县域医联体的现状及思考

张茂发安徽省望江县医院医教科，安徽安庆　246200

县域医联体的现状及思考

张茂发
安徽省望江县医院医教科，安徽安庆246200

建设县域医联体需采用纵向整合型医疗卫生联合服务体系，将县级区域医疗卫生服务整体化扩大，增加有限的医疗卫生服务效能及投入，对人民群众的生活及健康具有一定的重要意义。笔者将对国内县域医联体各个方面的现状及问题进行初步思考和总结，并阐述目前县域存在医联体的模式及运行出现的问题，并给予相应的建议。因国内主要医联体模式为医疗机构自身联合或政府行政机关进行支撑，导致县域医疗单位进展阻力较大，医疗信息不完善，资金不足等问题出现。又因政府机关划分出现环境局限性且配套政策不完善，医疗机构行动力不足，人民群众对新服务体系认知度较差，卫生传播信息滞后等，均可导致县域医联体发展出现缺医少药、转上容易转下难等问题。建议医疗行政机构积极开展医联体政策部署，完善各相关机构的运行及配套政策，改善医联体内部管理及建设评价机构，提升整体服务水平，增加广大人民群众对基层医疗机构的认可和信任度，完善县域医联体体系的制度安排。

医联体；分级诊疗；医保；县域医疗卫生服务

［Abstract］The construction of country hospital group service model needs vertically integrated medical and health service system，the overall country medical and health service is enlarged and limited medical and health service efficacy and investment were increased，which is of a certain major significance to the people’s life and health.The writer will initially consider and summarize various statuses and problems of county hospital group service model at home，elaborate the model of country hospital group service model and problems in operation and put forward corresponding suggestions.The bigger progress resistance of country medical unit，incomplete medical information and insufficient fund occur because the major hospital group service model is united medical institution themselves or government and administration for support at home. Shortage of doctors and drugs and easy up-referral and difficult down-referral occur in the development of country hospital group service model due to the limited environment in the government organ division，imperfect supporting policy，insufficient medial institution action force，poor people’s awareness of new service system and hysteretic health communication information.The medical administration institutions are suggested to actively carry out policy deployment of hospital group service model，and we should improve the operation and supporting policies of various relevant institutions，improve the internal management of hospital group service model，building the evaluation institution，improve the whole service level，enhance people’s recognition and credibility of basic medical institutions and improve the system arrangement of the country hospital group service model system.

［Key words］Hospital group service model；Grading diagnosis and treatment；Medical insurance；County medical and health services

国家医改方案中将调整医疗资源配置作为区域医疗卫生体制改革的重要任务，目前医联体作为一项新探索，构建“小病在社区、大病在医院、康复回社区”的分级诊疗模式取得了一定成绩，也面临一些待解决的问题。……