摘要
目的:分析医联体目前发展现状,系统地总结医联体探索和实践过程中存在的关键问题,提出有利于医联体发展的建议和举措。方法:采用系统评阅方法,梳理近十年来涉及国内外医联体发展现况和阻碍因素的相关文献。根据不同类别问题的关键词在文献中的提及率,按照从高到低原则进行排序,总结出前十位关键问题。采取德尔菲法进行两轮专家咨询,汇总出阻碍医联体发展的核心问题,并按照严重程度由高到低排序;将文献检索中得到前十位关键问题和专家咨询中汇总前十位问题进行加权排序。结果:阻碍当前医联体模式发展的核心问题前10位分别为医疗机构存在竞争性、病人不信任下级医院、下级医疗机构服务水平有限、政府缺乏顶层设计、医保对接模式有缺陷、信息化平台建设不完善、医联体内部管理模式落后、缺乏长期的激励机制、各医院间医疗水平差距过大及分级转诊流程不完备。结论:应不断提高基层医疗机构服务能力,完善医联体内医保支付方式和人事薪酬制度,在医联体内部形成激励、利益共享机制,完善医联体内信息化建设。
Objective:To analyze the current development status of Medical Cluster,systematically summarize the key problems in the process of exploration and practice of Medical Cluster,and put forward suggestions and initiatives that are beneficial to the development of Medical Cluster.Methods:A systematic review method was used to sort out the relevant literature involving the current situation and hindering factors of the development of Medical Cluster at home and abroad in the past decade.The top ten key issues were summarized by ranking the keywords of different categories of issues according to their mention rates in the literature from highest to lowest.Two rounds of expert consultation were conducted by the Delphi method to summarize the core problems that hinder the development of Medical Cluster,and rank them in descending order of severity;the top ten key problems obtained from the literature search and the top ten problems summarized in the expert consultation were weighted.Results:The top 10 core problems that hinder the development of the current Medical Cluster model are competitive medical institutions,patients'distrust of lower-level hospitals,the limited service level of lower-level medical institutions,lack of top-level design by the government,defective health insurance docking model,imperfect construction of information technology platform,backward management model within the Medical Cluster,lack of long-term incentive mechanism,excessive disparity in medical level among hospitals and incomplete graded referral process.Conclusion:The service capacity of the grassroots care institutions should be continuously improved,the payment method of medical insurance and personnel salary system within the Medical Cluster should be improved,the incentive and benefit sharing mechanism should be formed within the Medical Cluster,and the information construction within the Medical Cluster should be improved.
作者
姚冰洋
霍永鑫
吕本艳
任文杰
YAO Bingyang;HUO Yongxin;LV Benyan;REN Wenjie(School of Medical Humanities,Xinxiang Medical College,Xinxiang,He'nan Province,453000,PRC)
出处
《中国医院》
北大核心
2023年第8期30-33,共4页
Chinese Hospitals
基金
国家自然科学基金青年项目(71804159)
中原医创基金会医院管理研究项目(23YCG1001)。
关键词
医联体
系统评阅
研究现状
医疗联合体
Medical Cluster
systematic review
research status
medical consortium
