城市医院与社区卫生服务机构双向转诊激励与约束机制研究
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摘要
研究目标
本研究在文献研究的基础上,通过对医院与社区卫生服务机构双向转诊现状进行研究,分析各种双向转诊模式的影响因素以及激励与约束措施,进而建立适合我国实际的双向转诊激励与约束机制以及管理体系,从而实现病人的合理分流,为促进社区卫生服务机构和大中型医院之间双向转诊的实施,完善双向转诊制度提供决策依据。
研究方法
(1)文献回顾与情报分析:广泛查阅国内外双向转诊的有关专著、学术论文、专业杂志期刊以及网上检索相关文献资料,收集国内外双向转诊现状和影响因素、相关制度和运行机制的相关资料,并对收集来的各类文献资料中的主要观点进行归纳总结,作为研究方案的依据;同时收集居民就医行为与意愿的文献资料,为深入分析居民就医行为,合理引导患者就医提供依据;
(2)现场调查:在武汉、深圳、南京、杭州、无锡、苏州等城市,对双向转诊开展较好的社区卫生服务机构和医院进行调查,对卫生管理部门、医保部门管理者进行访谈;收集北京市、上海市、天津市等28个社区卫生服务体系建设重点联系城市2006年双向转诊的有关数据,包括社区卫生服务机构向上级医疗机构转诊的人次数、从医院转回社区卫生服务机构的人次数、管理方式、监督机制、运行机制、医保支付方式、双向转诊流程、信息传递方式及其影响因素等;
(3)专题小组讨论:邀请卫生管理学者、社区卫生专家、卫生行政部门官员、社区卫生服务机构人员、临床专业专家对双向转诊的影响因素和相应的对策建议进行讨论;
(4)居民问卷调查:根据我国城市开展双向转诊情况,在武汉市开展双向转诊的医院和社区卫生服务机构中,随机抽取2-3家二甲以上医院及其有转诊关系的社区卫生服务机构作为调查对象,并按照系统抽样对就医患者440人进行调查;
(5)联合分析法:采用联合分析法对患者就医偏好进行分析,并结合文献资料和个人访谈,对患者就医行为和意愿进行剖析;
(6)利益相关者分析:将政府、医院、社区卫生服务机构以及患者(居民)定义为不同的利益相关者,进行利益相关集团分析,运用归纳演绎等方法,探索其行为特征的相互作用,研究双向转诊的动力和阻力;
(7)PEST分析方法:运用PEST方法,从政治、经济、社会、技术4方面探索影响社区卫生服务机构、医院、居民三者在双向转诊中的深层次因素及其因素内部之间的复杂结构关系。
研究结果
(1)双向转诊现状
对28城市的调查显示,截止2006年12月,以市辖区为单位,只有36.13%的区建立并实施医院与社区卫生服务机构的双向转诊制度,大部分市辖区尚未建立双向转诊制度。2006年平均每个社区卫生服务中心上转病人212人次,而上级医院转回到社区卫生服务中心的人次数仅为56人。目前一些城市选择部分病种开展双向转诊试点。医院和社区卫生服务机构双向转诊的激励与约束措施主要有:以经济手段吸引患者到社区就诊;对转诊的患者减免部分医疗费用;选择部分病种开展双向转诊试点;制定双向转诊的参考指征;政府部门加大对双向转诊的监督考核力度。
(2)双向转诊存在的问题及其原因
从政府、医院、社区卫生服务机构、居民4方面探讨双向转诊存在的问题:政府对机构功能界定不明,没有制定双向转诊的有关法律法规,双向转诊还处于无法可依的阶段,也导致政府对双向转诊缺乏监督和考核依据;医疗保险对双向转诊支持不足,而且支付方式落后,不利于激励和约束医院和社区卫生服务机构的转诊行为。
医院担心因双向转诊而导致收入减少,不愿意将患者转回社区卫生服务机构。
社区卫生服务机构自身技术实力有限,人员水平不够高,居民信任度低。
居民就医时有选择大医院的偏好,就医观念不合理,门诊患者中,4.8%的患者在就诊前自我感觉病情严重,23.1%的患者就诊前自我感觉病情比较严重,由于存在信息不对称,在就医过程中存在非理性因素。
(3)双向转诊的影响因素
通过文献调查并结合专家咨询,影响医院与社区卫生服务机构双向转诊的因素可以归结为三个方面,一是政府相关的配套政策,包括制定双向转诊的上转和下转标准、推进医疗机构信息化建设、发展社区卫生服务措施等,二是医疗保险政策,三是居民就医意愿与行为。
(4)双向转诊激励与约束机制的构建
双向转诊激励与约束机制的前提条件:推进分级医疗,鼓励医院和社区卫生服务机构之间加强协作;制定双向转诊的转诊指征,建立基于临床路径的病种转诊标准;制定双向转诊过程中的医疗质量保障制度;制定转诊信息沟通制度。
政府的激励和监管机制:对双向转诊开展较好的医院和社区卫生服务机构给予一定的经济奖励;出台双向转诊法律法规,确保双向转诊有法可依,建立双向转诊考核指标和标准,加强对双向转诊的考核;加强社区卫生服务能力建设,增强其对居民的吸引力。
强化医疗保险对医院和社区卫生服务机构双向转诊的支持,建立基于医疗保险制度的激励和约束机制:改革医保支付方式,以临床路径为基础,根据疾病不同阶段分别测算急性期住院费用和康复期在社区卫生服务机构继续治疗的费用,医保经办机构分别向医院支付患者急性期住院费用和向社区卫生服务机构支付患者康复期在社区卫生服务机构继续治疗的费用;医保费用的支付与医院和社区双向转诊的考核结果挂钩。
针对居民的激励与约束机制:社区卫生服务机构转变服务模式,提高服务质量,增强居民的信任感,吸引患者到社区首诊;加大对社区卫生服务的宣传力度,转变居民就医观念,引导居民理性就医。
结论与建议
(1)我国的医院与社区卫生服务机构双向转诊还处于起步和探索阶段,部分地方通过一系列的措施,取得一定的成效,但还存在较多问题:下转人数少、转诊标准不明确、激励与约束制度不健全等。
(2)医院与社区卫生服务机构的双向转诊涉及面广,影响因素较多,是个系统工程,单一的激励与约束机制效果有限,应从政府、医疗保险等方面分别建立针对医院、社区卫生服务机构、患者的激励和约束机制。
(3)双向转诊应坚持以患者为中心,政府在推动医院和社区卫生服务机构双向转诊发展过程中应发挥主导作用。
Objective
The study is based on the research of the literature, and the demonstration research of the dual referral between urban hospitals and community health service institutions. It analyses the effect factors and the incentive and restrain measures of the dual referral, and set up the incentive and restraint mechanism of urban dual referral and the manage system which is suitable for our country, that will deliver the patients properly. It will advance the hospital and community health service institutions, and will offer the basis for decision making to the dual referral system.
Methods
1. Review the literature and analyze the information: Reading widely the famous works, the learning discourse, the major magazine and the index literature information on the Internet in and abroad the country. Collecting the information in and abroad about the effect factors, the system and the running system of the dual referral. Concluding the main points of them. They are all the basis of the research. Meanwhile collecting the information of the denizen medical treatment and willings, which provides the basis to the denizen medical treatment and lead patients to have a treatment.
2. Local research: Making research in the hospital and community health service institutions in Wuhan, Shenzhen, Nanjing, Hangzhou, Wuxi, Suzhou, ect, about dual referral; Having interviews with the managers in the health management and the medical insurance institution.
3. The special group discussion: invite the health management scholars, the experts of community heath, the health officials of the executive branch, community health service staff and clinical professional experts to discuss on the dual referral of the factors and the corresponding countermeasures.
4. Residents survey: According to the statu of dual referral in our country, in some hospital and community health service institution in Wuhan, we select optionally 2-3 hospital as the research and make a research among 440 patients in the system.
5. Conjoint analysis: analysis of patient’s preference of medical agencies by conjiont analysis, combine the literature and interviews, and analyze the denizen treatments and willings.
6. Analysis of stakeholders: take the analysis on the related benefit group by defining the government, hospitals, community health service institutions and patients (residents) into different stakeholders. Study the dynamic and resistance of the dual referral by the way of summarized interpretation to explore the interaction of the behavior character.
7. Analysis of PEST: Analyze dual referral with politics, economic, society, technique. And explore the complex structure relationship between the deep-seated causes of the influence and the internal factors among community health service institutions, hospitals and residents.
Results
(1) Status of dual referral
In the survey show that 28 cities, to the city district as a unit, only 36.13 percent of the establishment and implementation of hospitals and community health services dual referral system, in 2006 the average community health service centres referred 212 patients to hospital. And the number of patients return from higher-level hospital to the community health service center is only 56, most of the city area has not yet been established dual referral system. The incentive and restrictive measures of the hospitals and community health services dual referral are: the economic means to attract patients to community treatment; relief to the referral of patients with some medical costs; choice of the disease in dual referral pilot ; Develop dual referral indications; government departments to increase dual referral of the intensity of supervision and examination.
(2) Problems and causes of dual referral
From the government, hospitals, community health service institutions, residents of dual referral to discuss the issue: the definition of the bodies of unknown function, the absence of dual referral of the relevant laws and regulations, dual referral is still unable to follow the stage, but also led to the dual referral lack of basis of supervision and examination. Dual referral was lack of support by medical insurance. And for the backward methods of payment, it was not advance to incentive and restraint the dual referral behavior of hospitals and community health service institutions.
Dual referral hospital due to worries caused by reduced income patients do not want to be back to the community health service agencies.
Community health service institutions its own technical strength is limited, staff level is not high enough, residents of low confidence.
Residents for medical treatment at major hospitals have a choice of preference and to seek medical treatment concept of unreasonable, out-patients, 4.8 percent of patients in attendance before the self-serious condition, 23.1 percent of the former self-treatment in patients with more serious condition, because of asymmetric information, Medical treatment in the course of irrational factors.
(3) Factors affecting of dual referral
Through the combination of literature survey and expert advice, the impact on hospitals and community health service agencies of the dual referral can be attributed to three factors. First, the government of supporting policies, including the development of dual referral on to the next turn and standards. And promoting the construction of medical information, the development of community health services, and other measures, the medical insurance policy, the three wishes of the residents for medical treatment and behavior.
(4) Dual referral incentive and restraint mechanisms construction
According to existing problems and the main factors affecting of dual referral, the construction of the corresponding incentive and restrictive mechanism was provided. The basis of dual referral incentive and restrictive mechanism: promote the ratings medical treatment system to encourage hospitals and community health service institutions to strengthen collaboration; establishment of the medical referral process of quality assurance system: create the referral indications standards, based on the clinical pathway; establish an information sharing platform and communication system.
Government incentives and regulatory mechanism: the better two-way referral to the hospitals and community health service agencies must give economic incentives; introduced dual referral laws and regulations to ensure that dual referral law, the establishment of dual referral assessment indicators And standards to strengthen dual referral of the assessment; strengthen capacity-building of community health services, enhance its attractiveness to the residents.
Strengthening health insurance for hospital and community health service organizations in support of two-way referral, the establishment of the medical insurance system based on the incentive and restrictive mechanism: the reform of medical insurance payments, based on the clinical path, according to the disease were measured at different stages of the acute phase of hospital fees and Rehabilitation of health services in the community to continue treatment of the cost of health insurance agencies were paid to the hospital with acute phase of hospital fees and to pay for community health service organizations in the rehabilitation stage of community health service agencies to continue treatment costs; health insurance costs Cover and dual referral hospitals and communities linked to the examination results.
For residents of the incentive and restrictive mechanism: changes in community health service agencies deliver services, improve service quality and enhance the residents a sense of trust and attract patients to the first community consultation; intensify the promotion of community health services, and changes in residents for medical treatment concepts, to guide residents Reason for medical treatment.
Conclusions and recommendations
(1) Dual referral of hospitals and community health service institutions was at the initial stage of exploration, in part through a series of measures, and achieved certain results. However, there were some problems of dual referral, including the number of referred from hospital to community health service institutions being too less, lack of the standard of dual referral, lack of incentive and restraint mechanisms.
(2) Hospitals and community health service organizations involved in a wide range of dual referral, is a systems engineering project, a single incentive and restraint mechanism limited effect, respectively, should be established for hospitals, community health service institutions, with the incentive and restraint mechanisms from government and medical insurance.
(3) The dual referral should be patients-oriental; the government should play a leading role in promoting dual referral process.
本研究在文献研究的基础上,通过对医院与社区卫生服务机构双向转诊现状进行研究,分析各种双向转诊模式的影响因素以及激励与约束措施,进而建立适合我国实际的双向转诊激励与约束机制以及管理体系,从而实现病人的合理分流,为促进社区卫生服务机构和大中型医院之间双向转诊的实施,完善双向转诊制度提供决策依据。
研究方法
(1)文献回顾与情报分析:广泛查阅国内外双向转诊的有关专著、学术论文、专业杂志期刊以及网上检索相关文献资料,收集国内外双向转诊现状和影响因素、相关制度和运行机制的相关资料,并对收集来的各类文献资料中的主要观点进行归纳总结,作为研究方案的依据;同时收集居民就医行为与意愿的文献资料,为深入分析居民就医行为,合理引导患者就医提供依据;
(2)现场调查:在武汉、深圳、南京、杭州、无锡、苏州等城市,对双向转诊开展较好的社区卫生服务机构和医院进行调查,对卫生管理部门、医保部门管理者进行访谈;收集北京市、上海市、天津市等28个社区卫生服务体系建设重点联系城市2006年双向转诊的有关数据,包括社区卫生服务机构向上级医疗机构转诊的人次数、从医院转回社区卫生服务机构的人次数、管理方式、监督机制、运行机制、医保支付方式、双向转诊流程、信息传递方式及其影响因素等;
(3)专题小组讨论:邀请卫生管理学者、社区卫生专家、卫生行政部门官员、社区卫生服务机构人员、临床专业专家对双向转诊的影响因素和相应的对策建议进行讨论;
(4)居民问卷调查:根据我国城市开展双向转诊情况,在武汉市开展双向转诊的医院和社区卫生服务机构中,随机抽取2-3家二甲以上医院及其有转诊关系的社区卫生服务机构作为调查对象,并按照系统抽样对就医患者440人进行调查;
(5)联合分析法:采用联合分析法对患者就医偏好进行分析,并结合文献资料和个人访谈,对患者就医行为和意愿进行剖析;
(6)利益相关者分析:将政府、医院、社区卫生服务机构以及患者(居民)定义为不同的利益相关者,进行利益相关集团分析,运用归纳演绎等方法,探索其行为特征的相互作用,研究双向转诊的动力和阻力;
(7)PEST分析方法:运用PEST方法,从政治、经济、社会、技术4方面探索影响社区卫生服务机构、医院、居民三者在双向转诊中的深层次因素及其因素内部之间的复杂结构关系。
研究结果
(1)双向转诊现状
对28城市的调查显示,截止2006年12月,以市辖区为单位,只有36.13%的区建立并实施医院与社区卫生服务机构的双向转诊制度,大部分市辖区尚未建立双向转诊制度。2006年平均每个社区卫生服务中心上转病人212人次,而上级医院转回到社区卫生服务中心的人次数仅为56人。目前一些城市选择部分病种开展双向转诊试点。医院和社区卫生服务机构双向转诊的激励与约束措施主要有:以经济手段吸引患者到社区就诊;对转诊的患者减免部分医疗费用;选择部分病种开展双向转诊试点;制定双向转诊的参考指征;政府部门加大对双向转诊的监督考核力度。
(2)双向转诊存在的问题及其原因
从政府、医院、社区卫生服务机构、居民4方面探讨双向转诊存在的问题:政府对机构功能界定不明,没有制定双向转诊的有关法律法规,双向转诊还处于无法可依的阶段,也导致政府对双向转诊缺乏监督和考核依据;医疗保险对双向转诊支持不足,而且支付方式落后,不利于激励和约束医院和社区卫生服务机构的转诊行为。
医院担心因双向转诊而导致收入减少,不愿意将患者转回社区卫生服务机构。
社区卫生服务机构自身技术实力有限,人员水平不够高,居民信任度低。
居民就医时有选择大医院的偏好,就医观念不合理,门诊患者中,4.8%的患者在就诊前自我感觉病情严重,23.1%的患者就诊前自我感觉病情比较严重,由于存在信息不对称,在就医过程中存在非理性因素。
(3)双向转诊的影响因素
通过文献调查并结合专家咨询,影响医院与社区卫生服务机构双向转诊的因素可以归结为三个方面,一是政府相关的配套政策,包括制定双向转诊的上转和下转标准、推进医疗机构信息化建设、发展社区卫生服务措施等,二是医疗保险政策,三是居民就医意愿与行为。
(4)双向转诊激励与约束机制的构建
双向转诊激励与约束机制的前提条件:推进分级医疗,鼓励医院和社区卫生服务机构之间加强协作;制定双向转诊的转诊指征,建立基于临床路径的病种转诊标准;制定双向转诊过程中的医疗质量保障制度;制定转诊信息沟通制度。
政府的激励和监管机制:对双向转诊开展较好的医院和社区卫生服务机构给予一定的经济奖励;出台双向转诊法律法规,确保双向转诊有法可依,建立双向转诊考核指标和标准,加强对双向转诊的考核;加强社区卫生服务能力建设,增强其对居民的吸引力。
强化医疗保险对医院和社区卫生服务机构双向转诊的支持,建立基于医疗保险制度的激励和约束机制:改革医保支付方式,以临床路径为基础,根据疾病不同阶段分别测算急性期住院费用和康复期在社区卫生服务机构继续治疗的费用,医保经办机构分别向医院支付患者急性期住院费用和向社区卫生服务机构支付患者康复期在社区卫生服务机构继续治疗的费用;医保费用的支付与医院和社区双向转诊的考核结果挂钩。
针对居民的激励与约束机制:社区卫生服务机构转变服务模式,提高服务质量,增强居民的信任感,吸引患者到社区首诊;加大对社区卫生服务的宣传力度,转变居民就医观念,引导居民理性就医。
结论与建议
(1)我国的医院与社区卫生服务机构双向转诊还处于起步和探索阶段,部分地方通过一系列的措施,取得一定的成效,但还存在较多问题:下转人数少、转诊标准不明确、激励与约束制度不健全等。
(2)医院与社区卫生服务机构的双向转诊涉及面广,影响因素较多,是个系统工程,单一的激励与约束机制效果有限,应从政府、医疗保险等方面分别建立针对医院、社区卫生服务机构、患者的激励和约束机制。
(3)双向转诊应坚持以患者为中心,政府在推动医院和社区卫生服务机构双向转诊发展过程中应发挥主导作用。
Objective
The study is based on the research of the literature, and the demonstration research of the dual referral between urban hospitals and community health service institutions. It analyses the effect factors and the incentive and restrain measures of the dual referral, and set up the incentive and restraint mechanism of urban dual referral and the manage system which is suitable for our country, that will deliver the patients properly. It will advance the hospital and community health service institutions, and will offer the basis for decision making to the dual referral system.
Methods
1. Review the literature and analyze the information: Reading widely the famous works, the learning discourse, the major magazine and the index literature information on the Internet in and abroad the country. Collecting the information in and abroad about the effect factors, the system and the running system of the dual referral. Concluding the main points of them. They are all the basis of the research. Meanwhile collecting the information of the denizen medical treatment and willings, which provides the basis to the denizen medical treatment and lead patients to have a treatment.
2. Local research: Making research in the hospital and community health service institutions in Wuhan, Shenzhen, Nanjing, Hangzhou, Wuxi, Suzhou, ect, about dual referral; Having interviews with the managers in the health management and the medical insurance institution.
3. The special group discussion: invite the health management scholars, the experts of community heath, the health officials of the executive branch, community health service staff and clinical professional experts to discuss on the dual referral of the factors and the corresponding countermeasures.
4. Residents survey: According to the statu of dual referral in our country, in some hospital and community health service institution in Wuhan, we select optionally 2-3 hospital as the research and make a research among 440 patients in the system.
5. Conjoint analysis: analysis of patient’s preference of medical agencies by conjiont analysis, combine the literature and interviews, and analyze the denizen treatments and willings.
6. Analysis of stakeholders: take the analysis on the related benefit group by defining the government, hospitals, community health service institutions and patients (residents) into different stakeholders. Study the dynamic and resistance of the dual referral by the way of summarized interpretation to explore the interaction of the behavior character.
7. Analysis of PEST: Analyze dual referral with politics, economic, society, technique. And explore the complex structure relationship between the deep-seated causes of the influence and the internal factors among community health service institutions, hospitals and residents.
Results
(1) Status of dual referral
In the survey show that 28 cities, to the city district as a unit, only 36.13 percent of the establishment and implementation of hospitals and community health services dual referral system, in 2006 the average community health service centres referred 212 patients to hospital. And the number of patients return from higher-level hospital to the community health service center is only 56, most of the city area has not yet been established dual referral system. The incentive and restrictive measures of the hospitals and community health services dual referral are: the economic means to attract patients to community treatment; relief to the referral of patients with some medical costs; choice of the disease in dual referral pilot ; Develop dual referral indications; government departments to increase dual referral of the intensity of supervision and examination.
(2) Problems and causes of dual referral
From the government, hospitals, community health service institutions, residents of dual referral to discuss the issue: the definition of the bodies of unknown function, the absence of dual referral of the relevant laws and regulations, dual referral is still unable to follow the stage, but also led to the dual referral lack of basis of supervision and examination. Dual referral was lack of support by medical insurance. And for the backward methods of payment, it was not advance to incentive and restraint the dual referral behavior of hospitals and community health service institutions.
Dual referral hospital due to worries caused by reduced income patients do not want to be back to the community health service agencies.
Community health service institutions its own technical strength is limited, staff level is not high enough, residents of low confidence.
Residents for medical treatment at major hospitals have a choice of preference and to seek medical treatment concept of unreasonable, out-patients, 4.8 percent of patients in attendance before the self-serious condition, 23.1 percent of the former self-treatment in patients with more serious condition, because of asymmetric information, Medical treatment in the course of irrational factors.
(3) Factors affecting of dual referral
Through the combination of literature survey and expert advice, the impact on hospitals and community health service agencies of the dual referral can be attributed to three factors. First, the government of supporting policies, including the development of dual referral on to the next turn and standards. And promoting the construction of medical information, the development of community health services, and other measures, the medical insurance policy, the three wishes of the residents for medical treatment and behavior.
(4) Dual referral incentive and restraint mechanisms construction
According to existing problems and the main factors affecting of dual referral, the construction of the corresponding incentive and restrictive mechanism was provided. The basis of dual referral incentive and restrictive mechanism: promote the ratings medical treatment system to encourage hospitals and community health service institutions to strengthen collaboration; establishment of the medical referral process of quality assurance system: create the referral indications standards, based on the clinical pathway; establish an information sharing platform and communication system.
Government incentives and regulatory mechanism: the better two-way referral to the hospitals and community health service agencies must give economic incentives; introduced dual referral laws and regulations to ensure that dual referral law, the establishment of dual referral assessment indicators And standards to strengthen dual referral of the assessment; strengthen capacity-building of community health services, enhance its attractiveness to the residents.
Strengthening health insurance for hospital and community health service organizations in support of two-way referral, the establishment of the medical insurance system based on the incentive and restrictive mechanism: the reform of medical insurance payments, based on the clinical path, according to the disease were measured at different stages of the acute phase of hospital fees and Rehabilitation of health services in the community to continue treatment of the cost of health insurance agencies were paid to the hospital with acute phase of hospital fees and to pay for community health service organizations in the rehabilitation stage of community health service agencies to continue treatment costs; health insurance costs Cover and dual referral hospitals and communities linked to the examination results.
For residents of the incentive and restrictive mechanism: changes in community health service agencies deliver services, improve service quality and enhance the residents a sense of trust and attract patients to the first community consultation; intensify the promotion of community health services, and changes in residents for medical treatment concepts, to guide residents Reason for medical treatment.
Conclusions and recommendations
(1) Dual referral of hospitals and community health service institutions was at the initial stage of exploration, in part through a series of measures, and achieved certain results. However, there were some problems of dual referral, including the number of referred from hospital to community health service institutions being too less, lack of the standard of dual referral, lack of incentive and restraint mechanisms.
(2) Hospitals and community health service organizations involved in a wide range of dual referral, is a systems engineering project, a single incentive and restraint mechanism limited effect, respectively, should be established for hospitals, community health service institutions, with the incentive and restraint mechanisms from government and medical insurance.
(3) The dual referral should be patients-oriental; the government should play a leading role in promoting dual referral process.
引文
[1]刘洋,王小万.双向转诊制度问题探讨.中国医院管理,2004,24(12):72-73
[2] Ingram DV, Culham LE. Ophthalmologists and optometrists—interesting times? Br J Ophthalmol 2001,85:769–70
[3]劳社部发〔2006〕23号参保人员充分利用社区卫生服务的指导意见
[4]卫医发〔2006〕244号.关于公立医院支援社区卫生服务工作的意见
[5]蒋景春,扬世昌.北京市宣武区社区卫生服务双向转诊机制初探.中国全科医学,2002,5(1):35-37
[6]杜雪平,周海虹,钱宁.社区卫生服务机构改变患者就医模式的初步探索.中华医院管理杂志,2004,20(10):603-605
[7]陈子敏,唐瑛,彭晓明等.深圳市宝安区双向转诊制度实施现状分析.中国卫生事业管理,2004(4):227-228
[8]汤仕忠,吴佩华,洪大蓉等.城市医院与社区卫生服务机构互动模式构建及其意义.现代医学,2005,33(1):47-49
[9]汤仕忠,吴佩华,肖亦辉等.基于网络平台的城市大医院与社区卫生服务机构互动模式的构建和运行方式的探讨.中国新医药,2004,3(8):132-134
[10]宁政办发〔2006〕81号.关于开展社区首诊制及双向转诊试点工作的意见
[11]沈政办发[2005]41号.沈阳市民政局等部门关于进一步完善城市特困居民医疗救助制度的实施意见
[12]卫生部妇社司.全国城市社区卫生服务现状调查资料.2005
[13]葛军,陈允硕,吴敏生等.糖尿病患者双向转诊模式及其效果初探.中华全科医师杂志,2004,3(5):293-296
[14]代慧.社区卫生服务从单向上转完善到双向转诊的途径研究.中国医院管理,2006,26(6):61-62
[15]刘梅,陈金华,彭晓明.社区卫生服务实施双向转诊存在的问题及对策.中国卫生事业管理,2004(4):226
[16]韩方群.中、澳社区卫生服务的比较及启示.中国全科医学,2005,8(18):1506-1507
[17]王鸿勇,翟强.城市卫生服务体系的问题、弊端与改革策略.中国卫生经济,2000,19(5):27-28
[18] Graybeal K B, Green M, Mckenna B. Clinical Pathway development. The overlake model.Nurs Manage,1993 Apr 24:42-45
[19]董军.临床路径的特点与应用.中国医院管理,2003,23(6):11-12
[20]周海虹,杜雪,平钱宁等.2型糖尿病患者双向转诊临床路径应用的初步研究.中华全科医师杂志,2004,3(4):245-248
[21]梁万年,曹红霞,路孝琴等.城市社区2型糖尿病诊治临床路径的设计及双向转诊机制的建立.中华全科医师杂志,2005,4(3):156-161
[22]刘民,曹红霞,梁万年等城市社区2型糖尿病双向转诊路径应用的评价研究.中国全科医学,2005,8(5):347-349
[23]梁万年,曹红霞,路孝琴等.城市社区高血压临床路径的研制及双向转诊机制的建立.中华全科医师杂志,2005,8(6):433-436
[24]曹红霞,陈琦,杜雪平等.城市社区高血压双向转诊路径的应用评价.中国全科医学,2005,8(6):437-439
[25]梁万年,路孝琴,陈琦等.城市社区冠心病临床路径的研制及双向转诊机制的建立.中华全科医师杂志,2005,8(7):529-534
[26]路孝琴,杜雪平,曹红霞等.城市社区冠心病双向转诊路径应用的评价研究.中国全科医学,2005,8(7):538-540
[27]李菁,杜雪平,钱宁等.城市社区四种慢性病应用双向转诊临床路径的院前时间评价.中国全科医学,2005,8(4):297-298
[28]严春泽.城市社区高血压病双向转诊机制的建立与实施.中华医院管理杂志,2005,22(7):464-466
[29]梁万年,王亚东,杨兴华等.全国社区卫生服务现状调查.中国全科医学,2005,8(9):705-708
[30]张宇,肖十力,张拓红等.社区卫生服务机构与医院双向转诊实现途径和管理办法的研究.中国全科医学,2002,25(2):123-125
[31]杨建南,卢洪岩,刘勇华.成都市民看病不选择社区卫生服务机构的原因分析.卫生经济研究,2006,(10):32-33
[32]陆云霞.武汉市门诊病人选择就诊医院的影响因素分析.中国医院统计,2003,10(3):143-145
[33]马翔,李宁秀,任晓晖等.某区双向转诊实施机构人员认知行为调查.现代预防医学,2005,32(5):543-545
[34] Adam Oliver. The English National Health Service: 1979-2005.Published online in Wiley InterScience
[35] Department of Health. Delivering health and social care. http://www.dh.gov.uk
36 Gert H.Brieger. The National Health Service. A Political History. New edition. Oxford: Oxford University Press,2002
[37]刘吉成.英国卫生服务“守门人”模式的启示――中国卫生服务实行“守门人”模式的构想.中国卫生经济,2004,23(2):77-78 T[38] B J W Evans, D E Harle,B Cocco.T Optometric referrals: towards a two way flow of information? British Journal of Ophthalmology,2005,89:1663
[39] Lash SC. Assessment of information included on the GOS 18 referral form used by optometrists. Ophthalmic Physiol Opt 2003;23:21–3.
[40]刘利群,吕春雷.澳大利亚社区卫生服务的提供体系及启示.中国全科医学2002,5(1):40-42
[41] Adolf Stepan, Margit Sommersguter-Reichmann. Monitoring political decision-making and its impact in Austria. Published online in Wiley InterScience
[42] Mary Courtney. Financial Management in Health Services. First published 1997.Australia. Maclenna & Petty Pty Limited
[43]崔颖.澳大利亚的社区卫生服务与制约激励机制及其启发.中国全科医学,2002,5(11):927-930
[44]高大林.德国卫生保健制度.《国外医学》卫生经济分册,1998,15(4):145-148
[45] WHO Regional Office for Europe et. European Observatory on Health Care Systems (Germany).2000
[46] Gerlach FM, Szecsenyi J.Warum sollten Disease Management Progamme hausarztorientiert sein? Gruende , Grenzen und Herausforderungen. Deutsches Aerzteblatt,2002,99:20-26
[47] WONCA. The European definition of general practice/family medicine. World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/ Family Physicians, 2002 48 Boerma W. Flaming DM. The role of general practice in primary health care. Geneva: World Health Organization. 1998
[49]周宇,郑树忠,孙国祯.德国的DRG付费制度.中国卫生资源,2004,7(3):139-141
[50]张莹.中外社区卫生服务模式的比较与借鉴.中国卫生事业管理,2003(7):419-420
[51] Steven .Jonas. An introduction to the U.S. health care system. New York: Springer publishing company, 1998
[52] Keith H .Bachman, Donald K .Freeborn. HMO physicians'use of referral. Social Science & Medicine 48(1999):547-557
[53]郝晓宁,李士雪,李湘江.美国社区卫生服务运行机制和管理模式研究.医学与哲学(人文科学学版),2006,27(8):22-23 54 Patricia R. Loubeau, Robert Jantzen. The effect of managed care on hospital marketing orientation. Journal of management, 1998,43(3):229-241
[55] Charles A. Mowll. Assessing the effect of increased managed care on hospitals. Journal of healthcare management, 1998,43(1):68-81
[56] Jack E. Fincham. Pharmacy and the U.S. health care system. New York: The Haworth press, 1998
[57] Byd. June Foker, clinical pathway benefits and liabilities. Nurs Manage,1996,27(11):35-38
[58] Chang-P-L,Use of the transurethral prostatectomy clinical path to monitor health outcomes. J-Urol,1997 Jan,157(1):177-83
[59] Cheah-T-S;The impact of clinical guidelines and clinical pathways on medical practice: effectiveness and medico-legal aspects. Ann-Acad -Med-Singapore.1998 July,27(4):533-539
[60] Wazeka,-A; Valacer,-D-J;Impact of a pediatric asthma clinical pathway on hospital cost and length of stay. Pediatr-Pulmonol,2001,32 (3):211-216
[61]昆仑.严格就医流程和转诊制度――巴西社区卫生服务发展.中国社区医师,2006,23(13):6
[2] Ingram DV, Culham LE. Ophthalmologists and optometrists—interesting times? Br J Ophthalmol 2001,85:769–70
[3]劳社部发〔2006〕23号参保人员充分利用社区卫生服务的指导意见
[4]卫医发〔2006〕244号.关于公立医院支援社区卫生服务工作的意见
[5]蒋景春,扬世昌.北京市宣武区社区卫生服务双向转诊机制初探.中国全科医学,2002,5(1):35-37
[6]杜雪平,周海虹,钱宁.社区卫生服务机构改变患者就医模式的初步探索.中华医院管理杂志,2004,20(10):603-605
[7]陈子敏,唐瑛,彭晓明等.深圳市宝安区双向转诊制度实施现状分析.中国卫生事业管理,2004(4):227-228
[8]汤仕忠,吴佩华,洪大蓉等.城市医院与社区卫生服务机构互动模式构建及其意义.现代医学,2005,33(1):47-49
[9]汤仕忠,吴佩华,肖亦辉等.基于网络平台的城市大医院与社区卫生服务机构互动模式的构建和运行方式的探讨.中国新医药,2004,3(8):132-134
[10]宁政办发〔2006〕81号.关于开展社区首诊制及双向转诊试点工作的意见
[11]沈政办发[2005]41号.沈阳市民政局等部门关于进一步完善城市特困居民医疗救助制度的实施意见
[12]卫生部妇社司.全国城市社区卫生服务现状调查资料.2005
[13]葛军,陈允硕,吴敏生等.糖尿病患者双向转诊模式及其效果初探.中华全科医师杂志,2004,3(5):293-296
[14]代慧.社区卫生服务从单向上转完善到双向转诊的途径研究.中国医院管理,2006,26(6):61-62
[15]刘梅,陈金华,彭晓明.社区卫生服务实施双向转诊存在的问题及对策.中国卫生事业管理,2004(4):226
[16]韩方群.中、澳社区卫生服务的比较及启示.中国全科医学,2005,8(18):1506-1507
[17]王鸿勇,翟强.城市卫生服务体系的问题、弊端与改革策略.中国卫生经济,2000,19(5):27-28
[18] Graybeal K B, Green M, Mckenna B. Clinical Pathway development. The overlake model.Nurs Manage,1993 Apr 24:42-45
[19]董军.临床路径的特点与应用.中国医院管理,2003,23(6):11-12
[20]周海虹,杜雪,平钱宁等.2型糖尿病患者双向转诊临床路径应用的初步研究.中华全科医师杂志,2004,3(4):245-248
[21]梁万年,曹红霞,路孝琴等.城市社区2型糖尿病诊治临床路径的设计及双向转诊机制的建立.中华全科医师杂志,2005,4(3):156-161
[22]刘民,曹红霞,梁万年等城市社区2型糖尿病双向转诊路径应用的评价研究.中国全科医学,2005,8(5):347-349
[23]梁万年,曹红霞,路孝琴等.城市社区高血压临床路径的研制及双向转诊机制的建立.中华全科医师杂志,2005,8(6):433-436
[24]曹红霞,陈琦,杜雪平等.城市社区高血压双向转诊路径的应用评价.中国全科医学,2005,8(6):437-439
[25]梁万年,路孝琴,陈琦等.城市社区冠心病临床路径的研制及双向转诊机制的建立.中华全科医师杂志,2005,8(7):529-534
[26]路孝琴,杜雪平,曹红霞等.城市社区冠心病双向转诊路径应用的评价研究.中国全科医学,2005,8(7):538-540
[27]李菁,杜雪平,钱宁等.城市社区四种慢性病应用双向转诊临床路径的院前时间评价.中国全科医学,2005,8(4):297-298
[28]严春泽.城市社区高血压病双向转诊机制的建立与实施.中华医院管理杂志,2005,22(7):464-466
[29]梁万年,王亚东,杨兴华等.全国社区卫生服务现状调查.中国全科医学,2005,8(9):705-708
[30]张宇,肖十力,张拓红等.社区卫生服务机构与医院双向转诊实现途径和管理办法的研究.中国全科医学,2002,25(2):123-125
[31]杨建南,卢洪岩,刘勇华.成都市民看病不选择社区卫生服务机构的原因分析.卫生经济研究,2006,(10):32-33
[32]陆云霞.武汉市门诊病人选择就诊医院的影响因素分析.中国医院统计,2003,10(3):143-145
[33]马翔,李宁秀,任晓晖等.某区双向转诊实施机构人员认知行为调查.现代预防医学,2005,32(5):543-545
[34] Adam Oliver. The English National Health Service: 1979-2005.Published online in Wiley InterScience
[35] Department of Health. Delivering health and social care. http://www.dh.gov.uk
36 Gert H.Brieger. The National Health Service. A Political History. New edition. Oxford: Oxford University Press,2002
[37]刘吉成.英国卫生服务“守门人”模式的启示――中国卫生服务实行“守门人”模式的构想.中国卫生经济,2004,23(2):77-78 T[38] B J W Evans, D E Harle,B Cocco.T Optometric referrals: towards a two way flow of information? British Journal of Ophthalmology,2005,89:1663
[39] Lash SC. Assessment of information included on the GOS 18 referral form used by optometrists. Ophthalmic Physiol Opt 2003;23:21–3.
[40]刘利群,吕春雷.澳大利亚社区卫生服务的提供体系及启示.中国全科医学2002,5(1):40-42
[41] Adolf Stepan, Margit Sommersguter-Reichmann. Monitoring political decision-making and its impact in Austria. Published online in Wiley InterScience
[42] Mary Courtney. Financial Management in Health Services. First published 1997.Australia. Maclenna & Petty Pty Limited
[43]崔颖.澳大利亚的社区卫生服务与制约激励机制及其启发.中国全科医学,2002,5(11):927-930
[44]高大林.德国卫生保健制度.《国外医学》卫生经济分册,1998,15(4):145-148
[45] WHO Regional Office for Europe et. European Observatory on Health Care Systems (Germany).2000
[46] Gerlach FM, Szecsenyi J.Warum sollten Disease Management Progamme hausarztorientiert sein? Gruende , Grenzen und Herausforderungen. Deutsches Aerzteblatt,2002,99:20-26
[47] WONCA. The European definition of general practice/family medicine. World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/ Family Physicians, 2002 48 Boerma W. Flaming DM. The role of general practice in primary health care. Geneva: World Health Organization. 1998
[49]周宇,郑树忠,孙国祯.德国的DRG付费制度.中国卫生资源,2004,7(3):139-141
[50]张莹.中外社区卫生服务模式的比较与借鉴.中国卫生事业管理,2003(7):419-420
[51] Steven .Jonas. An introduction to the U.S. health care system. New York: Springer publishing company, 1998
[52] Keith H .Bachman, Donald K .Freeborn. HMO physicians'use of referral. Social Science & Medicine 48(1999):547-557
[53]郝晓宁,李士雪,李湘江.美国社区卫生服务运行机制和管理模式研究.医学与哲学(人文科学学版),2006,27(8):22-23 54 Patricia R. Loubeau, Robert Jantzen. The effect of managed care on hospital marketing orientation. Journal of management, 1998,43(3):229-241
[55] Charles A. Mowll. Assessing the effect of increased managed care on hospitals. Journal of healthcare management, 1998,43(1):68-81
[56] Jack E. Fincham. Pharmacy and the U.S. health care system. New York: The Haworth press, 1998
[57] Byd. June Foker, clinical pathway benefits and liabilities. Nurs Manage,1996,27(11):35-38
[58] Chang-P-L,Use of the transurethral prostatectomy clinical path to monitor health outcomes. J-Urol,1997 Jan,157(1):177-83
[59] Cheah-T-S;The impact of clinical guidelines and clinical pathways on medical practice: effectiveness and medico-legal aspects. Ann-Acad -Med-Singapore.1998 July,27(4):533-539
[60] Wazeka,-A; Valacer,-D-J;Impact of a pediatric asthma clinical pathway on hospital cost and length of stay. Pediatr-Pulmonol,2001,32 (3):211-216
[61]昆仑.严格就医流程和转诊制度――巴西社区卫生服务发展.中国社区医师,2006,23(13):6
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