某县域医共体试点建设回顾性调查分析与思考

目的分析某县域医共体试点建设过程中面临的困难和不足，为医共体推进工作提供决策参考。方法围绕试点建设内容——内部治理结构、医疗资源整合、分级诊疗、信息系统建设、薪酬制度改革、支付方式改革等几个维度，对区域内某县域医共体组建运行1年来的情况开展回顾性调研。结果实现紧密型医共体的目标——构建分级诊疗、合理诊治和有序就医新秩序还需要克服形式，深入推进。结论试点工作需要从政府治理层面入手，不仅需要理顺内部责、权，还需要重点解决好“管”“办”分开，内部人事薪酬制度重构、医保支付政策改革，同时在信息化、内部人员配置与优势医疗资源服务下沉、一体化协作、医防融合促进社会大健康理念方面统筹兼顾、释放活力。尤其在政策和配套制度改革方面更需因地制宜，利用政策来积极引导医疗模式转型，为实现连续性医疗提供动力。

Retrospective Investigation and Analysis on Pilot Construction of Medical Community in a County

ObjectiveTo provide decision-making reference for similar medical communities by analysis of the difficulties and challenges occurred in the pilot construction of a county-level medical community.MethodsRetrospective research centered on the establishment and operation of a compact medical community in a county for one year was carried out in its pilot construction from the following aspects: the internal governance structure, medical resource integration, hierarchical diagnosis and treatment, information system construction, salary system reform, payment method reform, etc.ResultsThe goal of establishing compact medical communities can be achieved by building up a new medical order by hierarchical, rational and orderly diagnosis and treatment system.Conclusion The pilot work had to start from the government governance, not only to sort out its internal responsibilities and powers, but also to separate the its "management" and "operation", to reconstruct its internal personnel compensation system, to reform its medical insurance payment policies, also to make an overall planning on informatization, internal staffing and providing superior resource to the grassroots, integrating collaboration, integrating medical treatment and prevention, so as to promote the overall health awareness of the society. In terms of policy making and supporting system reforming, it was more necessary to adapt measures to local conditions, and to use policies actively to guide the transformation of medical mode and provide impetus for the realization of continuous medical transformation.