【作者】 杜平；

【导师】 张录法；

【作者基本信息】 上海交通大学 ， 公共管理， 2014， 硕士

【摘要】 以“基层首诊、分级诊疗、双向转诊”为核心的分级诊疗制度被视为化解“看病难”“看病贵”一种重要手段,近年来受得广泛的关注和重视。在党的十八届三中全会通过的《中共中央关于全面深化改革若干重大问题的决定》中,将“完善分级诊疗模式,建立社区医生和居民契约服务关系”作为深化医药卫生体制改革重要举措写入文件中。全国各地也进行多种试点,说明分级诊疗在多年的叫好不叫座之后,即将进入全面实施。本文通过五个部分进行研究。第一章,介绍研究的背景、目的和意义、国内外研究综述、概念界定、研究思路与方法。第二章,从理论视角,研究了分级诊疗出发点、进行了利益相关者分析,介绍了三种不同的分级诊疗模式。第三章,以中小城市太仓为例,对其建国以来卫生体制进行分析,总结分级诊疗的兴起、衰退、重构的历史背景及其过程。第四章,采用问卷调查方式,对太仓2所二级医院与3所基层医院的376名患者、222名医务人员进行调查,得出了患者与医务人员对分级诊疗态度存在差异,患者的职业类型、文化程度、家庭总收入等因素,医务人员的工作负荷、工作环境、对基层能力认知等因素均影响了对分级诊疗的态度等结论。第五章,提出完善分级诊疗制度的对策,必须立足实际,实行渐进式改革,完善分级诊疗的动力和保障机制。本研究的创新点在于以中小城市为切入点,而当前的分级诊疗研究主要集中在大城市。不足之处在于研究未能涵盖三级大医院、对双向转诊与部分利益相关者研究仍然不够全面。更多还原

【Abstract】 Taking " grass-roots level treatment, classified diagnose and treatment, two-way transfer treatment" as the core of the classified diagnoses and treatment system, it is regarded as a kind of important means to solve the problem of seeing doctor difficultly and expensively. In the third plenary session of the 18 th central committee of the communist party of China, government adopted the decision of deepening reform of certain major issues, in which perfecting classified diagnose and treatment model and building contract relationship of community doctors and citizens were highlighted as an important move in deepening reform of medical and health system.There are five chapters in this paper. In the first chapter, it introduces the research background, purpose, significance, researches both at home and abroad, definition, research ideas and methods. In the second chapter, in theory perspective, it studies the starting point, analyzes the advocates of classified diagnose and treatment, and it introduces the three different kinds of classified diagnose and treatment. In the third chapter, Taicang was selected as the research background in small and medium-sized cities, this paper analyzes the birth of health system, summarizes the rise of classified diagnose and treatment, and its recession. In the fourth chapter, using the questionnaire, the subjects are 376 patients, 222 medical personnel in Taicang two secondary hospitals and 3 basic-level hospitals. The reasons for different attitudes towards classified diagnose and treatment are patients’ positions, education backgrounds, family income, and doctors’ work load, work environment and cognitive ability to grass-level hospitals. In the fifth chapter, the paper proposes the suggestions that perfecting the classified diagnose and treatment system and security mechanism should base on reality and step by step.The innovation point of this research is taking small and medium-sized cities as the breakthrough point, but the current classified diagnose and treatment research mainly concentrated in the big cities. However, the disadvantage of this research is that it cannot cover tertiary hospitals, and the research regarding to two-way transfer treatment and its advocates is still incomplete.更多还原