作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Current Situation, Challenges and Suggestions for the Development of Primary Health Care Services in China in the Post Pandemic Era
-
摘要: 基层医疗机构是我国医疗卫生服务体系的主力军, 是国家卫生保健系统的基石。在COVID-19疫情期间, 我国基层医疗机构发挥了巨大作用, 但同时也凸显出许多短板。本文通过系统文献检索与分析, 发现我国基层医疗机构存在患者就医需求不高、卫生系统整合性不强、服务基础薄弱、突发公共卫生事件应急能力不足等问题, 据此提出基于"三力理论"的基层医疗机构建设策略, 以期为完善基层医疗卫生服务体系、提升基层医疗卫生服务能力、更好地完成"健康中国2030"战略目标提供参考。
-
关键词:
- COVID-19 /
- 疫情 /
- 基层医疗卫生服务机构 /
- 突发公共卫生事件 /
- 初级卫生保健
Abstract: Primary health care institutions should be the main force of China's medical and health service system and the cornerstone of the national health care system. During the COVID-19 pandemic, China's primary health care institutions played a critical role, but many deficiencies and weaknesses were also highlighted. Through systematic literature search and analysis, this article finds that China's primary health care institutions have some problems such as low demand for patient care, weak integration of the health system, weak service foundation, and insufficient emergency response capacity for public health emergencies. Accordingly, we put forward a strategy for the construction of primary health care institutions based on the "Three Forces Theory", which aims to improve the primary medical and health care service system, upgrade the capacity of primary medical and health care services, and better fulfill the strategic goal of "Healthy China 2030".-
Key words:
- COVID-19 /
- epidemic /
- primary health care institutions /
- public health emergency /
- primary health care
作者贡献：柯丹丹负责选题设计、文献检索及论文撰写；贾楠负责选题的可行性分析及论文修订；崔埔安负责论文修订；何仲负责论文质控与审校。利益冲突：所有作者均声明不存在利益冲突 -
图 1 2015—2020年我国基层医疗机构人员经费支出占比
Figure 1. The proportion of personnel expenditure in primary health care institutions in China from 2015 to 2020
表 1 2015—2020年我国医疗机构床位数及同期增长率[8-13]
Table 1. Number of beds and growth rate of health care institutions in China from 2015 to 2020[8-13]
年份 基层医疗机构 医院 床位数
(万张)同期增长率
(%)床位数
(万张)同期增长率
(%)2015 141.38 - 533.06 - 2016 141.19 -0.13 568.89 6.72 2017 152.85 8.26 612.05 7.59 2018 158.36 5.51 651.97 6.52 2019 163.11 3.60 686.65 5.32 2020 164.94 1.12 713.12 3.85 
下载: 导出CSV
表 2 2015—2020年我国全科医师数量及学历构成[8-13]
Table 2. Number and educational composition of general practitioners in China from 2015 to 2020[8-13]
年份 全科医师总数
(n)全科医师类型[n(%)] 社区卫生执业人员学历构成(%) 注册为全科医学专业 取得全科医师培训资格证 硕士及以上 大学本科 大专 2015 188 649 68 364(36.24) 120 285(63.76) 1.0 25.0 41.5 2016 209 083 77 631(37.13) 131 452(62.87) 1.2 26.7 41.9 2017 252 717 96 235(38.08) 156 482(61.92) 1.3 29.5 41.4 2018 308 740 156 800(50.79) 151 940(49.21) 1.5 32.3 41.0 2019 365 082 210 622(57.69) 154 460(42.31) 1.5 35.5 40.6 2020 408 820 255 867(62.59) 152 953(37.41) - - - -：无数据
下载: 导出CSV
表 3 2015—2020年我国医疗卫生机构收入费用占比(%)[8-13]
Table 3. Income and expenses ratio of health care institutions in China from 2015 to 2020 (%)[8-13]
年份 财政拨款 医疗事业收入 其他 基层医疗机构 医院 基层医疗机构 医院 基层医疗机构 医院 2015 32.13 8.21 60.25 89.39 7.62 2.40 2016 32.65 8.29 59.81 89.29 7.54 2.42 2017 32.54 8.27 59.87 89.22 7.59 2.51 2018 32.29 8.46 60.09 88.89 7.62 2.65 2019 30.75 8.57 61.47 89.25 7.78 2.18 2020 35.57 13.97 57.75 82.61 6.68 3.42
下载: 导出CSV
-
[1] Vanselow N A, Donaldson M S, Yordy K D. From the institute of medicine[J]. JAMA, 1995, 273(3): 192. doi: 10.1001/jama.1995.03520270026023 [2] 刘伟, 武瑞仙, 许宪春. "健康中国" 规模指标的关联研究[J]. 统计与信息论坛, 2022, 37(5): 3-11. Liu W, Wu R X, Xu X C. Correlation study on "healthy China" scale index[J]. J Stat Inform, 2022, 37(5): 3-11. [3] World Health Organization. Operational framework for primary health care: transforming vision into action[R]. Geneva: World Health Organization and the United Nations Children's Fund (UNICEF), 2020: 13. [4] 刘民, 梁万年. 提升城市突发疫情防控能力: 以首都新冠肺炎疫情防控为例[J]. 前线, 2022(10): 28-31. Liu M, Liang W N. Improve the ability to prevent and control urban outbreaks: taking the prevention and control of COVID-19 in the capital as an example[J]. Front, 2022(10): 28-31. [5] Yan Y Y, Fan T Y, Zheng Y L, et al. Prevention and control of COVID-19 by primary health care facilities in China: a field-survey-based qualitative study in three typical cities[J]. BMC Health Serv Res, 2022, 22(1): 399. doi: 10.1186/s12913-022-07770-4 [6] Tangcharoensathien V, Bassett M T, Meng Q Y, et al. Are overwhelmed health systems an inevitable consequence of covid-19? Experiences from China, Thailand, and New York State[J]. BMJ, 2021, 372: n83. [7] Bitton A, Ratcliffe H L, Veillard J H, et al. Primary health care as a foundation for strengthening health systems in low- and middle-income countries[J]. J Gen Intern Med, 2017, 32(5): 566-571. doi: 10.1007/s11606-016-3898-5 [8] 中华人民共和国国家卫生和计划生育委员会. 2015中国卫生和计划生育统计年鉴[M]. 北京: 中国协和医科大学出版社, 2015. National Health and Family Planning Commission of the People's Republic of China. China health and family planning statistical yearbook(2015)[M]. Beijing: Peking Union Medical College Press, 2015. [9] 中华人民共和国国家卫生和计划生育委员会. 2016中国卫生和计划生育统计年鉴[M]. 北京: 中国协和医科大学出版社, 2016. National Health and Family Planning Commission of the People's Republic of China. China health and family planning statistical yearbook(2016)[M]. Beijing: Peking Union Medical College Press, 2016. [10] 中华人民共和国国家卫生和计划生育委员会. 2017中国卫生和计划生育统计年鉴[M]. 北京: 中国协和医科大学出版社, 2017. National Health and Family Planning Commission of the People's Republic of China. China health and family planning statistical yearbook(2017)[M]. Beijing: Peking Union Medical College Press, 2017. [11] 中华人民共和国国家卫生健康委员会. 2018中国卫生健康统计年鉴[M]. 北京: 中国协和医科大学出版社, 2018. National Health Commission of the People's Republic of China. China health statistical yearbook(2018)[M]. Beijing: Peking Union Medical College Press, 2018. [12] 中华人民共和国国家卫生健康委员会. 2019中国卫生健康统计年鉴[M]. 北京: 中国协和医科大学出版社, 2019. National Health Commission of the People's Republic of China. China health statistical yearbook(2019)[M]. Beijing: Peking Union Medical College Press, 2019. [13] 中华人民共和国国家卫生健康委员会. 2020中国卫生健康统计年鉴[M]. 北京: 中国协和医科大学出版社, 2020. National Health Commission of the People's Republic of China. China health statistics yearbook(2020)[M]. Beijing: Peking Union Medical College Press, 2020. [14] Senn N, Breton M, Ebert S T, et al. Assessing primary care organization and performance: literature synthesis and proposition of a consolidated framework[J]. Health Policy, 2021, 125(2): 160-167. doi: 10.1016/j.healthpol.2020.10.004 [15] 中华人民共和国国家卫生健康委员会统计信息中心. 2020年1-4月全国医疗服务情况[EB/OL]. (2020-07-07)[2023-06-10]. http://www.nhc.gov.cn/mohwsbwstjxxzx/s7967/202007/c8c897a6320d47c59c8f950f8acd2a23.shtml . Statistical Information Center of the National Health Commission of the People's Republic of China. National medical service situation from January to April 2020[EB/OL] (2020-07-07)[2023-06-10].http://www.nhc.gov.cn/mohwsbwstjxxzx/s7967/202007/c8c897a6320d47c59c8f950f8acd2a23.shtml .[16] Kroneman M W, Maarse H, Van Der Zee J. Direct access in primary care and patient satisfaction: a European study[J]. Health Policy, 2006, 76(1): 72-79. doi: 10.1016/j.healthpol.2005.05.003 [17] 李丹, 张钟文, 王成, 等. 分级诊疗制度下基层医疗卫生服务PEST-SWOT分析与对策研究[J]. 卫生软科学, 2022, 36(8): 66-73. Li D, Zhang Z W, Wang C, et al. PEST-SWOT analysis and countermeasures study on primary medical and health services under the system of hierarchical diagnosis treatment[J]. Soft Sci Res, 2022, 36(8): 66-73. [18] 张焱, 李静, 黄新玲, 等. 新型冠状病毒肺炎疫情基层医疗机构防控探讨[J]. 疾病监测, 2022, 37(3): 311-314. Zhang Y, Li J, Huang X L, et al. Discussion on prevention and control of COVID-19 epidemic in primary medical institutions[J]. Dis Surveil, 2022, 37(3): 311-314. [19] 吕奕鹏, 程帆, 张晓琼, 等. 新时期我国基层公共卫生服务发展现况与展望[J]. 中华全科医学, 2022, 20(10): 1631-1634. Lyu Y P, Cheng F, Zhang X Q, et al. The current situation and prospect of the primary public health services in China in the new era[J]. Chin J Gen Pract, 2022, 20(10): 1631-1634. [20] Li X, Krumholz H M, Yip W, et al. Quality of primary health care in China: challenges and recommendations[J]. Lancet, 2020, 395(10239): 1802-1812. doi: 10.1016/S0140-6736(20)30122-7 [21] Li X, Lu J P, Hu S, et al. The primary health-care system in China[J]. Lancet, 2017, 390(10112): 2584-2594. doi: 10.1016/S0140-6736(17)33109-4 [22] 郑艳玲, 余芳, 陈艳黎, 等. 我国全科医生职业倦怠状况及影响因素研究[J]. 中国全科医学, 2019, 22(7): 764-769. Zheng Y L, Yu F, Chen Y L, et al. Prevalence and influencing factors for job burnout among general practitioners in China[J]. Chin Gen Pract, 2019, 22(7): 764-769. [23] 郝晋伟, 江冬冬, 王全, 等. 新冠肺炎疫情后武汉市基层医疗卫生服务体系建设: 基于利益相关者视角[J]. 中国卫生政策研究, 2020, 13(9): 15-21. Hao J W, Jiang D D, Wang Q, et al. Construction of primary health service system in Wuhan after the epidemic of COVID-19: from the perspective of stakeholders[J]. Chin J Health Pol, 2020, 13(9): 15-21. [24] Tan X, Liu C J, Wu H. Reflections on China's primary care response to COVID-19: roles, limitations and implications[J]. Prim Health Care Res Dev, 2022, 23: e46. doi: 10.1017/S1463423622000378 [25] 魏吉利, 白文辉, 卢颖, 等. 突发公共卫生事件中社区应急准备能力评价研究进展[J]. 中国全科医学, 2022, 25(31): 3960-3964. Wei J L, Bai W H, Lu Y, et al. Recent developments in capacity evaluation of community emergency preparedness and response for public health emergencies[J]. Chin Gen Pract, 2022, 25(31): 3960-3964. [26] 陈宁, 王朝昕, 杨燕, 等. 国外基层医疗卫生机构应急管理及对我国的启示[J]. 中国卫生资源, 2021, 24(3): 319-323. Chen N, Wang C X, Yang Y, et al. Emergency management of primary healthcare institutions abroad and its implications for China[J]. Health Resour, 2021, 24(3): 319-323. [27] 刘远立. 疫情防控常态化建设: 顶层设计与基层落实[J]. 中国研究型医院, 2020, 7(5): 74-77. Liu Y L. Dealing with the new normal of pidemic control: strategic design and implementation at the grassroots level[J]. J Chin Res Hosp, 2020, 7(5): 74-77. [28] Zhao A R, Bishai D M. Public health spending, primary care, and perceived risk promoted vaccination against H1N1[J]. Vaccine, 2022, 40(2): 325-333. doi: 10.1016/j.vaccine.2021.11.064 [29] Kringos D S, Boerma W G W, Bourgueil Y, et al. The European primary care monitor: structure, process and outcome indicators[J]. BMC Fam Pract, 2010, 11: 81. [30] 中华人民共和国国务院办公厅. 国务院办公厅关于推进分级诊疗制度建设的指导意见[EB/OL]. (2015-09-11)[2023-06-11]. https://www.gov.cn/zhengce/content/2015-09/11/content_10158.htm . General Office of the State Council of the People's Republic of China. Guiding opinions of the General Office of the State Council on promoting the construction of a graded diagnosis and treatment system[EB/OL]. (2015-09-11)[2023-06-11].https://www.gov.cn/zhengce/content/2015-09/11/content_10158.htm .[31] 习近平. 高举中国特色社会主义伟大旗帜为全面建设社会主义现代化国家而团结奋斗: 在中国共产党第二十次全国代表大会上的报告(2022年10月16日)[M]. 北京: 人民出版社, 2022. Xi J P. Holding high the great banner of socialism with Chinese characteristics and uniting for the comprehensive construction of a socialist modernized country: report at the 20th National Congress of the CPC (October 16, 2022)[M]. Beijing: People's Publishing House, 2022. [32] Chamboredon P, Roman C, Colson S. COVID-19 pandemic in France: health emergency experiences from the field[J]. Int Nurs Rev, 2020, 67(3): 326-333. doi: 10.1111/inr.12604 [33] Schäfer W L A, Boerma W G W, Kringos D S, et al. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care[J]. BMC Fam Pract, 2011, 12: 115. -
点击查看大图
图(1) / 表(3)
计量
- 文章访问数: 836
- HTML全文浏览量: 149
- PDF下载量: 176
- 被引次数: 0
