构建顾问医师模式推动区域新农合双向转诊守门人体制建设的调查研究

摘要

Objective To Know the role and significance of building consultant doctor model to promotion of gatekeeper system construction for two -way referral in new rural cooperative medical service ( NRCM ) . Methods A total of 18 experts in NRCM management, health law, and medical fields were interviewed in group discussion. A self - designed questionnaire survey was conducted among 103 doctors from third - grade hospitals, 112 doctors from township health centers and 1 031 participating farmers, who could represent the three - subject population in consultant doctor model. Results A majority of the experts agreed that the consultant doctor model was a positive and realistic way to promote the system construction of two - way referral gatekeeper in unforced first visits, and most of them held that the model was practical and compatible with the existing medical legal rules. All the NRCM management experts considered that the model was compatible with the future general practitioner system and continuous in timeliness. There were totally 186 doctors ( 86.5% ) who recognized the model, including 111 ( 99. 1% ) from township health centers and 75 ( 72. 8% ) from third - grade hospitals who were willing to serve as the responsible or consultant doctors. The major benefit demands of the participating famers for the guideline and procedure of the consultant doctor model were simple and shortcutting. Conclusion The two - way referral gatekeeper system of unforced first visits is the only option in certain east areas in Guangdong. The model that doctors from third - grade hospitals take the role of consultant doctor in two - way referral would be the starting point for promoting the construction of two - way referral gatekeeper system in local NRCM.%目的 了解构建顾问医师模式对推动区域新型农村合作医疗(新农合)双向转诊守门人体制建设的作用和意义.方法 选取新农合管理、卫生法律、医疗等领域的18名专家进行个人深入访谈和小型座谈;采用自制调查问卷,对顾问医师模式三大主体的代表人群三级医院医生103人、乡镇卫生院医生112人、参合农民1031人进行问卷调查.结果 绝大多数专家认为以顾问医师模式推动非强制首诊的双向转诊守门人体制建设是一种积极、现实的方法;大部分专家认为顾问医师模式与现行医疗法规、规则相容,并具有可操作性;新农合管理专家都认为顾问医师模式与将来的全科医生制度能相容并在时间上具有连续性.共有186名(86.5%)医生认可顾问医师模式,分别有111名(99.1%)乡镇卫生院医生、75名(72.8%)三级医院医生愿意承担责任医师或顾问医师.顾问医师的指导意见和手续简单、快捷是参合农民对顾问医师模式的主要利益诉求.结论 目前粤东某市区域只能选择非强制首诊的双向转诊守门人体制,由三级医院医生承担双向转诊顾问医师的模式,可作为目前推动区域新农合双向转诊守门人体制建设的切入点.