全国县级公立医院综合改革第一批示范县改革进展研究  

Study of the reform progress and effects of the first pilot counties of comprehensive reform of county-level public hospitals

作　　者：代涛[1] 郑英[1] 甘戈 杨越涵[1] 胡佳[1] 朱晓丽[1] 李力[1] 王清波[1] 吴琼[1] 马晓静[1] 黄菊[1] DAI Tao;ZHENG Ying;GAN Ge;YANG Yue-han;HU Jia;ZHU Xiao-li;LI Li;WANG Qing-bo;WU Qiong;MA Xiao-jing;HUANG Ju(Institute of Medical Information, Center for Health Policy and Management, Chinese Academy of Medical Sciences, Beijing 100020, China;National Health Commission of the People's Republic of China, Beijing 100044, China)

机构地区：[1]中国医学科学院医学信息研究所卫生政策与管理研究中心,北京100020 [2]国家卫生健康委员会,北京100044

出　　处：《中国卫生政策研究》2019年第5期1-10,共10页Chinese Journal of Health Policy

基　　金：国家卫生健康委员会体制改革司委托项目

摘　　要：目的:全面分析全国县级公立医院综合改革第一批四个示范县的改革措施、取得的效果、形成的经验与面临的问题,并对进一步深化改革提出建议。方法:通过现场调研收集资料,主要包括统计描述和内容分析法。结果:四县(市)主要从医改领导体制和工作机制、政府投入责任、公立医院补偿机制、医联体建设、基本医保制度、现代医院管理制度、人事薪酬制度等方面进行改革,具体措施各有侧重;在控制医疗费用、优化医院收入结构、提高基本医保补偿、降低就医负担、提高医务人员收入、提升服务能力等方面取得积极效果。结论与建议:四县(市)的公立医院综合改革均取得重要突破和显著进展,但仍存在一些共性体制机制障碍和各自的特定问题;建议进一步推广已形成的经验,强化"三医"联动,针对具体问题不断完善细化改革措施。Objective:To analyze the reform measures, effects, experiences and problems of the first demonstration counties of the comprehensive reform of county-level public hospitals,and put forward suggestions for further development. Methods:In this study, field investigation is used to collect data in 4 counties, and statistical description and content analysis methods are applied to do comparative analysis.Results:While each of the four counties hasits own focus, they have carried out the reform from various aspects such as leadership system and working mechanism, investment responsibility of government, compensation mechanisms of public hospitals, construction of medical alliances, basic medical insurance system, modern hospital management system, personnel quota management and remuneration system, and they have achieved certain results in the aspects of controlling medical expenses, optimizing income structure of hospitals, increasing reimbursement rate of basic medical insurance, alleviating patients' economic burden, increasing medical staffs' income, and improving medical service ability.Conclusions and suggestions:The four counties have made significant break throughs and remarkable progress in the reform,but they are still facing some common institutional obstacles and their own specific problems as well. The reform experiences should be summarized and promoted on a wider scale. The system and mechanism reform should be deepened and the comprehensive reform of "medical treatment, medical insurance, and medicine linkage" should be strengthened. The reform measures should be continuously improved and refined aiming at the specific challenges.

关 键 词：公立医院综合改革 示范县 措施与效果 

分 类 号：R197[医药卫生—卫生事业管理]