社区居民就医流向剖析及政策建议.docVIP

社区居民就医流向剖析及政策建议 　　摘 要 目的：了解闸北区社区居民就医流向，提出政策建议。方法：采用文献检索、综述、利用卫生统计报表年鉴对闸北区19家公立医疗机构卫生服务提供情况进行描述性分析。结果：2008―2014年闸北区区域医疗机构门、急诊总次数平均增长率在三级医院为13.46%，二级医院为5.15%，社区卫生服务中心为7.04%。2012年上转患者比例为94.16%，下转为5.84%。调整流向后发现，门、急诊费用中有16.35%是由于就医流向不合理导致的。结论：闸北区社区卫生服务中心的卫生服务量已在医疗总服务量中占有一定份额，但离“70%～80%的疾病在社区解决的”WHO标准仍有一段距离。整体就医流向呈现倒置的不合理现状。医保对社区卫生服务中心投入不足，双向转诊不通畅是造成就医流向倒置的主要影响因素。 　　关键字 就医流向 卫生服务提供 影响因素 　　中图分类号：R197.322 文献标识码：A 文章编号：1006-1533（2016）06-0017-04 　　Analysis of the flow direction of the medical service of the community residents and 　　policy recommendations 　　YU Mengzhu， WANG Guangrong 　　（1.Pengpuxinchun Community Health Service Centre of Zhabei District， Shanghai 200435， China； 　　2.Bureau of Human Resources and Social Security of Zhabei District， Shanghai 200070， China） 　　ABSTRACT Objective： To understand the flow direction of the community residents seeking medical service in the Zhabei District to put forward the policy recommendations. Methods： The information of health services provided by 19 public medical institutions in Zhabei District was descriptively analyzed by using literature search， review and health statistics yearbooks. Results： The average annual growth rates of the total number of the outpatient and emergency departments in the tertiary hospitals， secondary hospitals and community health service centers were 13.46%， 5.15% and 7.04% from 2008 to 2014 in Zhabei District， respectively. The proportion of the patients transferred to up level hospitals was 94.16% in 2012， and that transferred to low level hospitals was 5.84%. After the adjustment of the flow direction， 16.35% of the medical expenses were caused by the unreasonable flow of medical service. Conclusion： The medical service volume of the community health service centers has a certain share in the total amount of the medical services in Zhabei District， but there is still a distance from the WHO standard for “70%～80% of disease being treated in the community”. The overall flow of the medical s