公立和私立医疗机构合作提供医疗卫生服务策略的描述性系统评价  

Strategies on Public-private Partnership in the Provision of Health Care Services:A Descriptive Systematic Review

作　　者：刘琴[1] 王宏[1] 李蕾[1] 张帆[1] 李鹃[1] 宋文丰[1] 刘惠[1] 汪洋[1] 

机构地区：[1]重庆医科大学公共卫生学院,重庆400016

出　　处：《中国循证医学杂志》2009年第5期492-502,共11页Chinese Journal of Evidence-based Medicine

基　　金：中国卫生政策支持项目(HPSP)

摘　　要：目的全面评价公立和私立医疗机构合作提供医疗卫生服务的策略。方法检索19个电子数据库和3个灰色文献数据库截止至2008年9月收录的文献,并检索了9个相关机构网站和Google搜索引擎以弥补数据库的遗漏。纳入所有描述或评价公立和私立医疗机构合作提供医疗卫生服务策略的文献。由两名研究者独立进行文献筛查、质量评价及资料提取。对质量评分为A级和B级的研究进行最后的综合分析。结果共纳入38篇文献,其中22篇描述策略,16篇评价策略。医疗卫生服务对象主要包括结核病患者、艾滋病患者、精神病患者、社区居民和儿童等人群。公私合作伙伴关系主要有六种方式:①正式或非正式协议;②工作组委员会;③督导培训和监管;④支持资助;⑤医疗卫生服务组织的整合;⑥公私同址。评价公私合作策略的研究大部分为观察性研究,仅有3篇是干预前后对照研究。绝大多数研究结果显示,公私合作伙伴关系对医疗卫生服务的提供有积极的促进作用,同时也面临许多问题与挑战。结论现有研究表明公立与私立医疗机构合作对医疗卫生服务的提供能起到一定的促进作用。但目前公私合作提供医疗卫生服务的领域和研究深度有限,尚缺乏设计严谨的评价性研究。策略实施的效果与其相应的实施背景密切相关,因此需要结合中国的实际情况对目前实施较为成功的公私合作策略选择性地借鉴。Objective To describe the range of Public-private partnerships （PPP） in the provision of healthcare services, and how the authors have assessed these partnerships. Methods We searched 19 international electronic databases and 3 grey literature databases up to September 2008. Nine websites of relevant organizations and Google were searched for any missing information. Search terms were determined by both health policy experts and search specialists after repeated discussion and pilot searching. Our inclusion criteria were research papers that reported describing or evaluating any public-private partnerships in provision of healthcare services. Two reviewers independently screened, appraised and extracted the data, and disagreements were resolved by discussion or by consulting a third researcher. The studies that scored A or B in terms of quality assessment were analyzed. Results Of the 38 studies included in the analysis, 22 studies aimed to describe strategies, while 16 ones were to evaluate the effectiveness of strategies. The targeted populations were tuberculosis patients, AIDS patients, psychiatric patients, community residents and children. Six partnership mechanisms were categorized： （1） formal/informal contract; （2） working group committee; （3） supervision, training and regulation; （4） support and subsidizing;（5） integration of health care organizations; and （6） colocation. Most of the studies evaluating effectiveness were observational studies. Only three studies were comparative studies, pre- and post- intervention. The results of the most evaluation studies showed that PPP had positive impact on service provision, while it also had some problems and challenges. Conclusion Current studies show that PPP could improve health service provisions to some extent. There are limitations in the range of health services and the depth of the studies, especially evaluation studies that lack rigorous design. However, people should be cautious when they try to learn from the experience fr

关 键 词：公立医疗机构 私立医疗机构 公私合作伙伴关系 卫生服务 系统评价 

分 类 号：R197.1[医药卫生—卫生事业管理] R197.3[医药卫生—公共卫生与预防医学]