加拿大健康服务整合:实践与启示
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摘要
系统梳理了近年来有关加拿大卫生服务整合的文献和政策文件,归纳了安大略省、阿尔伯塔省和魁北克省的卫生服务整合实践及方式,包括卫生组织机构间整合、卫生服务团队整合以及一系列卫生服务整合,并总结组织机构间整合的促成因素和阻碍因素以及具体的整合策略。结合中国实际,提出我国在推进卫生服务整合过程中应坚持以政府为主导,充分发挥市场机制的积极作用,通过基层卫生服务的网络式管理与组团式服务,将重点人群和特定疾病的卫生服务整合视为战略重点,发挥护士在卫生服务整合中的助推作用,建设有利于整合的卫生信息系统,不断推进分级诊疗并弥合割裂的卫生服务体系,为居民提供个性化、方便、综合、连续的整合型卫生服务。
This paper systematically reviews the latest and relevant literatures and policy documents on the integrated health services in Canada in recent years. Therefore,it summarizes the practice and mode of integrated service delivery in Ontario,Alberta and Quebec wherein the integration among health organization,health service team,and a series of health services are included. The contributing factors and impeding factors( the barriers) of organizational integration and specific integration strategy were summarized. Finally,according to the actual practical situation,it is proposed that China should adhere to the government-led approach in promoting the integration of health services,and give a full play to the positive role of the market mechanism. Through strengthening the network management and group service of primary health services,emphasis will be put on health services of population groups and specific diseases. Therefore,integration will be regarded as a strategic priority,increasing incentives and boosting promotion of nursing personnel on the process of Integrated Service Delivery,building the health information system that is conducive to integration in order to continuously advance Hierarchical Diagnosis and bridge the fragmented service system. This will help in providing residents with personalized,convenient,comprehensive,and continuous health services.
This paper systematically reviews the latest and relevant literatures and policy documents on the integrated health services in Canada in recent years. Therefore,it summarizes the practice and mode of integrated service delivery in Ontario,Alberta and Quebec wherein the integration among health organization,health service team,and a series of health services are included. The contributing factors and impeding factors( the barriers) of organizational integration and specific integration strategy were summarized. Finally,according to the actual practical situation,it is proposed that China should adhere to the government-led approach in promoting the integration of health services,and give a full play to the positive role of the market mechanism. Through strengthening the network management and group service of primary health services,emphasis will be put on health services of population groups and specific diseases. Therefore,integration will be regarded as a strategic priority,increasing incentives and boosting promotion of nursing personnel on the process of Integrated Service Delivery,building the health information system that is conducive to integration in order to continuously advance Hierarchical Diagnosis and bridge the fragmented service system. This will help in providing residents with personalized,convenient,comprehensive,and continuous health services.
引文
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[24]匡莉,曾益新,张露文,等.家庭医师整合型服务及其医保支付制度:台湾地区的经验与启示[J].中国卫生政策研究,2015,8(7):26-35.
[25]中华人民共和国国务院医改办.关于推进家庭医生签约服务的指导意见[EB/OL].(2016-06-06).http://www.nhfpc.gov.cn/tigs/s3577/201606/e-3e7d2670a8b4163b1fe8e409c7887af.shtml
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[27]峗怡.我国社会办医发展中存在的问题及治理策略研究[J].中国全科医学,2016,19(13):1560-1564.
[28]张颂奇.在职医师开诊所前路不明[J].中国医院院长,2014(5):39-41.
[29]侯志远,孟庆跃,袁璟,等.城市社区基本医疗服务提供能力现状研究[J].中国卫生经济,2010,29(2):41-43.
[30]杜丽君,水黎明,林伟良.宁波市江东区基于重点人群健康管理的家庭医生服务模式实践与探索[J].中国全科医学,2014,17(4):453-456.
[31]陈桂英.加拿大开业护士在长期护理中发挥着重要作用[J].中国护理管理,2015(3):380.
[32]张莉,孙宏玉,岳彤,等.北京地区基层社区护理服务运行现状调查[J].中华护理教育,2013,10(7):328-331.
[33]郭珉江,代涛,万艳丽,等.加拿大卫生信息化建设经验及启示[J].中国数字医学,2015,10(7):15-19.
[2]Bywood P.Integrated care:What policies support and influence integration in health care across New Zealand,England,Canada and the United States?[R].Australia:Phcris,2013.
[3]Hutchison B,Levesque J F,Strumpf E,et al.Primary Health Care in Canada:Systems in Motion[J].Milbank Quarterly,2011,89(2):256-288.
[4]World Health Organization.Integrated health services-what and why?[R].Geneva:World Health Organization,2008.
[5]张亮.卫生事业管理学[M].北京:人民卫生出版社,2013.
[6]Leutz W N.Five laws for integrating medical and social services:lessons from the United States and the United Kingdom[J].Milbank Quarterly,1999,77(1):77-110.
[7]Contandriopoulos A P,Denis J L,Touati N,et al.The integration of health care:Dimensions and implementation[Z].2003.
[8]Goes J,Savage G T,Friedman L.The Evolution Of Integrated Health Care Strategies[M].Emerald Group Publishing Limited,2000.
[9]Hussey P S.Health Systems in Transition:Canada[J].Journal of the American Medical Association,2007,297(6):647-648.
[10]Bode I,Firbank O.Barriers to Co-Governance:Examining the“Chemistry”of Home-Care Networks in Germany,England,and Quebec[J].Policy Studies Journal,2009,37(2):325-351.
[11]Breton M,Pineault R,Levesque J F,et al.Reforming healthcare systems on a locally integrated basis:is there a potential for increasing collaborations in primary healthcare?[J].Bmc Health Services Research,2013,13(1):262.
[12]Haggerty J L,Pineault R,Beaulieu M D,et al.Practice features associated with patient-reported accessibility,continuity,and coordination of primary health care[J].Annals of Family Medicine,2008,6(2):116.
[13]Pomey M P,Martin E,Forest P G.Quebec's Family Medicine Groups:Innovation and Compromise in the Reform of Front-Line Care[J].Canadian Political Science Review,2009,3(4):31-46.
[14]Jiwani I,Fleury M J.Divergent modes of integration:the Canadian way[J].International Journal of Integrated Care,2011,11(5):e018.
[15]Beaulieu M D,Denis J L,D'amour D,et al.Implementing family medicine groups:The challenge in the reorganization of practice and interprofessional collaboration[R].2006.
[16]Vedel I,Monette M,Beland F,et al.Ten years of integrated care:backwards and forwards.The case of the province of Québec,Canada[J].International Journal of Integrated Care,2011,11(5):e004.
[17]Macadam M.Moving Toward Health Service Integration:Provincial Progress in System Change for Seniors[R].Canada:Canadian Policy Research Networks,2009.
[18]Blais C,Jean S,Sirois C,et al.Quebec Integrated Chronic Disease Surveillance System(QICDSS),an innovative approach[J].Chronic Diseases&Injuries in Canada,2014,34(4):226.
[19]Nolte E,Knai C,Mckee M,et al.Managing chronic conditions:experience in eight countries[R].2008.
[20]Moulding R,Grenier J,Blashki G,et al.Integrating psychologists into the Canadian health care system:the example of Australia[J].Canadian journal of public health Revue canadienne de sante publique,2009,100(2):145.
[21]Leatt P.Sharing the Learning:Health Transition Fund:Synthesis Series:Integrated Service Delivery[R].2002.
[22]J Marriott A M.An Overview of Progress and Potential in Health System Integration in Canada[R].2002.
[23]Hutchison B,Abelson J,Lavis J.Primary care in Canada:so much innovation,so little change[J].Health Affair,2001,20(3):116-131.
[24]匡莉,曾益新,张露文,等.家庭医师整合型服务及其医保支付制度:台湾地区的经验与启示[J].中国卫生政策研究,2015,8(7):26-35.
[25]中华人民共和国国务院医改办.关于推进家庭医生签约服务的指导意见[EB/OL].(2016-06-06).http://www.nhfpc.gov.cn/tigs/s3577/201606/e-3e7d2670a8b4163b1fe8e409c7887af.shtml
[26]中华人民共和国国务院办公厅.国务院办公厅关于推进医疗联合体建设和发展的指导意见[EB/OL].(2017-04-23).http://www.gov.cn/zhengce/content/2017-04/26/content_5189071.htm
[27]峗怡.我国社会办医发展中存在的问题及治理策略研究[J].中国全科医学,2016,19(13):1560-1564.
[28]张颂奇.在职医师开诊所前路不明[J].中国医院院长,2014(5):39-41.
[29]侯志远,孟庆跃,袁璟,等.城市社区基本医疗服务提供能力现状研究[J].中国卫生经济,2010,29(2):41-43.
[30]杜丽君,水黎明,林伟良.宁波市江东区基于重点人群健康管理的家庭医生服务模式实践与探索[J].中国全科医学,2014,17(4):453-456.
[31]陈桂英.加拿大开业护士在长期护理中发挥着重要作用[J].中国护理管理,2015(3):380.
[32]张莉,孙宏玉,岳彤,等.北京地区基层社区护理服务运行现状调查[J].中华护理教育,2013,10(7):328-331.
[33]郭珉江,代涛,万艳丽,等.加拿大卫生信息化建设经验及启示[J].中国数字医学,2015,10(7):15-19.