北京市与深圳市儿童分级诊疗相关政策对比分析  

Policy Analysis on Children's Hierarchical Medical System between Beijing and Shenzhen

作　　者：刘舒嫣 姚弥 张家玮 祁祯楠[2] 齐建光[4] 冼俊芳 迟春花[2] LIU Shuyan;YAO Mi;ZHANG Jiawei;QI Zhennan;QI Jianguang;XIAN Junfang;CHI Chunhua(Dalang Community Health Service Center,the People's Hospital of Longhua District,Shenzhen 518109,China;General Practice Department,Peking University First Hospital,Beijing 100034,China;Department of Community Health Care,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;General Practice Department,the People's Hospital of Longhua District,Shenzhen 518110,China)

机构地区：[1]广东省深圳市龙华区人民医院大浪社康中心,518109 [2]北京大学第一医院全科医学科,北京市100034 [3]北京积水潭医院社区医学保健科,北京市100035 [4]北京大学第一医院儿科,北京市100034 [5]广东省深圳市龙华区人民医院全科医学科,518110

出　　处：《中国全科医学》2024年第13期1550-1555,共6页Chinese General Practice

基　　金：2020年北京大学医学部教育教学研究课题(2020YB31);2021年全国全科医学教育教学研究课题(A-YXGP20210303-01);龙华区医学重点学科建设经费资助(MKD202007090211)。

摘　　要：背景为了解决儿童“看病难”“看病贵”的医疗困境,我国推行了分级诊疗制度。目前国内对儿童分级诊疗相关政策分析的系统研究献见报道。目的作为分级诊疗第一批试点城市,北京市和深圳市社区卫生服务机构(以下简称社区卫生机构)儿童接诊情况差异较大,本研究通过分析两地儿童分级诊疗相关政策,探索政策对社区卫生机构接诊儿童的影响。方法根据研究小组制定的分级诊疗政策研究框架(社区首诊制、双向转诊、医联体、薪酬激励、儿科培训、宣传、农村医疗可及性),在北京市政府、北京市卫生健康委员会、深圳市政府在线、深圳市卫生健康委员会官方网站检索儿童分级诊疗相关政策文件。筛选符合纳入、排除标准的政策,比较两市纳入政策的数量与内容,分析异同点。结果从6953篇政策文件中筛选出35篇符合分级诊疗政策研究框架的政策文件,其中北京市27篇、深圳市8篇。在医联体、薪酬激励、儿科培训方面,两市都有相关政策。在差异性方面北京市在分级诊疗的宣传和农村医疗可及性方面有相关政策,深圳市在社区首诊制和双向转诊制有相关政策。结论通过落实社区首诊制或加大医保支付比例差距方法促进儿童基层首诊、完善双向转诊指征、完善医联体、薪酬激励和儿科培训相关分级诊疗政策可能对改善社区卫生机构接诊儿童现况有重要意义。Background In order to solve the children's medical dilemmas of poor accessibility and high cost,a hierarchical medical system has been carried out in our country.No systematic research on policy analysis of children's hierarchical medical system has been reported in China at present.Objective Beijing and Shenzhen are the first pilot cities of the hierarchical medical system,but there are obvious differences in the status of community health services for children.This study aims to explore the impact of policies on community health services for children by analyzing the policies in these two cities.Methods According to the research framework of policies on community health services developed by an expert group(community first contact care,dual referral,medical alliance,salary compensation mechanism,pediatric professional training,publicity,rural medical accessibility),policy documents about hierarchical medical services for children were searched from the official website of Beijing Municipal Government,Beijing Municipal Health Commission,Shenzhen Municipal Government,and Shenzhen Municipal Health Commission.Compare the number and content of policies that meet the inclusion and exclusion criteria in the two cities and analyze similarities and differences.Results Thirty-five policy documents that fit the research framework were selected from 6953,of which 27 were from Beijing and 8 from Shenzhen.Both cities have policies on medical alliances,wage incentives and pediatric training.Compared with Shenzhen,Beijing has policies on publicity,and rural medical accessibility,but not on community first contact care and dual referral.Conclusion It may be of great significance to improve the situation of community health services for children by implementing the community first contact care or increasing the gap in medical insurance payment ratio,completing the indications for dual referral,promoting the medical alliance,salary compensation mechanism and training of pediatric skills policies.

关 键 词：社区卫生服务 儿童 分级诊疗 政策分析 分析框架 

分 类 号：R197[医药卫生—卫生事业管理]