国内外整合医疗理论、实践及效果评价  

The theoretical and practical research and effect evaluation at home and abroad: a review of integrated care

作　　者：袁浩文 杨莉[1] YUAN Haowen;YANG Li(School of Public Health,Peking University/Health Policy and Technology Assessment Center,Peking University Health Science Center,Beijing 100191,P.R.China)

机构地区：[1]北京大学公共卫生学院/北京大学医学部卫生政策与技术评估中心,北京100191

出　　处：《中国循证医学杂志》2020年第5期585-592,共8页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:71273016、71673004、71911530221)。

摘　　要：目的分析国内外整合医疗的理论研究、发展模式和效果评价,为我国医联体的发展提供参考。方法计算机检索PubMed、CNKI和WanFang Data数据库,补充检索相关网站的政府文件、研究报告等,搜集国内外有关整合医疗的研究,并进行描述性分析。结果国外整合医疗以政府主导为主,整合涉及医疗机构和保险机构等多部门,整合度较高、资金充足,分别从宏观、中观、微观角度建立理论框架,提出以人为中心、基于价值的整合医疗。国内则以政府引导、地方实践为主,多为不同医疗机构间整合,但整合较松散、资金不足,理论研究多为合作关系、利益机制等方面。国内外都集中评价医疗服务利用和质量指标,但国外更注重医疗成本,国内因利益机制不均衡更多注重医疗费用和绩效评价。结论目前对于整合医疗没有统一的理论框架和方法,未来的研究应结合国内外成功经验和特点,考虑本国复杂政策背景,因地制宜。Objectives To analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China. Methods PubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed. Results Foreign integrated care was dominated at government level.The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on.At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation. Conclusion There is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.

关 键 词：整合医疗 医联体 理论框架 效果评价 医疗服务体系 

分 类 号：R197.1[医药卫生—卫生事业管理]