我国分级诊疗服务体系问题与对策研究
发布时间:2019-05-25 02:03
【摘要】:国务院出台的分级诊疗有关意见中提到,到2017年的推进分级诊疗工作的目标为改善医疗卫生资源配置、促进优质医疗资源有效下沉、基层医疗卫生机构的门诊量占总体比重上升以及医疗资源利用效率与整体效益提升。本文从国务院出台的分级诊疗规划目标出发,运用基尼系数、泰尔指数分析我国分级诊疗服务体系医疗资源分配的投入现状,包括执业(助理)医师与医疗卫生机构床位数,为改善医疗卫生资源配置、促进优质医疗资源有效下沉提出合理化建议。并用统计分析分级诊疗服务体系医疗卫生资源实际利用的产出现状,包括门诊服务与入院服务。最后运用包络数据分析法(DEA)中的BCC模型测算我国各级医疗卫生机构的投入-产出的服务效率。为基层医疗卫生机构的门诊量占总体比重上升以及医疗资源利用效率和整体效益提升做出参考意见。基于本文的分析,得出以下结果与结论:第一,我国医疗卫生人力与物力资源在医院过度集中,医疗卫生机构床位数尤为明显。2014年我国医院拥有全国54.8%执业(助理)医师、75.2%医疗卫生机构床位。第二,我国医疗资源配置城乡差异是造成地区间医疗资源配置差异的主要原因。2014年医疗资源泰尔指数中,执业(助理)医师城乡间贡献率为62.5%,床位资源城乡间贡献率为78.6%。第三,我国医疗卫生资源在省际分布较为均衡,各省区的物力资源配置比人力资源配置更为均衡。2014年,执业(助理)医师与床位数的总体基尼系数值均低于0.2,且床位数基尼系数低于执业(助理)医师。第四,居民就诊意愿向医院倾斜。基层医疗卫生机构的门诊人次略高于医院,但是医院占比均在逐年上升,而基层医疗卫生机构占比在逐年下降。入院人次医院占比远高于基层医疗卫生机构,并且其比重还在逐年上升。东部地区就诊积极性更高,选择医院就诊的现象更为明显。基层医疗卫生机构的密度远胜于医院,尽管如此,大部分居民舍近求远选择在医院就诊,基层医疗卫生机构密度大、方便就医的优势并没有得到发挥。第五,全国整体而言,基层医疗卫生机构的综合效率、纯技术效率、规模效率均低于医院。2014年,在全国31个省区中,25.8%的医院、16.1%的基层医疗卫生机构的卫生资源效率为DEA相对有效,这些地区的卫生床位和医师的投入得到了充分的利用,达到了相对的最优产出值。41.9%的医院、12.9%的基层医疗卫生机构的医疗卫生资源投入处于规模报酬递增阶段。29.0%的医院、67.7%的基层医疗卫生机构的医疗卫生资源投入处于规模报酬递减阶段。我国大部分地区的基层医疗卫生机构的规模效率普遍不高。针对我国分级诊疗服务体系的现状问题,并结合国内外的实践经验,为使城乡居民能够真正享受到健康,完善我国医疗卫生服务体制,本文提出以下几点建议。第一,优化医疗卫生资源配置,引导优质医疗卫生资源下沉。第二,推进“医联体”建设,打造“互联网+”医疗服务。第三,提高医疗资源利用效率,提升医疗服务整体效益。
[Abstract]:As mentioned in the relevant opinions on the classification and treatment issued by the State Council, the goal of advancing and grading diagnosis and treatment in 2017 is to improve the allocation of medical and health resources and to promote the effective settlement of high-quality medical resources. The outpatient quantity of the grass-roots medical and health institution accounts for the rise of the overall specific gravity and the improvement of the utilization efficiency of the medical resources and the overall benefit. In this paper, based on the objective of the classification and treatment planning issued by the State Council, the author uses the Kiri factor and the Terre Index to analyze the current situation of the medical resource allocation in the medical service system of the Chinese grading and treatment system, including the number of the doctors and the medical and medical institutions in practice (assistant), so as to improve the allocation of medical and health resources. So as to promote the effective subsidence of high-quality medical resources and propose reasonable suggestions. The present situation of the actual utilization of the medical and health resources of the service system of the diagnosis and treatment service system is analyzed and analyzed, including the outpatient service and the admission service. Finally, using the BCC model of the envelope data analysis method (DEA) to measure the service efficiency of the input-output of our country's health-care institutions at all levels. Reference is made to the rise in the overall specific gravity of the basic health care institutions and the improvement of the use efficiency and overall benefits of medical resources. Based on the analysis of this paper, the following results and conclusions are drawn: First, the medical and medical personnel and material resources in China are over-concentrated in the hospital, and the number of beds in the medical and medical institutions is particularly obvious. In 2014, the hospital of our country has 54.8% of the medical practice (assistant) and 75.2% of the medical and health facilities. Second, the urban and rural difference of medical resource allocation in China is the main reason for the difference of medical resource allocation among the regions. In the 2014 medical resource, the contribution rate between the urban and rural areas of the medical practitioner (assistant) is 62.5%, and the contribution rate between the urban and rural areas of the bed resources is 78.6%. Third, the distribution of medical and health resources in our country is more balanced in the inter-provincial distribution, and the distribution of material resources in the provinces is more balanced than that of the human resources. In 2014, the total Gini coefficient of the practice (assistant) and the bed number is lower than 0.2, and the Gini coefficient of the bed number is lower than that of the medical practitioner (assistant). Fourth, the residents visit the hospital to incline to the hospital. The number of outpatient visits of the grass-roots medical and health institutions is slightly higher than that of the hospital, but the proportion of the hospitals is increasing year by year, while the proportion of the grass-roots medical and health institutions is decreasing year by year. The number of hospital admissions is much higher than that of the grass-roots medical and health institutions, and the specific gravity of the hospital is increasing year by year. It is more positive to see a doctor in the east, and it is more obvious to select a hospital to see a doctor. The density of the grass-roots medical and health institutions is far from that of the hospital. Nevertheless, most of the residents are seeking to go to the hospital for a long time, the density of the grass-roots medical and medical institutions is large, and the advantages of the medical treatment are not brought into play. Fifth, in the whole country, the comprehensive efficiency, the pure technical efficiency and the scale efficiency of the grass-roots medical and health institutions are lower than that of the hospitals. In 2014, 25.8% of the 31 provinces and autonomous regions of the country, 16.1% of the grass-roots medical and health institutions have a relatively effective health resource efficiency, the health bed and the physician's input in these areas have been fully utilized, In the hospital of 41.9%, the medical and health resources of 12.9% of the grass-roots medical and health institutions were put into the progressive stage of scale compensation. In 29.0% of the hospitals, 67.7% of the medical and health resources of the grass-roots medical and health institutions were put into the stage of scale compensation. The scale efficiency of grass-roots medical and health institutions in most parts of China is generally not high. In view of the present situation of our country's classification and treatment service system, and in combination with the practical experience at home and abroad, this paper puts forward the following suggestions in order to make the urban and rural residents truly enjoy the health and improve the health service system in our country. First, optimize the allocation of medical and health resources and guide the sinking of high-quality medical and health resources. Second, advance the construction of the "a union of medicine" and build the "Internet +" medical service. And thirdly, the utilization efficiency of the medical resources is improved, and the overall benefit of the medical service is improved.
【学位授予单位】:华中师范大学
【学位级别】:硕士
【学位授予年份】:2016
【分类号】:R197.1
[Abstract]:As mentioned in the relevant opinions on the classification and treatment issued by the State Council, the goal of advancing and grading diagnosis and treatment in 2017 is to improve the allocation of medical and health resources and to promote the effective settlement of high-quality medical resources. The outpatient quantity of the grass-roots medical and health institution accounts for the rise of the overall specific gravity and the improvement of the utilization efficiency of the medical resources and the overall benefit. In this paper, based on the objective of the classification and treatment planning issued by the State Council, the author uses the Kiri factor and the Terre Index to analyze the current situation of the medical resource allocation in the medical service system of the Chinese grading and treatment system, including the number of the doctors and the medical and medical institutions in practice (assistant), so as to improve the allocation of medical and health resources. So as to promote the effective subsidence of high-quality medical resources and propose reasonable suggestions. The present situation of the actual utilization of the medical and health resources of the service system of the diagnosis and treatment service system is analyzed and analyzed, including the outpatient service and the admission service. Finally, using the BCC model of the envelope data analysis method (DEA) to measure the service efficiency of the input-output of our country's health-care institutions at all levels. Reference is made to the rise in the overall specific gravity of the basic health care institutions and the improvement of the use efficiency and overall benefits of medical resources. Based on the analysis of this paper, the following results and conclusions are drawn: First, the medical and medical personnel and material resources in China are over-concentrated in the hospital, and the number of beds in the medical and medical institutions is particularly obvious. In 2014, the hospital of our country has 54.8% of the medical practice (assistant) and 75.2% of the medical and health facilities. Second, the urban and rural difference of medical resource allocation in China is the main reason for the difference of medical resource allocation among the regions. In the 2014 medical resource, the contribution rate between the urban and rural areas of the medical practitioner (assistant) is 62.5%, and the contribution rate between the urban and rural areas of the bed resources is 78.6%. Third, the distribution of medical and health resources in our country is more balanced in the inter-provincial distribution, and the distribution of material resources in the provinces is more balanced than that of the human resources. In 2014, the total Gini coefficient of the practice (assistant) and the bed number is lower than 0.2, and the Gini coefficient of the bed number is lower than that of the medical practitioner (assistant). Fourth, the residents visit the hospital to incline to the hospital. The number of outpatient visits of the grass-roots medical and health institutions is slightly higher than that of the hospital, but the proportion of the hospitals is increasing year by year, while the proportion of the grass-roots medical and health institutions is decreasing year by year. The number of hospital admissions is much higher than that of the grass-roots medical and health institutions, and the specific gravity of the hospital is increasing year by year. It is more positive to see a doctor in the east, and it is more obvious to select a hospital to see a doctor. The density of the grass-roots medical and health institutions is far from that of the hospital. Nevertheless, most of the residents are seeking to go to the hospital for a long time, the density of the grass-roots medical and medical institutions is large, and the advantages of the medical treatment are not brought into play. Fifth, in the whole country, the comprehensive efficiency, the pure technical efficiency and the scale efficiency of the grass-roots medical and health institutions are lower than that of the hospitals. In 2014, 25.8% of the 31 provinces and autonomous regions of the country, 16.1% of the grass-roots medical and health institutions have a relatively effective health resource efficiency, the health bed and the physician's input in these areas have been fully utilized, In the hospital of 41.9%, the medical and health resources of 12.9% of the grass-roots medical and health institutions were put into the progressive stage of scale compensation. In 29.0% of the hospitals, 67.7% of the medical and health resources of the grass-roots medical and health institutions were put into the stage of scale compensation. The scale efficiency of grass-roots medical and health institutions in most parts of China is generally not high. In view of the present situation of our country's classification and treatment service system, and in combination with the practical experience at home and abroad, this paper puts forward the following suggestions in order to make the urban and rural residents truly enjoy the health and improve the health service system in our country. First, optimize the allocation of medical and health resources and guide the sinking of high-quality medical and health resources. Second, advance the construction of the "a union of medicine" and build the "Internet +" medical service. And thirdly, the utilization efficiency of the medical resources is improved, and the overall benefit of the medical service is improved.
【学位授予单位】:华中师范大学
【学位级别】:硕士
【学位授予年份】:2016
【分类号】:R197.1
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