基于SFIC模型的社会办医牵头医共体建设问题分析*

目的：分析社会办医牵头医共体建设的协同效果及现存问题。方法：运用SFIC模型分析潜江市社会办医牵头医共体建设的关键环节及问题。采用间断时间序列分析改革前后医共体内就医格局、医疗卫生服务能力、医疗卫生资源利用的变化。结果：SFIC模型分析得出潜江市社会办医牵头医共体建设主要存在社会办牵头医院缺乏财政投入、医共体内仍存在患者竞争、打包付费预算参照历史基数、公共卫生经费尚未实现医共体打包支付、社会办医牵头医共体内缺乏公共卫生指导机构、 薪酬制度尚未配套改革等问题。间断时间序列结果显示改革前后医共体内就医格局、医疗卫生资源利用优化不足，医疗服务能力有效提升。结论：社会办医牵头医共体建设有正向效应，但社会办医牵头医共体建设环节仍需优化。

Analysis on the Social Medical Institutions Leading Construction of the Medical Community Based on the SFIC Model

Objective: To analyze the synergistic effect and existing problems of social medical institutions leading the construction of medical community. Methods: The SFIC model is used to analyze the key links and problems in the construction of a medical community led by social medical institutions in Qianjiang City, Hubei Province. Intermittent time series are used to analyze the changes in the medical treatment pattern, medical and health service capacity, and medical and health resource utilization in the medical community before and after the reform. Results: The SFIC model analysis shows that the construction of the socially-run medical community in Qianjiang mainly includes the lack of financial investment in the socially-run leading hospitals, the competition for patients still exists in the medical community, the packaged payment budget refers to the historical base, and the public health funds have not yet realized the packaged payment of the medical community. The lack of public health guidance institutions in the medical community led by the community, and the lack of supporting reforms in the compensation system. Intermittent time series results show that before and after the reform, the medical treatment pattern within the medical community and the optimization of medical and health resources utilization are insufficient, and the medical service capacity is effectively improved. Conclusion: The construction of a medical community led by socially-run hospitals has a positive effect, but the construction of a community-led medical community still needs to be optimized.