【作者】 余筱燕；

【导师】 王雁红；

【作者基本信息】 宁波大学 ， 公共管理（专业学位）， 2018， 硕士

【摘要】 医疗资源分布不均是造成我国“看病难,看病贵”的重要原因,直接关系到民生问题。在人口老龄化、疾病谱变化、医疗需求提高、医疗费用上涨、政府投入不足、医疗服务效率低下、医疗保险制度不完善和覆盖不全面、私人资本投资迅猛发展等背景下,国家为了促进医疗机构的服务效率、提升管理水平,有效利用有限的医疗资源,促使其合理流动,2013年卫生部长在全国卫生工作会议上提出:“要加快探索建立区域医疗联合体。”区域医疗联合体是公立医院改革的重要趋势。通过几年来医联体的运作,各地区卫生医疗系统进行了大胆的探索,收到了初步的效果。本文的目的是了解宁波市江北三甲综合医院和社区卫生服务中心形成医联体协作的运行状况,提出推动城市两级医疗机构区域医联体合作的进一步建议和措施。本研究釆用文献分析法、头脑风暴法和小组讨论法、人物访谈法、现场调查的研究方法,实行理论与实践相结合、逻辑推理与归纳总结相结合、定性与定量研究相结合的方法。通过五个部分对医改背景下,宁波江北区域医联体现状研究及对策分析展开论述。第一部分,选题的背景及意义,了解国内外研究现状,建立研究框架,明确研究方法。第二部分,明确医联体概念、分类和特点,介绍本研究运用的相关理论。第三部分,综合分析国内外医疗卫生服务体系的发展特点及经验启示。第四部分,以宁波江北区域医疗联合体为例,分析区域医联体的运行状况及存在的问题。第五部分,借鉴国内外经验,完善区域医疗联合体运行的对策及建议。本文通过宁波江北区域医疗联合体的运行现状和医患对其的认知情况分析,认为现行区域医联体运行过程中存在新旧框架体系交叉、转诊困难、医师人力资源利用率低下、检验影像资料的互认度不高、信息化建设广度和深度不足、基层医疗团队业务能力不足、考核制度存在缺失等问题。提出解决问题的对策,包括:明确政府在医联体中的角色与管理职责;完善医联体运行的相关政策法规;提升基层医疗团队业务能力;完善组织内部考核制,促进资源的相对均衡分配;构建多元社会力量参与医联体运作体系;构建多元化、多层次、全方位信息共享平台。更多还原

【Abstract】 An important reason to “hard to have medical care and high medical costs” in our country is uneven distribution of medical resources that is directly related to the people’s livelihood.Because of the aging population,change of disease spectrum,increasing medical demands,rising medical costs,insufficient government investment,inefficient medical services,imperfect and incomprehensive coverage of medical insurance system,rapid development of private capital investments,in order to improve the management and service of medical institutions,make effective and fluently reasonable use of limited medical resources,the Minister of Health in China declared in the National Health Working Conference in 2013 that we need to speed up the exploration of the establishment of regional medical Alliance.Regional Medical Alliance(RMA)is an important trend of public hospital reform,the regional health care systems have made bold exploration on this and got the preliminary achievements with the operation of RMA during the past years.This study is aiming to understand the operation status of RMA between Jiangbei General hospital and Community Health Service Center in Ningbo,provide further suggestions and solutions to promote the collaboration of RMA in the two levels urban medical institutions.The following research methods including literature analysis,brainstorming,panel discussion,interview and field investigation,with integration of theory and practice,combination of logic reasoning and inductive summary,combination of qualitative and quantitative analysis,were applied in this study to discuss the current situation and solutions of Jiangbei RMA in Ningbo.The thesis was divided into five parts: Part Iintroduce the background and significance of the topic,get to know the domestic and international research status,establish the research framework and clarify the methods for research;Part II-clarify the conception,classification and characteristics of RMA,introduce the theories applied in this study;Part III-comprehensively analyze the development characteristics and experience of domestic and foreign medical health service system;Part IV-discuss the operation status and existing problems of RMA by analyzing Jiangbei RMA in Ningbo;Part V,provide suggestions and countermeasures for improvement of RMA by adopting experiences at home and abroad.Based on the analysis of current operation status of Jiangbei RMA in Ningbo and its cognition by the doctors and the patients,we consider that the following problems exist in current RMA operation including cross-over of the old and new frameworks,difficulties in referral,low utilization of physician resources,low mutual recognition of imaging,insufficient breadth and depth of information construction,incapable of primary medical team and lack of assessment system,etc,and put forward the following countermeasures and solutions:the first is to clarify the role and management responsibilities of the government in RMA;the second is to improve the relevant policies and regulations for the operation of RMA;the third is to improve the professional ability of primary medical team;the fourth is to improve the internal assessment system of the organization and promote a relatively balanced distribution of resources;the fifth is to build multi-social forces to participate in the operation system of RMA;the sixth is to build a diversified,multi-level,comprehensive information sharing platform.更多还原