英国国民卫生服务CCG医改带给中国医改的启示与借鉴  

Enlightenment and references of NHS Clinical Commissioning Groups medical reform

作　　者：全世超[1] 瞿舒婧 陈素秀[1] 赵玺华 潘景业[1] 黄跃跃[1] 

机构地区：[1]温州医科大学附属第一医院全科医学科,浙江温州325000 [2]温州医科大学全科医学学院,浙江温州325035

出　　处：《中华全科医学》2017年第3期365-368,共4页Chinese Journal of General Practice

基　　金：浙江医学支撑学科创新学科建设计划(浙卫办科教[2015]13号)

摘　　要：目的通过对英国近年来备受关注与争议的全科医生临床执业联盟(clinical commissioning group,CCG)改革进行讨论,探讨其产生背景及原因、现实意义以及其对中国医改的借鉴之处。方法通过笔者在英国伯明翰大学接受国际全科师资培训时所了解的CCG改革并进一步调研及大量的文献检索、浏览英国政府及医疗保健网站并进行归纳总结,深入了解英国国民卫生服务体系(NHS),了解其独具特色的运行模式及其优势所在,研究英国医改的演变过程和当下进展,以及CCG改革的具体措施对中国医改的启示与借鉴。结果 NHS原来的卫生策略管理局和初级医疗信托会被NHS执行委员会和211家全科医生领导的CCG所取代,CCG接管NHS约80%的预算,向次级保健购买服务,自下而上来决定资金流向,但改革不太顺利,争议频出,对患者享有的自主权程度和范围拿捏失当、私人医疗机构的引进影响医疗服务的质量、长久建立的医患良好关系恐被破坏或是造成CCG略受挫折的原因。结论 CCG医改提高了医疗体系的运转效率,但这种做法对于尚未完全施行分级诊疗制度、有序进行患者分流的中国,CCG医改措施并不适合,中国医改内容需根据其自身特点制订,需平衡公益与市场,计划经济与市场经济需并重。Objective To discuss the concerned and controversial medical reform by National Health Service （NHS） Clinical Commissioning Group （CCG） in UK,explore the background and reasons of the reform,and evaluate the refer- ence point for the medical reform in China. Methods Through what I saw and investigate in UK, literature search and other information on WEB of British government and heahhcare sites, We gain some insight into National Health Service in UK, understand its operation mode and advantages, study the evolution and the present progress of UK medical reform, and the specific measures on reform by CCG. Results Strategic Health Authority and Primary Care Trust were replaced by NHS Executive Committee and 211 CCG which leaded by GP,80% budget of NHS was taken over by CCG. CCG would purchase service from secondary care and determine the flow of funds from the bottom up. But the reform did not go well with frequent controversy. The courses of medical reform getting a bloody nose might be misconduct in guideline on the range and degree of autonomy enjoyed by the patients, the introduce of private medical institutions affecting the quality of medical service, and the doubt on long established doctor-patient relationships may be damaged. Conclusion CCG reform can improve the operation efficiency of the health care system, but it cannot be transplanted completely in China medical reform because the grading diagnosis and treatment system and patients ordered distribution has not been completed. Chi- nese health care reform need to balance the public interest with the market, both needs planned economy and market econ- omy.

关 键 词：国民卫生服务(NHS) 临床执业联盟(CCG) 医改 

分 类 号：R197[医药卫生—卫生事业管理]