新医改背景下上海社区卫生服务双向转诊模式研究

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新医改背景下上海社区卫生服务

双向转诊模式研究

摘要

医疗卫生服务体系是群众看病就医的重要平台，社区卫生服务是医疗卫生服

务体系的基础性环节。当前我国医药卫生事业发展水平与经济社会协调发展要求

不尽一致，与人民群众健康需求的矛盾还比较突出。所以，加快社区卫生服务建

设是医疗卫生体制改革的突破口，是有效缓解群众“看病难、看病贵”问题的重

要举措；加快社区卫生服务建设是深入贯彻科学发展观，着眼于实现人人享有基

本医疗卫生服务的目标；着力解决人民最关心的健康问题，对构建社会主义和谐

社会有着重要意义。

近年来，中央出台了一系列文件与政策，要求改革卫生服务体系，积极发展

社区卫生服务，逐步形成功能合理、方便群众的卫生服务网络，特别是新医改把

建设社区卫生服务放在了重要位置。同时要求各地积极探索建立医院与社区卫生

服务机构定点分工协作关系，同时建立有效的双向转诊信息沟通渠道。然而，在

地方政府发展社区卫生服务的进程中面临着许多亟待解决的关键问题，特别是社

区卫生发展过程中存在的财政投入机制、政策引导机制、人才培养机制、内部运

行机制不完善等问题在一定程度上制约着这项制度的健康发展。

本文结合新医改实施的社会背景，借鉴国内外社区卫生服务的主要模式，以

个案分析的形式，深入研究了上海社区卫生服务取得的成效和亟待解决的问题，

并且选取了青浦区作为案例，对其区域内的医疗机构的一些相关数据进行比较分

析，并针对性地提出了若干政策建议，包括加强对全科医生的培养和扶持、提高

社区医疗服务机构的服务质量、均衡医院间的利益分配、完善医疗保险等相关法

规政策和保障措施、改革医保支付方式、建立网络病例信息库和标准化转诊模式、

加大宣传引导力度等七个方面。

关键词：社区卫生服务双向转诊新医改医疗保险

ABSTRACT

Medical health service system is an important platform for the common people

seeking medical treatment and community health service is the basic stage of the

medical health service system. Currently, the development level of the medical and

hygienic undertaking in our country is not completely consistent with the requirements

of harmonious development of economic society and its contradiction with the health

care demands of people is relatively prominent. Therefore, accelerating the construction

of community health service is the breakthrough of the medical-sanitary system reform

and an important move to address people’s troubles such as “poor access to and high

cost of receiving medical treatment”; accelerating the construction of community health

service is the objective of the thorough implementation of the Scientific Outlook on

Development and focusing on endowing everyone the basic medical and health

services; to spare no efforts in solving the health problems people care the most is of

great significance for the construction of the harmonious socialist society.

In recent years, the central government has carried out a series of documents as

well as policies requiring reforming the health service system, actively developing

community health service, and gradually forming a health service network with

reasonable function bringing convenience to the common people. In particular, the new

medical reform puts the construction of community health service in an important

position. At the same time, it is required to explore positively the cooperative

relationship of fixed point coordination between the establishment of the division and

the community health service units and to establish effective communication channel of

two-way referral information in the meantime. However, there are a lot of crucial

problems to be solved in the process of local government’s developing community

health service, especially problems existing in the process of community health

development such as the financial input mechanism, policy guidance mechanism,

personnel training mechanism, and the imperfect internal operation mechanism and so

on, which restrict the healthy development of the system to some degree.

This paper tries to use the management theory and method to analysis of Shanghai

community health service center in the new reform under the background of the

bidirectional clinics are faced with the problem, and selected the qingpu district as an

example, the area of medical institutions carry on comparative analysis to some relevant

data, and try to Shanghai community health puts forward some personal understanding

of the two-way referral mode.

Based on the social background of the practice of new medical reform and

referring to the major modes of domestic and overseas community health service, the

paper thoroughly studies the achievements made by Shanghai community health service

and its pressing problems in the form of case study. By choosing Qingpu area as an

example, the paper conducts comparative analysis of relevant data of medical

institutions in this area and puts forward several policy suggestions with pertinence

including strengthening the training and support for general practitioners, improving the

service quality of the community health service units, balancing the interests

distribution among hospitals, perfecting relevant regulations and policies as well as

measures of safeguard such as medical insurance, reforming the mode of medical

insurance payment, setting up network case information database and standardized

mode of referral and strengthening the vigor of publicity as well as guidance.

Keywords: community health service, two-way referral,

the new health reform, the medical insurance

目  录
中文摘要
ABSTRACT 
第一章 绪论.........................................................1
1 研究的背景、目的及意义........................................1
1.1 研究背景..................................................1
1.2 研究目的及意义............................................2
2 国内外文献综述................................................2
2.1 国外文献综述..............................................2
2.2 国内文献综述..............................................5
3 主要内容及研究方法............................................6
3.1 研究的内容及框架..........................................6
3.2 研究方法..................................................7
3.3 本文研究的创新............................................7
第二章 社区卫生服务双向转诊现状及存在的问题.........................9
1 我国社区卫生服务的双向转诊模式分析............................9
1.1 国内社区卫生服务机构与医院双向转诊现状....................9
1.2 国内社区卫生服务机构与医院双向转诊模式分析...............10
2 上海社区卫生服务双向转诊现状及问题...........................13
第三章 基于医疗保险的上海社区卫生服务状况分析......................16
1 上海医疗卫生发展概况.........................................16
2 上海基本医疗保险简介.........................................17
2.1 上海医保支付制度简介.....................................17
2.2 四项基本医疗保险制度介绍.................................18
2.3 四项基本医疗保险制度待遇比较.............................22
3 青浦区定点医疗机构城镇职工基本医疗保险住院情况分析...........24
3.1 青浦区人口分布状况与医疗卫生服务状况.....................24
3.2 青浦区二级医院与社区卫生服务中心住院情况分析.............25
第四章 上海社区卫生服务双向转诊改革的构思..........................29
1 社区卫生服务机构与医院双向转诊相关理论研究...................29
1.1 利益相关者理论...........................................29
1.2 委托代理理论.............................................31
1.3 机制设计理论.............................................33
1.4 激励理论.................................................34
2 上海实施社区卫生服务双向转诊改革的基本构思...................34
2.1 国外社区卫生服务先进经验对上海的启示借鉴.................34
2.2 上海实施社区卫生服务双向转诊改革的对策...................36
第五章 结论与不足..................................................42
1 本文主要结论.................................................42
2 本文研究的不足...............................................43

参考文献...........................................................44

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摘要：

新医改背景下上海社区卫生服务双向转诊模式研究摘要医疗卫生服务体系是群众看病就医的重要平台，社区卫生服务是医疗卫生服务体系的基础性环节。当前我国医药卫生事业发展水平与经济社会协调发展要求不尽一致，与人民群众健康需求的矛盾还比较突出。所以，加快社区卫生服务建设是医疗卫生体制改革的突破口，是有效缓解群众“看病难、看病贵”问题的重要举措；加快社区卫生服务建设是深入贯彻科学发展观，着眼于实现人人享有基本医疗卫生服务的目标；着力解决人民最关心的健康问题，对构建社会主义和谐社会有着重要意义。近年来，中央出台了一系列文件与政策，要求改革卫生服务体系，积极发展社区卫生服务，逐步形成功能合理、方便群众的卫生服务网...

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