“十二五”期间,北京市医疗卫生事业取得的主要成绩是医疗资源进一步增强、资金投入水平和占GDP比重都迅速提升,为今后的优化发展争取到了经费份额空间。存在的主要矛盾是投入的高增长与产出质量和效率提高不明显间的矛盾。从量上分析,主要原因在于,社会资源投入在不同层级的医疗机构之间存在结构性失衡,以及卫生总费用供给结构趋向合理但医疗保险保费支出增长不可持续。解决这两个矛盾,除了继续推进医药分开外,关键在于落实分级诊疗。医联体建设作为实施分级诊疗的主要载体,近三年的推进存在不少问题,其中机制性问题在新的工作推进机制下有望得到有效解决,但体制性问题需要进一步关注和探索。本文提出,首先,医联体的组建,应结合按人头预付费的医保支付改革,在同一地域引入适度竞争,以提高效率,并激励医联体做好居民健康管理。其次,结合城市公立医院改革的方向,医联体应形成统分结合的双层结构,兼顾协调效率和组织管理效率。
<<During the “Twelfth Five-Year Plan” period,Beijing Municipality has realized,as a major achievement,fast growth in resource input into the medical and healthcare undertakings. The crucial problem to be solved rests on the unsatisfactory quality and inefficiency vis-à-vis the fast growth in input. A qualitative analysis reveals the structural imbalance existing in the distribution of medical resources among different strata of medical institutions. A quantitative analysis shows the unsustainability of the growing expenditure of medical insurance. In addition to the separation between medical and pharmaceutical services,stratified diagnosis and treatment might be a feasible solution. In conclusion,the paper puts forth proposals on the construction of the medical alliance.
<<Keywords: | Structural Imbalance in Resource InputStratified Diagnosis and TreatmentMedical Alliancemoderate CompetitionCombination of Centralized Operation With Decentralized Operation |