分级诊疗制度的上海模式及推进建议

摘要

分级诊疗是医改核心目标,也是各地探索方向.通过文献及二次资料分析和专家咨询法,归纳出“控制顶端、强化承接、联合均衡、需方引导”的分级诊疗上海模式.该模式下,住院病人分流效果明显,而囿于三级医院动力和社区承接能力的不足,门诊病人下沉仍有较大空间.建议在坚持已有模式的基础上,发展医院集团以增加三级医院下沉门诊病人动力,拓展社区药品可及性、推动医生多地点执业、发展互联网医疗,以加强社区承接能力.%Hierarchical diagnosis and treatment system is the core objective of national health care reform.Based on literature analysis,the second data analysis and expert consultation,the study summarized Shanghai hierarchical diagnosis and treatment system model,which can be described as "top control,undertaking strengthening,joint equilibrium and demand guidance".Shanghai model's effect of triaging inpatients is obvious,and due to the insufficiency of senior hospitals' initiative and the capacity of community institutions,there is still a lot of room for senior hospital to sink outpatients,It is suggested that Shanghai should adhere to existing model,enhance the initiative of senior hospital to sink outpatients by developing hospital group,enhance the community institution's capacity to undertake those outpatients by expanding drug accessibility for outpatients in community institutions,promote multi-site practice of doctors and develop internet-medical-service.