整体性治理视角下我国分级诊疗的实现路径  

The Implementation Path of Hierarchical Medical Treatment in China from the Perspective of Holistic Governance

作　　者：吴万宝 苏敏[1] WU Wan-bao;SU Min(School of Public Administration,Inner Mongolia University,Hohhot Inner Mongolia 010070,China)

机构地区：[1]内蒙古大学公共管理学院,内蒙古呼和浩特010070

出　　处：《内蒙古社会科学》2024年第5期92-99,共8页Inner Mongolia Social Sciences

基　　金：国家自然科学基金项目“家庭医生‘以患者为中心’的健康服务模式优化机制及实证研究”(编号:72204128);国家自然科学基金项目“边疆民族地区基层医疗机构肺结核‘电子药盒+手机APP’诊疗管理模式实施效果及优化机制研究”(编号:72164031)。

摘　　要：作为建立在行政体制之上的医疗卫生制度,分级诊疗与政府治理密切相关,整体性治理理论为我们研究分级诊疗制度提供了全新的理论视角与分析框架。分级诊疗制度已推行十余年,取得了显著成效,我国以医联体为主要载体,集家庭医生签约、远程医疗、对口支援、差异化医保报销等于一体的分级诊疗模式已基本确立。然而,多元主体的协同不足与制度实施的碎片化制约着制度的执行效果,优质医疗资源短缺限制着医疗服务水平的提升,考核机制的缺位与信息化建设的滞后阻碍着分级诊疗的进一步推进。鉴于此,应发挥政府主导作用,实现满足公民需求的治理导向;构建分工协作的诊疗格局,完善医疗资源整合的治理机制;强化信息化治理手段,构建分级诊疗网络。Hierarchical medical treatment,as a healthcare system based on the administrative framework,is closely connected to government governance.Holistic governance theory provides a novel theoretical perspective and an analytical framework for examining the hierarchical medical treatment system.Over the past decade,this system has made significant success.In China,with the medical alliance as the main carrier,a hierarchical treatment model integrating family doctor contracting,telemedicine,counterpart assistance,and differentiated medical insurance reimbursement has been basically established.However,the lack of coordination of multiple subjects and the fragmentation of policy implementation have constrained the implementation effect of policies.The shortage of high-quality medical resources has limited the improvement of medical service levels,while the lack of assessment mechanism and the lag of information construction have hindered the further advancement of hierarchical treatment.The leading role of the government should be played to achieve a governance orientation that meets the needs of citizens.A pattern of division of labor and collaborative diagnosis and treatment should be constructed to improve the governance mechanism for the integration of medical resources.The means of information governance should be improved to build a hierarchical medical treatment network.

关 键 词：整体性治理 分级诊疗 基层医疗机构 治理效能 

分 类 号：R197.1[医药卫生—卫生事业管理]