全科医疗特征功能视角下分级诊疗的定义及制度层次

明确分级诊疗定义和内涵是建立和完善分级诊疗制度的逻辑起点,是制度的基础性研究。本文在剖析国际上分级诊疗的相关概念、探求分级诊疗本质的基础上,辨析了国内分级诊疗的定义。认为国内分级诊疗制度存在以下不足:以疾病诊治的单一维度作为三级医疗服务分工依据,忽略了人们对医疗服务体系间接性医疗服务功能的需求;导致服务体系规划忽略了非直接性医疗服务功能,缺失了具有特征功能的全科医疗与专科医疗之间的分化和互补;全科医疗和专科医疗之间功能清晰、界限分明的医疗卫生服务体系结构尚未形成;用组织治理取代了原本属于全科医疗和专科医疗之间的专业治理。最后,本文从全科医疗特征功能视角,完善了分级诊疗的定义;尝试回答了分级诊疗的三个基础性问题,并归纳提出分级诊疗制度应该包括微观、中观、宏观三个层次。

The definition of tiered health care systems and institutional levels from perspective of general practice attributes in China

The definition and connotation of tiered health care system (THCS) is a fundamental field of research for the system and a logic orientation of institution establishment and smoothing as well. Through analyzing and distinguishing the related international and domestic THCS concepts and exploring its essence from the general practice attributes perspective, we found several problems existing in the Chinese THCS. First of all, the three-tiered patient transfer principle which, merely based on the disease, have seriously neglected patient's health care system service requirements. Second, the specialty of the general practice lost the function of making a supplement of specialized disciplines. Third, it did not generate a straightforward boundary between the general practice and special care system. Forth, the organizational management was adopted to replace the professional one required by two specialties. Based on these findings, we gave a clear and smooth THCS definition and answered three fundamental TMSS questions. Additionally, we proposed a concept for which TMSS management should be composed of micro-, medium-and macro-level institutions.