外医学》卫生经济分册.1998,15(4)：145-148.
[24]WHO Regional Office for Europe et. European Observatory on Health Care Systems (Germany).2000.
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[26]刘利群,吕春雷.澳大利亚社区卫生服务的提供体系及启示[J].中国全科医学.2002,05(01)：40-42.
[27]崔颖.澳大利亚的社区卫生服务与制约激励机制及其启发[J].中国全科医学.2002,05(11)：927-930.
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[2]国务院.关于印发医药卫生体制改革近期重点实施方案(2009-2011年)的通知.2009.
[3]国家工商管理总局.企业集团登记管理暂行规定.1998.
[4]李永秋,李士雪,张英洁.关于医院集团发展的问题和建议[J].中国卫生事业管理.2006,01：19-20.
[5]蒋蕊.新加坡公立医疗机构体制的借鉴[J].医院领导决策参考.2002,23：34-36.
[6]全继凤.论英国撒切尔—梅杰政府的国民医疗保健制度[D].中国优秀硕士论文全文数据库.2007,06.
[7]王晓明,姚永浮.英国的公立医院管理制度改革及启示[J].医院领导决策参考.2005,08：46-49.
[8]宋文舸,赵郁馨.英国卫生改革与医院组织的重建(下)[J].卫生软科学.1996,06：41-43.
[9]宋文舸,赵郁馨.英国卫生改革与医院组织的重建(上)[J].卫生软科学.1996,05：42-44.
[10]彼得·弗里德里希,郭小沙.社会保险改革中的立法与利益平衡：2007年德国医疗卫生改革[J].社会保障研究(北京).2007,06：25-34.
[11]陈翔,王小丽.德国社会医疗保险筹资、支付机制及其启示[J].卫生经济研究.2009,12(268)：20-22.
[12]王丙毅,尹音频.德国医疗管制模式的特点、改革取向及借鉴意义[J].理论学刊.2008,07(137)：58-61.
[13]Marion Caspers-Merk. The Medical System in Germany:Characteristics, Problems and Resolutions[R]北京：中国人民大学,2006.
[14]侯建林,刘金峰,雷海潮,胡善联,王吉善,董德刚,陈卫国,焦云智.德国公立医院近期改革动态及对我国的启示[J].中国医院.2002,03：57-59.
[15]胡善联,龚向光.新加坡医院体制改革[J].卫生经济研究.2001,11：10-12.
[16]郝兵.新加坡医院改革良方——医院公司化[J].国际医药卫生导报.2005, 02：83-84.
[17]常修泽.新加坡医疗卫生体制的四点启示[J].学习月刊.2007,04：38-40.
[18]陈志兴,龚宇.医院重组的基本模式和政策向导[J].中国医院管理.2001,20(01)：15-17.
[19]邹俐爱,丘金彩,冯丽仪,刘琳,喻星、呈许军.公立医院集团化运营模式剖析[J].现代医院.2002,10(12)：106-107.
[20]刘洋,王小芳.双向转诊制度问题探讨[J].社区区卫生服务,2004,12：72-73.
[21]Department of health. Delivering health and social Care. http://www.dh.gov.uk
[22]郝晓宁,李士雪,李湘江.美国社区卫生服务运行机制和管理模式研究.医学与哲学(人文社会医学版).2006,27(8)：22-23.
[23]高大林.德国卫生保健制度[J].《国外医学》卫生经济分册.1998,15(4)：145-148.
[24]WHO Regional Office for Europe et. European Observatory on Health Care Systems (Germany).2000.
[25]陈迎春,姚建红.德国的社区卫生服务[J].国际医药卫生导报.2002,13：29.
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