分级诊疗制度蕴含的知情选择伦理价值
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摘要
结合2017年底在中国9省份45家医院完成的一项医患问卷调查结果,论证了尊重原则是分级诊疗制度设计重要伦理依据之一,进而提出了分级诊疗实施中遵循知情选择伦理要求的含义及其必要性。并提出建议:加强宣传引导,保障患者知情选择权;把握好行政主导与发挥医疗机构自主性之间的动态平衡。
Based on the results of a doctor-patient questionnaire survey completed in 45 hospitals of 9 provinces in China at the end of 2017,this paper demonstrated that the principle of respect was one of the important ethical bases for the design of the tiered diagnosis and medical treatment system,and then put forward the meaning and necessity of the ethical requirements to follow informed choices in the implementation of the tiered diagnosis and medical treatment system. Furthermore,this paper put forward some suggestions: strengthening publicity and guidance to ensure patients' informed choice,and grasping the dynamic balance between administrative leadership and the autonomy of health care institutions.
Based on the results of a doctor-patient questionnaire survey completed in 45 hospitals of 9 provinces in China at the end of 2017,this paper demonstrated that the principle of respect was one of the important ethical bases for the design of the tiered diagnosis and medical treatment system,and then put forward the meaning and necessity of the ethical requirements to follow informed choices in the implementation of the tiered diagnosis and medical treatment system. Furthermore,this paper put forward some suggestions: strengthening publicity and guidance to ensure patients' informed choice,and grasping the dynamic balance between administrative leadership and the autonomy of health care institutions.
引文
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[15]宋海燕,叶小琴,甄诚,等.北京市医联体内患者基层首诊意愿及其影响因素研究[J].中国卫生政策研究,2018,11(2):30-36.
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[18]姜道新,王楠,谢川,等.基层医院分级诊疗和双向转诊的实施现状与对策[J].中国农村卫生事业管理,2017,37(9):1034-1037.
[19]朱琳,范素芳,申美玲.分级诊疗推进过程中双向转诊问题及对策研究---以某市为例[J].中国冶金工业医学杂志,2018,35(1):8-10.
[20]王橙,张蕾,喻雪双,等.成都市基层医疗卫生机构服务能力现状研究---基于基本医疗服务提供视角[J].卫生经济研究,2018(4):48-51.
[21]李宇飞,王虎峰,李颖,等.患者视角下北京市某区基层首诊制影响因素质性研究[J].中国医院管理,2016,36(2):4-6.
[22]邱仁宗.医联体实践中的认知误区---兼论实现“健康中国”目标的关键[J].医学与哲学,2018,39(6A):1-5.
[2]Kruk M E,Porignon D,Rockers P C,et al.The contribution of primary care to health and health systems in low-and middle-income countries:a critical review of major primary care initiatives[J].Soc Sci Med,2010,70(6):904-911.
[3]Wang H,Gusmano M K,Cao Q.An evaluation of the policy on community health organizations in China:will the priority of new healthcare reform in China be a success?[J].Health Policy,2011,99(1):37-43.
[4]谢宇,于亚敏,佘瑞芳,等.我国分级诊疗发展历程及政策演变研究[J].中国医院管理,2017,37(3):24-27.
[5]肖月,赵琨.分级诊疗政策内涵与理论基础初探[J].中华医院管理杂志,2015(9):641-644.
[6]余红星,姚岚,李莹,等.基于分级诊疗的医疗卫生服务机构分工协作机制探究[J].中国医院管理,2014,34(7):1-3.
[7]辛沁玲,苏敏,方鹏骞,等.我国医疗联合体激励约束机制的关键问题与路径分析[J].中华医院管理杂志,2017(12):889-892.
[8]唐绍军,姜洁,曾利辉,等.分级诊疗中的伦理学思考[J].中国医学伦理学,2017,30(1):98-100.
[9]孙昌林,向小曦.关于新医改医联体建设中的伦理问题探讨[J].中国医学伦理学,2016,29(1):77-79.
[10]刘建伟.从患者权益保障角度完善我国双向转诊制度的立法建议[D].北京:中央民族大学,2016.
[11]Marteau T M,Dormandy E,Michie S.A measure of informed choice[J].Health Expectations,2001,4(2):99-108.
[12]孙君雷,杜学礼,于兴,等.中英社区卫生服务发展模式的对比研究[J].中国卫生产业,2010,7(12):78-85.
[13]黎晓奇,张新庆,高文慧,等.基层医疗卫生机构标准化建设中的问题与对策研究[J].中国卫生事业管理,2017,34(7):488-490.
[14]叶仲书,梅文华,郭文燕,等.珠海地区非高血压、糖尿病的慢性病患者基层首诊意愿及影响因素分析[J].实用预防医学,2017,24(7):889-891.
[15]宋海燕,叶小琴,甄诚,等.北京市医联体内患者基层首诊意愿及其影响因素研究[J].中国卫生政策研究,2018,11(2):30-36.
[16]Johnston M,V9gele C.Benefits of Psychological Preparation for Surgery:a Meta-Analysis[J].Annals of Behavioral Medicine,1993,15(4):245-256.
[17]钟艳宇,陈娟.我国医联体中双向转诊制度的实施现状及对策[J].中国医药导报,2017,14(16):154-158.
[18]姜道新,王楠,谢川,等.基层医院分级诊疗和双向转诊的实施现状与对策[J].中国农村卫生事业管理,2017,37(9):1034-1037.
[19]朱琳,范素芳,申美玲.分级诊疗推进过程中双向转诊问题及对策研究---以某市为例[J].中国冶金工业医学杂志,2018,35(1):8-10.
[20]王橙,张蕾,喻雪双,等.成都市基层医疗卫生机构服务能力现状研究---基于基本医疗服务提供视角[J].卫生经济研究,2018(4):48-51.
[21]李宇飞,王虎峰,李颖,等.患者视角下北京市某区基层首诊制影响因素质性研究[J].中国医院管理,2016,36(2):4-6.
[22]邱仁宗.医联体实践中的认知误区---兼论实现“健康中国”目标的关键[J].医学与哲学,2018,39(6A):1-5.
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