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。

Retrospection of hierarchical medical system and key policy recommendations during the 14th Five-year Plan period

The establishment of tiered healthcare system is an important part of improving health management capacity, and is of great significance to promoting the rational healthcare resources allocation, equal access to basic medical and healthcare services and orderly medical treatment. During the 13th Five-year Plan period, the construction of hierarchical medical system as a whole leveraged the layout optimization of many systems, such as the integration of healthcare institutions, the optimization of medical insurance payment modes, the integration of medical care and prevention, and the integration of family doctors contracting services, with remarkable results. However, in the process of promoting the establishment of hierarchical medical system, there is still room for enhanced improvement of the policy confidence, ideas on its establishment and operation methods. Therefore, the process of hierarchical medical system reform should be reorganized and the main policy term definitions should be redefined and differentiated accordingly. Based on the findings of this retrospective study, during the 14th Five-year Plan period, policymakers should take medical service classification system and continuity system as the core systems, and social health insurance system, information system, supervision system, and patient cultivation system as security systems, so as to gradually adjust and form an impeccable tiered healthcare system.