【摘要】 纵向型区域医疗联合体是纵向整合型卫生服务体系的组织形式,对于实现区域医疗卫生服务整体效能最大化,使有限的卫生投入发挥最大效益,具有重要意义。本文综述了国内在纵向型区域医疗联合体方面的实践和进展,目前绝大部分的模式主要是通过医疗机构自身联合或行政手段支撑,外部政策支持不足,进展阻力较大。发现主要存在外部行政区划分割造成的体制性环境限制,外部运行机制性配套政策支撑不具协同性,各层级医疗机构纵向协作内在动力不足等问题,群众对于创新服务体系的组织形式缺乏理解和认同,区域卫生信息网络化滞后等。建议政府作为主要推动者,开展医联体顶层政策设计;在顶层政策设计下完善外部运行机制的各项配套政策;完善医联体运行的内部治理和外部评价机制;提高基层服务能力,提高患者对基层医疗卫生机构的认同感和信任度;对县域纵向整合型服务体系作出统筹的制度安排。更多还原

【Abstract】 A vertical regional hospital cluster is a kind of vertically integrated medical service system. Such a cluster is important to maximize the effectiveness of regional health services and achieve the best possible results with limited resources. This paper reviews the development of vertical regional hospital clusters in China and discusses the achievements and failings of these clusters. Some of the failings of regional hospital clusters include institutional limitations imposed by external division of administrative areas,lack of policies that support communicating with external operational systems,lack of cooperation between medical facilities at all levels,lack of public awareness of this innovative health service system,and undeveloped regional health IT. It is suggested that it is imperative for the government to push for regional clusters,develop policies from the top down,implement policies for communicating with external operational systems,and improve internal management and external assessment of regional hospital clusters. It is also suggested to upgrade primary health services,encourage patient acceptance of and trust in primary healthcare services,and formulate policies that will lead to the vertical integration of prefecture-wide health resources.更多还原