基于电子文件的分级诊疗模式研究

目的 了解我国分级诊疗现状和业务流程，提出基于电子文件的分级诊疗服务模式。方法 采用描述分析法对当前分级诊疗业务及所产生的电子文件进行研究，结合电子文件的特性，探索分级诊疗服务模式。结果 从电子文件中心构建、双向转诊、远程医疗、慢性病管理等方面构建了基于电子文件的分级诊疗模式。结论 基于电子文件开展分级诊疗服务能优化现有的业务流程，为分级诊疗进程的不断推进提供信息化支撑。     

基于社会分工理论的分级诊疗服务体系研究

医疗卫生服务体系结构复杂，建立规划合理、分工明确的分级诊疗服务体系是保障医疗资源合理配置、提高医疗服务协调性和连续性的重要手段。通过探讨当前分级诊疗服务体系存在的问题，进而结合社会分工理论为形成适应我国国情的分级诊疗制度提出对策建议。     

部分国家和地区分级诊疗特点及启示

通过剖析部分国家和地区分级诊疗的特点,即分级诊疗是医疗卫生服务体系健全的自然结果,分级诊疗的实质在于服务整合,合理的支付制度是分级诊疗的重要促进因素;提出以强基层、建机制的原则发展分级诊疗,将医疗机构分工合作、服务功能整合作为分级诊疗的重要路径,增强医保对医疗服务体系的影响力以促进分级诊疗等建议。     

我国省级层面分级诊疗文件比较分析

通过访问各省（区、市）卫生计生委的官方网站,获取有关分级诊疗政策的文件,在获取国家卫计委和万方、知网的相关分级诊疗文献的基础上,对各省（区、市）2016年2月28日以前的分级诊疗文件进行分析研究,通过对比各省分级诊疗文件的基本情况和实施措施等具体内容,分析不同省份在分级诊疗文件内容设定中存在的问题,从而为未来的分级诊疗决策和实践提供经验。     

南充市高坪区居民关于分级诊疗制度知晓度调查及分析

目的:了解南充市高坪区居民分级诊疗制度的知晓程度,以及对该制度的实施提供进一步理论依据。方法:采取自制调查问卷进行面对面调查,并用统计学方法进行分析。结果:在接受调查居民中,对分级诊疗制度的知晓率为87.3%,然而分级诊疗制度实施结果并不理想。结论:居民对分级诊疗制度的知晓率与分级诊疗制度实施情况不相符,说明分级诊疗制度实施仍然面临许多阻碍。     

县级医院实施分级诊疗机制探讨

北京市延庆县医院作为北京市公立医院改革的试点单位之一,在实施分级诊疗的过程中进行了一系列的探索,总结了部分经验。通过发现实施分级诊疗过程中存在的问题,提出相应的对策,从而不断促进分级诊疗机制的完善,并为其他县级医院实施分级诊疗机制提供经验。     

我国分级诊疗发展历程及政策演变研究

分级诊疗已成为“健康中国”战略的核心制度体系,并作为重塑我国医疗服务体系的重要内容。通过对我国分级诊疗发展历程和相关政策的梳理,总结分析了不同阶段分级诊疗发展的经验与教训,为分级诊疗制度的理论研究和政策制定提供制度的分析视角和历史资料的参考。     

基于新制度主义的分级诊疗制度创新研究

为了合理利用区域医疗卫生资源,国家倡导建立分级诊疗制度以缓解“看病难、看病贵”问题。但在实际实施过程中,分级诊疗制度遭遇制度动力不足和实施效率低下等问题。基于新制度主义的理论观点,认为新制度的“合法性”危机、原有体制的路径依赖以及制度变革中的权力与利益博弈是产生分级诊疗制度化困境的原因。因此,我们应该创新分级诊疗制度,建立以政府与市场共同参与的分级诊疗实施网络,重新配置医疗卫生资源,完善社区医疗机构的“守门人”制度,加快社会组织的功能实现,实现分级诊疗制度的利益共享。     

立法推进分级诊疗制度建设的思考

自2015年发布《关于推进分级诊疗制度建设的指导意见》以来,相关配套政策相继出台,分级诊疗制度能否持续有效贯彻落实,仍需法律层面的调整和保障。为此,针对当前分级诊疗制度建设存在的主要问题,作者进行了深入调查分析,提出了立法推进分级诊疗制度建设的思路和建议。     

台湾地区全民健保下分级诊疗制度之借鉴

借鉴我国台湾地区全民健保下分级诊疗制度,落实和完善现行分级诊疗制度以保证医疗资源的合理配置。利用文献分析,对比研究两岸不同卫生体制下分级诊疗制度实施现状,结合专家访谈的形式明确台湾分级诊疗制度的特点。通过建立短期医疗网计划、成立社区医疗群、改革医保补偿机制、构筑医联体等方式优化分级诊疗制度。     

Anatomy of health care reform proposals.

The current proliferation of proposals for health care reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The current health care system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for health care services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of health care, includes how physician services are organized, how they are paid for, what mechanisms are in place for quality assurance, and the degree of organization and oversight of the health care system. We describe 7 models of the organization component, including the current fee-for-service system with no national health budget, managed care, salaried providers under a budget, and managed competition with and without a national health budget. These 2 components provide the building blocks for health care plans, presented as a matrix. We also evaluate several reform proposals by how they combine these 2 elements.     

从北京市DRGs试点看医保费用支付方式改革方向选择

医保费用如何支付一直以来都是整个医保体系建设的关键环节之一,医保费用支付方式如何改革在我国医改探索实践中相对比较敏感。北京市于2011年在医保费用支付方式上率先推出国际上比较先进的DRGs支付方式改革新举措,文章介绍了北京大学第三医院作为试点医院的实践。     

Costs and coverage. Pressures toward health care reform.

Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely.     

Making the health care system 'safe' for persons with HIV infection or AIDS.

If health care reform is implemented in states and nationally, the safety of this process needs to be examined for persons with human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS). Reform should assure ongoing prevention and transmission control of HIV and continuous coverage of medical costs for persons ill with HIV or AIDS. These persons currently benefit from various state and federal categoric programs designed to assure access to preventive and personal care services. Washington State has passed health care reform legislation that envisions integrating these programs to provide a system of population-based and personal health care. This legislation was analyzed using existing epidemiologic and entitlement information about persons with HIV infection or AIDS in the state to assess its effect. The relationship between public health and personal care services will be a central concern for those with HIV infection or AIDS, and complete coverage of this group may be achieved relatively late in the process of implementing health care reform. Health personnel planning under health care reform will affect the delivery of HIV- and AIDS-related services. Including treatment of AIDS in the basic benefit package merits particular attention. These issues parallel those being faced by the nation as a whole as it seeks to ensure epidemic disease control and compassionate care for long-term disabling illness if health care reform is implemented.     

Attitudes of Washington State physicians toward health care reform.

Attitudes of Washington State physicians about health care reform and about specific elements of managed competition and single-payer proposals were evaluated. Opinions about President Clinton''s reform plan were also assessed. Washington physicians (n = 1,000) were surveyed from October to November 1993, and responses were collected through January 1994; responses were anonymous. The response rate was 80%. Practice characteristics of respondents did not differ from other physicians in the state. Of physicians responding, 80% favored substantial change in the current system, 43% favored managed competition, and 40% preferred a single-payer system. Of physicians responding, 64% thought President Clinton''s proposal would not adequately address current problems. Reduced administrative burden, a central element of single-payer plans, was identified by 89% of respondents as likely to improve the current system. Other elements of reform plans enjoyed less support. More procedure-oriented specialists than primary care physicians favored leaving the current system unchanged (28% versus 8%, P < .001). While physicians favor health care reform, there is no consensus on any single plan. It seems unlikely that physicians will be able to speak with a single voice during the current debates on health care reform.     

建立适合中国国情的高效双向转诊机制

建立适应我国国情的高效双向转诊机制,对于推进我国的医疗体制改革具有至关重要的作用。本文通过对中西方现行卫生制度的对比,结合我国有中国特色的社会主义国家的国情,对我国的卫生制度中存在的问题进行了深入剖析,探讨如何才能有效地实现高效的双向转诊。目前,我国医疗卫生事业的问题覆盖多个方面：主要表现在医疗资源,医院管理,在岗医护人员的个人职业素质,卫生部门的监管,医疗资源的大量浪费,医院分级不平衡另多数患者普遍选择三级医院就诊,而选择二级以下医院就诊的患者则较少。如何在符合我国国情的基础上改变我国的医疗卫生现状、满足人民群众不断提高的医疗服务需求是我国医疗改革亟待解决的问题。建立高效率的双向转诊制度势在必行。目前,在双向转诊中遇到的问题：1．传统理念导致的对各级医疗机构职能的理解上存在偏差,2．医疗机构自身定位不明确,3．双向转诊制度的各项相关配套政策不完善,4．双向转诊制度的社会认同度低。高效双向转诊机制建立以后,可以节省大量的医疗资源,减少了不必要的浪费,推进了医疗资源的合理配置,减少了因地区差异引起的治疗时机延误,高效的双向转诊制度会使医疗卫生资源配置进一步优化、还可以加强医疗机构之间的协作、降低医疗费用支出、促进社区卫生服务迅速发展等有重大的意义。     

The primary care workforce: a critical element in mending the fractured US health care system

A focus on the primary care workforce is critical when discussing plans to address the fractured United States health care system. However, we must first address the primary care physician shortage crisis when planning for health care reform which focuses on increasing access to the US population. Initial strategies may include improving reimbursement rates for primary care services, incentivizing medical schools in making primary care training a priority, and developing robust loan-forgiveness programs for those who enter and work in primary care specialties. Planning with congressional representatives about these elements will better ensure sustainable health reform efforts are implemented.     

我国实施医师多点执业的政策分析与思考

医师多点执业试点工作正在各地逐步推开。文章依据国家新医改政策,以医师多点执业为基点,对医师多点执业现状和对医疗卫生系统的运行管理可能带来的影响进行综合分析,结合医疗单位的实际,提出意见建议。     

新医改背景下我国分级诊疗实践及问题分析

分级诊疗是医改的重中之重,将为健康中国和基本医疗卫生制度建设提供坚实的体系基础和制度保障。系统总结了我国现阶段各地分级诊疗的实践,分析存在的主要问题,在此基础上提出相应的对策建议,为我国有序推进分级诊疗建设、深化医改提供参考依据。     

美国退伍军人医疗系统成功改革对我国公立医院改革的启示

首先总结了美国退伍军人医疗系统取得卓越成绩的几点做法;然后结合中国公立医院当前改革的实际情况,提出了对我国公立医院改革的启示,如明确我国公立医院的使命、加强对公立医院改革的领导和把以公立医院为重点的卫生系统整体信息化建设提高到国家卫生发展战略的高度等。