影响我国分级诊疗制度推进的关键问题研究

目的:从问题的重要性与可解决程度两个维度,评价影响我国分级诊疗制度推进的关键问题,为下一步的政策制定提供决策参考。方法:通过文献回顾,系统性收集和筛选了77篇相关文献,在此基础上归纳出影响我国分级诊疗制度推进的20个问题;同时运用德尔菲法和层次分析法,构建相应的评价指标体系;对这20个问题的重要性与可解决性进行评价,最后运用变异系数法确定影响我国分级诊疗制度推进的关键问题。结果:将全科医生急缺且服务能力不足、医师多点执业制度的不完善阻碍医生自由流动以及现行财政投入机制不利于分级诊疗的推行这三个问题列为关键问题。结论:建议通过改革全科医学教育,解除医师自由执业的政策束缚,大力支持基层民营医疗机构的发展,构建基层医疗机构与上级医院之间的协作制约关系等政策来解决当前分级诊疗制度所面临的关键问题。

Research on the key issues affecting the promotion of hierarchical medical system in China

Objective:To conduct a two-dimensional analysis on the key issues that affect the promotion of hierarchical medical system in China, whereby the two dimensions being taken into consideration are the imminence and solvability of the issue, so as to provide reference for the future decision-making on the policy formulation. Methods:77 papers were systematically collected and 20 issues that may be hindering the hierarchical medical system in China were summarized through the literature review. The imminence and solvability of each issue under cause were evaluated through Delphi method and analytic hierarchy process (AHP). Finally, the key issues hobbling hierarchical medical system were listed by using the variation coefficient method. Results:Research results confirmed that the three issues found to be the key issues include the acute shortage and insufficient service capacity of general practitioners, imperfect physician multi-point practice system which hinders the free flow of doctors, and the current financial input mechanism which is not conducive to the implementation of graded diagnosis and treatment in China. Conclusion:In order to promote hierarchical medical system, suggested are the general practice education reform, stopping the policy restrictions to the doctors'' free flow, strongly advocating for the development of primary private healthcare institutions, and constructing the cooperative and restrictive relationship between primary healthcare institutions and higher level hospitals.