分级诊疗“顶层设计”说了啥

<正>近日,国务院办公厅发布《关于推进分级诊疗制度建设的指导意见》(以下简称《意见》),提出以提高基层医疗服务能力为重点,逐步建立符合我国国情的分级诊疗制度。《意见》指出,建立分级诊疗制度,是合理配置医疗资源、促进基本医疗卫生服务均等化的重要举措,要立足我国经济社会和医药卫生事业发展实际,遵循医学科学规律,按照以人为本、群众自愿、统筹城乡、创新机制的原则,以提高基层医疗服务能力为重点,以常见病、多发病、慢性病分级诊疗为突破口,完善服务网络、运行机制和激励机制,引导优质医疗     

医改进入新阶段的重要标志

<正>分级诊疗是我国当前医改的重要内容,扎实有序推进分级诊疗制度建设,标志着我国医改进入新阶段,医疗服务发展模式开始转型。由过去重点建立和完善医疗保障制度,强化患者费用保障机制,到同步重视精细化管理服务;从强调体制改革,到同步重视医疗资源配置和使用,分级诊疗将供方和需方有机连接起来,将改革和发展统一起来,将管理和服务结合起来。做好分级诊疗试点工作,需要把握以下几点。一、合理配置和科学使用医疗资源,明确各层级医疗机构定位是做好分级诊疗工作的基础。当前我     

北京大学肿瘤医院远程医疗协作网的实践与思考

医联体建设是推动分级诊疗制度建设的重要抓手,远程医疗协作网作为医联体建设的4种组织模式之一,对促进优质医疗卫生资源下沉,推进分级诊疗具有重要意义.本研究围绕北京大学肿瘤医院借助“互联网+医疗健康”创新服务模式建设远程医疗协作网的实践举措,分析运行中存在的不足之处,探讨远程医疗协作网推进分级诊疗制度的发展策略,为医院决策...     

运用SWOT分析法探讨分级诊疗背景下三级医院的发展策略

分级诊疗是新医改背景下出台的医疗政策,以提高医疗卫生体系的诊疗效率、降低医疗负担为目标,根据各医疗卫生机构的功能定位,结合疾病的轻重缓急、治疗的难易程度将医疗资源进行分级整合。目前我国分级诊疗制度尚处于起步阶段,仍存在不足,因此本文运用SWOT分析法探讨在分级诊疗背景下三级医院在发展中可能存在的优势、劣势、挑战、机遇,并提出推进分级诊疗体系建设的建议。     

分级诊疗如何开往“下一站”

建立分级诊疗制度,是合理配置医疗资源、促进基本医疗卫生服务均等化的重要举措,是深化医药卫生体制改革、建立中国特色基本医疗卫生制度的重要内容.根据国家卫生健康委近日发布的消息,“十三五”期间,分级诊疗制度建设取得了阶段性成效.我国县域医疗服务能力显著提升,医联体建设实现了跨越式发展.接下来,分级诊疗该如何推进落实?近日,...     

我国分级诊疗制度发展现状、问题及对策研究*

新医改以来,政府大力推动分级诊疗制度的建设,但实施效果并不理想。本研究分析了我国分级诊疗制度的发展现状,针对目前分级诊疗实践中存在的问题,总结出推进和落实分级诊疗制度的相关对策:提高基层医疗服务能力、健全保障机制、加强宣传教育和促进区域信息共享。     

推进分级诊疗 落实功能定位

<正>2015年《关于推进分级诊疗制度建设的指导意见》印发我国医疗资源总量不足、优质资源匮乏、分布不合理,特别是基层医疗服务能力较弱。最现实的办法就是采取分级诊疗制度,以便更好地发展卫生事业,调整资源结构,合理分流病人,提高服务机构的整体效能。自新中国成立以来,我国针对分级诊疗曾推出过相关制度规定,但缺乏有效的政策约束和配套措施。2015年9月,国务院办公厅印发《关于推进分级诊疗制度建设的指导意     

构建分级诊疗新格局

正山西省卫生计生委主任卫小春分级诊疗制度是一项全局性的制度安排。只有抓住分级诊疗这个关键点,改革才能更好的推进。2016年,山西省将以山西新农合分级诊疗、医联体建设为主要载体,全面推进分级诊疗制度建设。当前,山西省医疗卫生服务体系薄弱、优质医疗资源整体不足、城乡区域发展不平衡的问题仍然十分突出,基层卫生专业技术人员数量短缺、青黄不接、结构不合理问题尚未得到根本扭转。因此,在推进分级诊疗工作中亟待破解这些深层次矛盾和问题。     

分级诊疗模式下医疗风险的防范△

目的：为推进分级诊疗制度建设,提出医疗风险的防范措施。方法：分析我国分级诊疗模式下医疗风险的现状,阐述南通大学附属医院在分级诊疗模式下医疗风险的防范措施。结果：通过组建医疗联合体,开展专病门诊,设定医疗风险基金,建立医疗风险信息管理制度等措施有效防范医疗风险。结论：医院须明确自己的定位,在自身发展的同时,带动基层医疗机构提升服务能力,有效防范医疗风险,逐步实现基层首诊,双向转诊的分级诊疗模式。     

远程医疗助力分级诊疗的应用实践

构建适合国情的分级诊疗服务体系是当前我国医疗体制改革的重要目标,在推进这项工作的过程中,大型公立医院承载着重大的职责和使命。新疆医科大学第一附属医院以远程医疗为抓手,构建区域联动分级诊疗远程网络平台并转化应用于区域医疗协同发展,合理引导优质医疗资源下沉基层,为探索我国分级诊疗有效实施提供实践佐证。     

分级诊疗制度实施中医院检验科如何提供区域检验服务的思考

随着我国分级诊疗制度的实施,三级医院检验科面临分级诊疗带来的挑战和机遇。理性评估检验科的优势、劣势、机会和威胁,积极响应国家政策的号召,适时调整学科发展的方向,集医学检验之优势资源,整合检验设备,发挥在医学服务、技术创新、质量管理和人才培养等方面的引领作用,积极探索并大力发展区域医学检验机构和尝试分级检验模式,服务基层群众,提升检验行业的公信力和竞争力;以拓展服务领域,开创良好的检验医学发展前景。     

供给侧改革视角下的中国医改探索

2016年,我国医疗领域掀起对"医疗供给侧改革"的讨论热潮.阐述我国实施医疗供给侧改革的意义和策略;"健康中国"战略推进下我国医疗服务供给体系将面临深刻的结构性变革,供给侧改革思路将从构建能够合理分流患者的有序就医格局、以公立医院改革提高优质医疗资源服务质效、引入社会办医力量发展健康服务业三个方面入手引领中国医疗服务体系重构,同时支付制度改革引入预付制、卫生人力资源优化配置以及互联网医疗兴起都将配套医疗服务体系的供给侧改革,从而将以公立医院为主体、以疾病治疗为中心的诊疗模式转变为全面涵盖预防、体检、治疗、康复、健康管理等多环节、多流程的整合型医疗模式.     

分级诊疗制度变迁回溯及“十四五”期间的关键政策建议

建立分级诊疗制度,是提升国家卫生健康治理能力的重要内容,对促进医疗资源合理配置、基本医疗健康服务均等化和有序就医意义重大。“十三五”期间,分级诊疗制度建设整体上撬动了卫生健康组织整合、医保支付模式优化、医防融合、家庭医生签约等诸多体系的布局优化,成效显著。然而在推进分级诊疗制度建设进程中,各方对分级诊疗制度的政策信心、建设思路以及操作方法,尚存优化空间。因此,应进一步梳理分级诊疗制度变迁过程,对分级诊疗制度最主要的政策术语释义辨析,并在“十四五”期间,以医疗服务分级制度和连续性制度为核心制度,以医保制度、信息制度、监管制度、患者培育制度为保障制度,渐进调整形成分级诊疗格局。     

“医疗联合体”下的远程心电诊断中心

随着我国医疗卫生体制改革的深入推进,如何解决老百姓“看病难、看病贵”的问题日趋迫切.目前,在中国优质医疗资源紧缺与相对不足的现状下,建立“医疗联合体”（下称“医联体”）,推进医疗资源纵向整合,是当前提高医疗服务体系整体效率,提升基层医疗服务能力的重要手段.     

The need for integration in health sciences sets the future direction for public health education

Since the foundation of the People's Republic of China in 1949, there has been remarkable developments in public health in the country. These achievements are primarily attributed to the public health services and patriotic public health campaigns, although the contribution of high-technology medical applications is also recognized. However, along with the recent socio-economic developments and scientific and technological progress, medical disciplines have become more and more specialized, and clinical and preventive medicine have become further separated from each other. Conventional Chinese wisdom says 'when long divided they must unite, when long united they must divide'. At the onset of the new round of reforms of health care in China, it seems important to revisit the discussions on the urgency for integration of health sciences in medicine in China. Several issues and viewpoints on integrating medicine are discussed in this paper. The biopsychosocial model for health calls for broad integration. Primary care development in China requires integration in education and practice, and in treatment and prevention. Control of chronic diseases requires integrated and united action. Integration of traditional Chinese medicine with Western medicine requires creativity. The integration perspective should be instilled in the minds of medical students. Integration also entails integrated practice. After all, integration entails integrated education and practice in public health education. Changing the current public health education system still has a long way to go. True integration requires integration of concepts, policies, resources and measures, as well as changes in the organization of health care including public health, prevention and treatment. This needs to be a systematic process. Finally, success of integration relies on social mobilization, advocacy, promotion and attention of the entire society.     

我国港澳地区医疗券制度及其对内地的启示

引入市场竞争机制是医疗体制改革的重点和难点。我国港澳地区的医疗券制度能够为内地推进医改体制创新、倒逼公立医院改革和合理配置医疗卫生资源提供借鉴。本文首先介绍了医疗券制度的起源和发展。然后详细阐述了港澳地区医疗券制度的实施背景、异同与政策效果,发现医疗券制度在引导需方更多使用私立医疗服务、提高居民预防保健意识、推广家庭医生制度等方面起到了积极作用。最后对医疗券制度在内地的适用性进行了分析,指出其与内地医改导向相契合,并可作为内地医保制度的有益补充和推动社会办医的有效措施,在完善内地医疗保险、医疗救助制度和发展私立医疗机构等方面具有一定的可行性。     

Simulation Suggests that medical group mergers won't undermine the potential utility of health information exchanges

Federal and state agencies are investing substantial resources in the creation of community health information exchanges, which are consortia that enable independent health care organizations to exchange clinical data. However, under pressure to form accountable care organizations, medical groups may merge and support private health information exchanges. Such activity could reduce the potential utility of community exchanges-that is, the exchanges' capacity to share patient data across hospitals and physician practices that are independent. Simulations of care transitions based on data from ten Massachusetts communities suggest that there would have to be many such mergers to undermine the potential utility of health information exchanges. At the same time, because hospitals and the largest medical groups account for only 10-20 percent of care transitions in a community, information exchanges will still need to recruit a large proportion of the medical groups in a given community for the exchanges to maintain their usefulness in fostering information exchange across independent providers.     

Health economic evaluation in Japan: a case study of one aspect of health technology assessment

There is a burgeoning literature in health economic evaluation, with this form of analysis becoming increasingly influential at the health policy making level in a number of countries. However, a search of the literature reveals that in Japan, the world's second largest health care market, very little health economic evaluation has been undertaken. The main reason for the lack of interest in economic evaluation is that the fee-for-service and strict price regulation that characterises the system of health care financing in Japan is not conducive to this form of analysis. Moreover, the government and many researchers are satisfied that the current organisation of health care has given long life and low infant mortality at low cost. Even if it is accepted that low health care costs and good health prevail in Japan, slower economic growth rates, an ageing population and the development of new medical technologies will place increasing pressure on health care resources and will necessitate a more rational use of these resources. Good economic evaluation, by weighing benefits against costs, has an important role to play.     

分级诊疗制度下考虑患者偏好的医疗服务资源纵向整合研究

分级诊疗制度是现阶段改善患者无序就医、合理配置医疗资源、促进基本医疗服务均等化的重要举措。本文界定了个人可支配收入、年龄、自感疾病严重程度及医疗机构门诊价格、服务容量等多因素影响的患者理性就医行为的效用函数,构建了基于患者就医偏好的就医选择动态博弈模型,通过将理性就医偏好下虚拟行动仿真的秦皇岛医疗机构患者分布与实际统计数据进行比较,验证了所建模型的合理性。研究结果表明:患者在基层医疗机构与高水平医疗机构间的就医行为较理性,在二三级医院间却较不理性。因而分级诊疗制度下医疗服务资源优化的重点在于建立患者按需就医的整合型医疗服务体系。     

基于资源与产能关系的医疗机构层级间的非良性互动机理分析

在卫生服务领域和经济学中资源与产能相对应的是卫生资源与卫生服务供给能力,卫生资源与卫生服务供给能力及其相互关系是不同级别医疗机构间分工协作与良性互动的重要因素。然而医疗机构卫生资源的倒置与卫生服务供给能力的错位,在居民自由择医理念的影响下,加重了病源在三级医疗机构的集聚程度,医疗机构层级间的非良性互动与相互竞争成为分级诊疗政策推行的重要障碍,因此亟需厘清其机理并提出针对性的政策建议。