我国医防融合困境中的管理和服务机制剖析  

Analysis of the management and service mechanisms in the integration dilemma of medicine and prevention in China

作　　者：王晨舟 张研[1,2] 张亮 WANG Chen-zhou;ZHANG Yan;ZHANG Liang(School of Medicine and Health Management,Tongji Medical College of Huazhong University of Science and Technology,Wuhan Hubei 430030,China;Research Centre for Rural Health Service,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education,Wuhan Hubei 430030,China;School of Political Science and Public Administration,Wuhan University,Wuhan Hubei 430072,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]湖北省人文社科重点研究基地农村健康服务研究中心,湖北武汉430030 [3]武汉大学政治与公共管理学院,湖北武汉430072

出　　处：《中国卫生政策研究》2024年第1期2-8,共7页Chinese Journal of Health Policy

基　　金：国家自然科学基金面上项目(72274069)。

摘　　要：本文分析了我国医防融合推进过程中的主要阻力在于重医轻防的观念、条块分割的体系架构、方向相悖的筹资和激励以及服务供给中分工和合作的根本矛盾。尝试从管理和服务机制的角度分析我国医防融合的推进现状和存在的问题,发现其根源在于管理与服务机制不匹配。提出当前医防融合的实践应当首先以服务机制为重点,明确医防融合的服务接口,建立以患者为中心的医防融合服务路径;在服务机制的建立中平衡效率与质量,在分工的基础上整合;再围绕医防融合服务机制进行管理机制的调整,在管理机制改革中协调多方主体利益,控制改革成本。This paper analyzes the main obstacles in the process of promoting the integration of medicine and prevention in China,including the mindset of prioritizing medical care over prevention,fragmented system architecture,conflicting direction of funding and incentives,and inherent contradictions in the division of labor and cooperation in service provision.Furthermore,this article attempts to present the current status and constraints of medical and health integration in China from the perspectives of management mechanisms and service mechanisms,highlighting the mismatch between these two aspects as the root cause.It proposes that the reform logic of current medical and health integration practices should prioritize the service mechanism.This involves clarifying the service interface of medicine and prevention integration and establishing patient-centered service pathways for integration.In the establishment of the service mechanism,a balance should be struck between efficiency and quality,while also integrating based on division of labor.Subsequently,adjustments to the management mechanism should be made in accordance with the medicine and prevention integration service mechanism.In the reform of the management mechanism,various stakeholders interests should be coordinated and the costs of reform should be controlled.

关 键 词：医防融合 管理机制 服务机制 困境 整合 

分 类 号：R197[医药卫生—卫生事业管理]