治理视阈下分级诊疗的反思与展望  

Reflections and Prospects of Hierarchical Medical Care from the Perspective of Governance

作　　者：岳林琳[1] 玄桂英[2] 张翠萍[1] 王波[1] 刘文凤 贺敬超 时永利 邵佳娴 Yue Linlin(School of Public Health and Management,Weifang Medical University,Weifang,261053)

机构地区：[1]潍坊医学院公共卫生与管理学院,潍坊261053 [2]潍坊医学院附属医院门诊部,潍坊261053 [3]中国人民大学公共管理学院,北京100872

出　　处：《医学与社会》2020年第8期39-44,共6页Medicine and Society

基　　金：2019年度山东省社会科学规划项目,编号为19CGLJ28;2019年度山东省社会科学规划项目,编号为19CGLJ29;2018年度山东省社科普及项目,编号为2018-SKZZ-09。

摘　　要：治理理论为完善分级诊疗制度建设和实践提供了思路。分级诊疗和治理具有逻辑上的内在自洽性和利益关系处理上的一致性。治理视阈下,反思分级诊疗存在的不足包括:分级诊疗制度体系内部协调性不足;医疗机构参与分级诊疗的动力不足;医保机构引导分级诊疗的合力不足;患者诊疗就医的理性认知能力不足。治理视阈下,健全分级诊疗的对策包括:协调并发挥不同层面分级诊疗制度的合力;协调形成不同医疗机构利益共享的合作格局;协调形成医保患之间良性互动的治理格局;引导居民积极参与分级诊疗治理过程。Governance theory provides ideas and opportunities for improving the development and practice of hierarchical medical care.Hierarchical medical care and governance have both logical internal self-consistency and consistency in the treatment of interest relations.From the perspective of governance,the shortcomings of hierarchical medical care include:insufficient coordination within the hierarchical medical system;lack of motivation for medical institutions to participate in hierarchical medical care;the joint efforts of medical insurance institutions to guide hierarchical medical care are insufficient;The rational cognitive ability of patients in hierarchical medical care is insufficient.From the perspective of governance,countermeasures for improving hierarchical medical care include:coordinating and exerting the synergy of hierarchical medical system at different levels;coordinating the formation of a cooperative pattern of benefit sharing between different medical institutions;coordinating the formation of a governance pattern of benign interaction between doctors,medical insurance and patients;guiding residents to actively participate process of hierarchical medical care.

关 键 词：分级诊疗 治理 医疗机构 医保机构 患者 

分 类 号：R197.1[医药卫生—卫生事业管理]