我国基层卫生综合改革进展

摘要

This paper systematically reviewed typical practices and experience of the comprehensive reform of primary care in the whole country from 2009 to 2016,focusing on the innovation management system,financial compensation mechanism,personnel system reform,human resource management,performance allocation and assessment mechanism,performance appraisal mechanism,contracted services of general practitioners,primary health care workers system and development system of rural doctors in China.Analyzing data from China Health and Family Planning Statistical Year Book 2010-2017,National Financial Annual Report of Health Service 2009-2016 and survey data of contacted areas of primary care comprehensive reform 2014-2016,obvious achievements of comprehensive reform of primary health care have been shown as following.(1) The network of primary health care workers has been improved.(2) The number of primary health care workers has increased to a certain scale.(3) Quantity of primary health care services is increasing year by year in a more efficient manner.(4) The drug proportion as the whole revenue has been reduced and the cost of drugs has been reasonably controlled.(5) Patients and primary health care workers are more satisfied with primary health care system.However,challenges and problems exist.Firstly,the progress of comprehensive reform of primary health care in different areas is unbalanced.Secondly,the lack of sufficient services of primary care workers and the rapid development of hospital have a negative impact on comprehensive reform of primary care.Thirdly,the lack of talents in primary care system has become a bottleneck restricting the development of primary care system.Fourthly,multi-channel compensation mechanism needs further improvement.Fifthly,human resource management system is not sophisticated yet.Sixthly,essential drugs in primary care system can not meet the demand.Based on above analysis,this paper puts forward eight suggestions as follows.(1) Continuing to strengthen the primary care system.(2) Enhancing the competency of primary care services.(3) Innovating the primary care management system.(4) Establishing multi-channel compensation mechanism.(5) Further deepening the reform of the personnel system.(6) Improving the performance allocation and assessment mechanism.(7) Promoting contracted services of family doctors.(8) Establishing information support system for primary care.It is expected that these suggestions can provide the reference for a new round of comprehensive reform of primary care.%本文系统梳理了2009-2016年全国基层卫生综合改革典型做法和经验,从创新管理体制、完善财政补偿机制、创新编制管理制度、深化人事制度改革、完善分配激励机制、健全绩效考核机制、推进家庭医生签约服务、加强基层卫生人才队伍建设、稳定和优化乡村医生队伍等九个方面分别探讨.利用2010-2017中国卫生和计划生育统计年鉴、2009-2016年全国卫生财务年报数据、2014-2016年国家卫生计生委和财政部基层卫生综合改革重点联系区县监测数据以及结合相关调研结果,展示我国基层卫生综合改革取得的成效:基层医疗卫生服务网络得到巩固;基层卫生人才队伍初具规模;基层医疗卫生服务量逐年增加,效率得到提升;药占比下降,基层医药费用得到合理控制;基层医务人员和患者满意度进一步提高.深入探讨我国基层卫生综合改革面临的困难及挑战:基层卫生综合改革进展不平衡;受基层服务能力不足及医院快速发展双重影响,改革效果严重削弱;人才匮乏成为制约基层卫生发展的瓶颈;多渠道补偿机制亟须完善;人事分配制度尚不健全;基本药物不能满足需要.并且针对各地创新做法、典型经验结合存在问题提出八个方面的建议:继续加强基层卫生服务体系建设;提升基层医疗卫生服务能力;创新基层医疗卫生管理体制;完善多渠道补偿机制;深化编制人事制度改革;完善绩效分配及考核制度;推进家庭医生签约服务;建立信息化技术支持体系.以期这些建议能为新一轮基层卫生综合改革提供借鉴.