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1.
分析我国城市社区医疗供给制度包括社区首诊制和双向转诊制度、城市医疗服务体系和医疗服务供给制度的现状及其对社区医疗就诊的影响.指出严格执行社区首诊制和双向转诊制度,完善城市医疗服务体系和医疗服务供给制度是发展城市社区医疗服务,提高社区医疗就诊率,实现“小病在社区,大病到医院”的重要举措和关键所在.  相似文献   

2.
2006年2月,在我国召开的全国社区卫生工作会议上卫生部明确提出:要在全国范围内推广"双向转诊制度",鼓励社区医院实行"首诊制",从而实现"小病不出社区,大病及时转诊",缓解日益紧张的"看病难"。针对卫生部的相关要求,全国各地纷纷行动起来,积极尝试建立社区首诊制[1]。2009年4月《中共中央国务院关于深化医药卫生体制改革的意见》中,再次明确提出要"逐步实现社区首诊、分级医疗和双向转诊",社区首诊制成为深化医药卫生体制改  相似文献   

3.
为不断深化社区卫生全科服务理念与深入试试社区责任医生制度,本服务中心进行风险管理评估,预见可能的困难,避免矛盾发生,有效提高全科医生家庭责任制工作的社会满意度,通过风险管理评估,有效提高了全科医生家庭责任制工作的社会满意度,开展家庭医生制工作,加大力度推行家庭医生制度,才能真正做到"定点医疗,社区首诊,分级诊疗,逐级转诊"。  相似文献   

4.
社区医疗机构与医院双向转诊的实现   总被引:1,自引:0,他引:1  
发展社区医疗是国家调整医疗政策,解决群众看病难、看病贵问题的一个重要举措。要
真正发挥社区医疗的作用,必须解决好社区医疗机构与医院双向转诊的问题。由于多方面原因,目
前社区医疗机构与医院之间双向转诊通道并不通畅。本文分析了目前社区医疗机构与医院开展双
向转诊过程中存在的问题,并对如何解决这些问题,促进双向转诊制度的顺利开展提出意见和建议。  相似文献   

5.
双向转诊缺少激励与约束等相关政策、政府监督不力,这些反映了政府对双向转诊的作用和意义认识不足。双向转诊可以加快分级医疗服务体系重构的进程。其通过分流患者这一功能的发挥,增加社区医疗服务机构的下转患者,使社区医疗服务机构基于此获得医保等投入,也利于引导这些下转患者选择社区医疗机构作为首诊机构,还能增强社区医疗服务机构对医疗卫生服务人才的吸引力,进而加快社区医疗服务体系的构建。双向转诊也利于将三级医院和综合医院从常见病、小病诊治中解放,从而使其加快回归"高尖精"的医疗服务定位,进而加速"哑铃型"二级城市医疗服务体系的构建。  相似文献   

6.
《健康大视野》2009,(8):9-9
据了解,深圳市将先行尝试社区健康服务双向转诊制度。该制度以双向转诊为手段,实行社区医生首诊制,在该市范围内建立社区卫生服务与大中型医院合理分工、密切协作、相互支持的医疗架构体系,从而推动形成“小病在社区大病到医院”的医疗格局。  相似文献   

7.
双向转诊对于解决我国城乡居民看病难、看病贵问题具有十分重要的作用,新医改更是明确提出要逐步实现双向转诊。首先从双向转诊的涵义入手分析了双向转诊所存在的问题,包括社区卫生技术水平较低、人员素质不高、上级医院希望留住病人以获取更大的经济利益、转诊标准不确定和医保制度不健全等。然后通过分析国外的双向转诊模式,提出了针对解决双向转诊问题的合理化建议:建立社区首诊制;提高社区卫生服务水平;合理调整不同级别医疗机构之间的经济利益;建立健全转诊制度,规范转诊流程;医保制度与双向转诊相结合。  相似文献   

8.
《中国卫生》2008,(11):10-10
日前,从贵阳市卫生局获悉,作为贵州省社区医疗首个试点的贵阳市小河区,按照《贵阳市关于开展社区卫生双向转诊和首诊试点工作的实施意见》推行“社区首诊”和“双向转诊”医疗模式,参保人员选择社区医疗点首诊看病的个人花费将减少50%。  相似文献   

9.
社区首诊制在许多国家已是一项应用广泛的医疗制度。通过对我国社区首诊制试点的情况进行分析,总结目前实施过程中存在的制度嵌入不够充分、全科医学人才缺乏、双向转诊名存实亡等问题,并提出了加强政府作用、加强全科医学人才培养、切实实施双向转诊等相关建议。  相似文献   

10.
关于我国社区首诊制试点的分析与思考   总被引:1,自引:0,他引:1  
社区首诊制在许多国家已是一项应用广泛的医疗制度.通过对我国社区首诊制试点的情况进行分析,总结目前实施过程中存在的制度嵌入不够充分、全科医学人才缺乏、双向转诊名存实亡等问题,并提出了加强政府作用、加强全科医学人才培养、切实实施双向转诊等相关建议.  相似文献   

11.
This literature review pursues two main objectives: first, it argues that research on health policy actors and healthcare systems need to be separated more thoroughly. Though there are important interactions between both fields, it is often advisable to separate analytically research on health policy actors and on healthcare systems. Second, concentrating not only on actors and institutions but also on outcomes, we suggest, is theoretically valuable, practically feasible, and policy relevant. Most studies discussed in this review concentrate either on health policy implementation or on healthcare system characteristics. Our emphasis is on extending the understanding about the outcomes of different national healthcare arrangements and whether policy reforms actually deliver their promised results. To do this, more attention to the measurement of success is required.  相似文献   

12.
A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers' performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.  相似文献   

13.
ABSTRACT

Websites from medical specialist providers are becoming increasingly marketing oriented, but there exists a paucity of empirical research on the effects. This experimental study explored effects of exposure to real websites from medical specialist providers among Dutch adults under physician gatekeeper arrangements. Exposure led to a stronger intention to seek treatment from the specialist provider and motivation to rely on the providers’ claims. Weaker to absent effects were found for intention to question the physician gatekeeper’s referral and this was chiefly motivated by the belief that “the doctor knows best.” Implications for specialist provider marketing under gatekeeping arrangements are discussed.  相似文献   

14.
15.
Primary Care, Financing and Gatekeeping in Western Europe   总被引:10,自引:2,他引:8  
Primary care in western Europe is delivered by general practitioners(GPs) but their role within the overall health system is poorlyunderstood. The aim of this article is to present an overviewof the characteristics of general practice in the context ofhealth systems and to describe their variability and interrelationships.Data were obtained from two main sources: publications of officialorganizations and EC research projects. The characteristicsof general practice are described and analysed with regard tothree features: mode of payment, gatekeeper function and practiceorganization and workload. Despite their focus on general practiceas the cornerstone of the health system, western European countriesdiffer considerably in the major characteristics of primarycare. There is variability in the ratio of GPs to populationand in the extent to which patients relate to individual physicians.Although all countries have universal health in surance, themode of payment of GPs differs. In some countries, the gatekeeperfunction of general practice is more highly developed and theuse of specialist services varies accordingly. Practice characteristicssuch as workload, length of consultation, ordering of testsand reappointments also vary with differences in payment andgatekeeping arrangements. In particular, fee-for-service wasassociated with weaker physician-patient relationships, reducedattractiveness of general practice, more home visiting and longerconsultations. Strong gatekeeping arrangements are not incompatiblewith high public satisfaction and are associated with lowervisit rates. However, strong gatekeeping is not characteristicof fee-for-service arrangements. These findings suggest a needfor more concerted research that could inform policy decisionsconcerning primary care in the USA as well as in Europe.  相似文献   

16.
Assesses the degree of self-reported implementation of gatekeeping in clinical practice, and gains insight into primary care physicians' attitudes toward gatekeeping and their perceptions of necessary conditions for implementation of gatekeeping in daily practice. A self-administered questionnaire was mailed to a national sample of 800 primary care physicians in Israel, with a response rate of 86 per cent. Multivariate analysis indicated that sick fund affiliation was the main predictor of self-reported implementation of gatekeeping, while specialty training predicted primary care physicians' attitude toward this role. Close communication with specialists, continuous medical education, and management support of physician decisions were identified by respondents as being important conditions for gatekeeping. Discusses strategies to gain the cooperation of primary care physicians, which is necessary for implementing an effective gatekeeping system.  相似文献   

17.
Prior to the era of managed care in the US, health care delivery was managed by the professional activities of physicians. Managed care replaces management by profession with bureaucratic management structures and oversight, such as utilization review and gatekeeping (required referrals to specialty care). Practically, this means that physicians cannot use the professional relationships that typified practice under fee-for-service medicine, potentially changing not only what physicians do (e.g., order test or not, refer or not), but also how they do what they do. In this paper I look at just one of the changes brought about by managed care: contractual arrangements that require primary care providers to refer patients to a closed panel of specialist physicians. Through an in-depth case study of 45 primary care providers' in the USA who face restricted specialist panels for their managed care patients, but not for their fee-for-service patients, I investigate how the practice of referring is changed by this requirement. First, I use interview data to describe primary care providers general preferences for referral consultants, as well as their views of the referral process and potential barriers in it. Next I present data from all referrals over a four-week period to analyze the extent of referral relationships in actual referrals. Finally, I conclude by discussing some ways that managed care entities can facilitate rather than diminish referral relationships among physicians.  相似文献   

18.
BackgroundThis study compares continuity of care between Germany – a social health insurance country, and Norway – a national health service country with gatekeeping and patient lists for COPD patients before and after initial hospitalization. We also investigate how subsequent readmissions are affected.MethodsContinuity of Care Index (COCI), Usual Provider Index (UPC) and Sequential Continuity Index (SECON) were calculated using insurance claims and national register data (2009–14). These indices were used in negative binomial and logistic regressions to estimate incident rate ratios (IRR) and odds ratios (OR) for comparing readmissions.ResultsAll continuity indices were significantly lower in Norway. One year readmissions were significantly higher in Germany, whereas 30-day rates were not. All indices measured one year after discharge were negatively associated with one-year readmissions for both countries. Significant associations between indices measured before hospitalization and readmissions were only observed in Norway – all indices for one-year readmissions and SECON for 30-day readmissions.ConclusionOur findings indicate higher continuity is associated with reductions in readmissions following initial COPD admission. This is observed both before and after hospitalization in a system with gatekeeping and patient lists, yet only after for a system lacking such arrangements. These results emphasize the need for policy strategies to further investigate and promote care continuity in order to reduce hospital readmission burden for COPD patients.  相似文献   

19.
OBJECTIVES: We examined whether patients' perceptions of their relationships with primary care practitioners (PCPs) vary by vulnerability status and assessed the extent to which gatekeeping arrangements and primary care performance moderate potential disparities. METHODS: We used the nationally representative 1996-1997 Community Tracking Study Household Survey as our data source. RESULTS: Whites reported better patient-practitioner relationships than minorities. Requirements that patients select a PCP and obtain referral authorization neither reduced nor exacerbated racial disparities in the patient-practitioner relationship. On the other hand, access to and continuity with a PCP substantively reduced disparities, especially for the most vulnerable group. CONCLUSIONS: Enhancing primary care performance may reduce some of the barriers to care experienced by vulnerable populations, thereby improving patients' relationships with their PCPs.  相似文献   

20.
Using a policy analysis framework, we analyzed the implementation and perceived effectiveness of a rural allowance policy and its influence on the motivation and retention of health professionals in rural hospitals in the North West province of South Africa. We conducted 40 in-depth interviews with policy-makers, hospital managers, nurses, and doctors at five rural hospitals and found weaknesses in policy design and implementation. These weaknesses included: lack of evidence to guide policy formulation; restricting eligibility for the allowance to doctors and professional nurses; lack of clarity on the definition of rural areas; weak communication; and the absence of a monitoring and evaluation framework. Although the rural allowance was partially effective in the recruitment of health professionals, it has had unintended negative consequences of perceived divisiveness and staff dissatisfaction. Government should take more account of contextual and process factors in policy formulation and implementation so that policies have the intended impact.  相似文献   

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