上海市家庭医生制度研究

发布时间：2018-07-09 17:09

本文选题：家庭医生制度 + 成效与瓶颈　；参考：《上海工程技术大学》2016年硕士论文

【摘要】：家庭医生制度,是健全全民医保体系的有力抓手,是进一步深化医疗卫生体制改革的重要途径。在“互联网+”的时代背景和深化医药卫生体制的政策要求下,探索完善上海市家庭医生制度的新路径,不仅是对居民基本健康新需求的积极回应,而且能够提升医疗卫生服务体系的整体运行效率和医疗服务质量。上海作为新医改的排头兵和先行者,在全国的示范辐射效应是不容忽视的,剖析上海市家庭医生制度的实施效应和完善路径,对探析该制度的良性可持续发展具有重要意义,同时也可为全国其他地区家庭医生制度的推进提供可复制可推广的经验借鉴。本文在总结上海市家庭医生制度的建立过程和特点的基础上,科学地选取家庭医生制度的“二元”行为主体——家庭医生和签约居民为调研对象,透过上海市8区21个街道的实地调查,对家庭医生制度的实施效应进行剖析,总结出家庭医生制度取得的成效:家庭医生的签约率和居民满意度较高、社区居民就医的便利性和有序性提高的同时也降低了医疗费用支出、医患关系得到了明显改善、电子健康档案建设初见成效等。但与此同时,也存在着家庭医生数量质量缺口较大、内在激励不足、信息化平台建设有待加强、签约率与居民认同度不匹配和缺乏相应的配套政策等问题。对此,本文从横向和纵向两个视域,提出了完善家庭医生制度的系统化优化模型:在“互联网+”背景下,以完善体制机制建设为主体,以人力资源配置、管理体制设计和自上而下的制度保障为关键环节,通过抓组织、抓管理、抓配套、抓人才等手段,确保家庭医生制度的推进能实现医疗服务供需相匹配、资源配置及医疗服务公平化、各类政策、制度形成配套并协同进步的目标。此外,还需从“五条主线”入手逐步推进家庭医生制度的发展完善:(1)明确家庭医生制各行为主体的职责;(2)阶梯式探索推进“互联网+家庭医生”模式;(3)注重家庭医生人才的培养和考核;(4)完善制度运行事前、事中、事后的管理与监督;(5)完善配套政策与机制设计。
[Abstract]:The family doctor system is a powerful grasp of the health insurance system for the whole people. It is an important way to further deepen the reform of the medical and health system. In the context of the era of "Internet +" and the policy requirements of deepening the medical and health system, the new path of the family doctor system in Shanghai is explored and perfected, which is not only the product of the new needs of the residents' basic health. In response, and can improve the overall operation efficiency and medical service quality of the health service system, Shanghai, as the leader and pioneer of the new medical reform, can not be ignored in the national demonstration radiation effect. The implementation effect and the perfect path of the family doctor system in Shanghai are analyzed, and the benign sustainable development of the system is discussed. On the basis of summarizing the process and characteristics of the establishment of the family doctor system in Shanghai, this paper scientifically selects the "two yuan" behavior subject of the family doctor system, the family doctor and the contract residents, on the basis of the summary of the establishment of the family doctor system in the whole country. Object, through the field investigation of 21 streets in the 8 District of Shanghai, the effect of the family doctor system was analyzed, and the effect of the family doctor system was summarized. The family doctor's signing rate and the residents' satisfaction were higher, the convenience and order of the residents in the community were improved, and the medical expenses were reduced. The relationship between the doctors and patients was obtained. At the same time, there are many problems, such as the large gap between the number and quality of the family doctors, the insufficient internal incentive, the construction of the information platform, the mismatch between the contract rate and the identity of the residents, and the lack of corresponding supporting policies. This article from the horizontal and vertical two horizons, This paper puts forward a systematic optimization model for perfecting the family doctor system: in the context of "Internet +", the key link is to perfect the system and mechanism construction, with human resource allocation, management system design and top-down system guarantee as the key link, and to ensure the promotion of the family doctor system by means of grasping organization, grasping management, grasping matching and grasping talents. It can realize the matching of supply and demand of medical services, the allocation of resources and the fairness of medical service, all kinds of policies and systems to form a matching and coordinated progress. In addition, the development and improvement of the family doctor system should be progressively improved from the "five main lines": (1) clear the responsibilities of the various behavioral subjects of the family doctor system; (2) step by step exploration to promote the "interconnection" Network + family doctor "model"; (3) pay attention to the training and assessment of family doctor talents; (4) improve the system operation before, in the event, after the management and supervision of the post; (5) perfect the supporting policy and mechanism design.
【学位授予单位】：上海工程技术大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1

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