摘要
目的分析新一轮医药卫生体制改革(以下简称“新医改”)以来我国居民就诊流向的变化趋势,发现存在的问题,并提出政策建议。方法对2010—2019年国家卫生健康统计年鉴中的门急诊人次、出院人次变化趋势进行描述性分析。结果2009年推进新医改以来,医院和基层医疗卫生机构的诊疗量均呈上升趋势。医院的门急诊人次和出院人次增长速度远快于基层医疗卫生机构。各类机构诊疗人次构成比的变化趋势显示,患者持续流向医院。但基层医疗卫生机构中的社区卫生服务中心和门诊部的诊疗量增长快于医院。基层医疗卫生机构的医护人员学历普遍偏低。公立医院收入以医疗收入为主,财政补助收入不足10.0%。医院床位增长较快,且远快于基层医疗卫生机构。建议通过医疗保险的杠杆作用以及家庭医生签约服务,引导患者在基层医疗卫生机构首诊。通过提高政府补助,规范医院诊疗行为。通过提高基层医疗卫生机构的服务能力,做好健康守门人。
Objective To analyze the trend of Chinese patient flow since the new reform of the medical and health system,figure out problems,and propose corresponding policy recommendations.Methods Descriptive analysis on the trends of outpatient and emergency visits and discharge patients were employed,the National Health Statistical Yearbooks from 2010 to 2019 was used.Results Since the initiation of new reform of the medical and health system in 2009,the volume of diagnosis and treatment of hospitals and primary medical and health care institutions was on the rise.The number of outpatient and emergency visits and discharged patients of hospitals grew much faster than that of primary medical and health care institutions.Patients continued to flow to hospitals according to the trends of visit proportions of various institutions.However,the volume of diagnosis and treatment of community-level health service centers(a kind of primary medical and health care institutions)grew faster than that of hospitals.Doctors and nurses from primary medical and health care institutions received a lower education than those from hospitals.In public hospitals,medical income accounted for most of the total income,and fiscal income accounted for less than 10.0%.Public hospitals showed a steeper increase in hospital beds than primary medical and health care institutions.Conclusion It is suggested:to guide patients to visit primary medical and health care institutions through the lever of health insurance and the service of community family physicians;to increase government investment to regulate hospital treatment behavior;and to improve the ability of primary medical and health care institutions to provide better primary health care services.
作者
徐芳
王伟
严非
XU Fang;WANG Wei;YAN Fei(School of Public Health,Fudan University,National Health Commission,Key Laboratory of Health Technology Assessment(Fudan University),Collaborative Innovation Center of Social Risks Governance in Health,Shanghai 200032,China)
出处
《中国卫生资源》
北大核心
2020年第3期299-303,共5页
Chinese Health Resources
基金
上海市大城市结核病综合防治模式研究(2018ZX10715012)。
关键词
新一轮医药卫生体制改革
就诊流向
医院
基层医疗卫生机构
门急诊人次
出院人次
new reform of the medical and health system
patient flow
hospital
primary medical and health care institution
outpatient and emergency visit
discharge patient
