發(fā)布時(shí)間：2018-07-09 17:09

  本文選題：家庭醫(yī)生制度 + 成效與瓶頸��； 參考：《上海工程技術(shù)大學(xué)》2016年碩士論文

【摘要】：家庭醫(yī)生制度,是健全全民醫(yī)保體系的有力抓手,是進(jìn)一步深化醫(yī)療衛(wèi)生體制改革的重要途徑。在“互聯(lián)網(wǎng)+”的時(shí)代背景和深化醫(yī)藥衛(wèi)生體制的政策要求下,探索完善上海市家庭醫(yī)生制度的新路徑,不僅是對(duì)居民基本健康新需求的積極回應(yīng),而且能夠提升醫(yī)療衛(wèi)生服務(wù)體系的整體運(yùn)行效率和醫(yī)療服務(wù)質(zhì)量。上海作為新醫(yī)改的排頭兵和先行者,在全國(guó)的示范輻射效應(yīng)是不容忽視的,剖析上海市家庭醫(yī)生制度的實(shí)施效應(yīng)和完善路徑,對(duì)探析該制度的良性可持續(xù)發(fā)展具有重要意義,同時(shí)也可為全國(guó)其他地區(qū)家庭醫(yī)生制度的推進(jìn)提供可復(fù)制可推廣的經(jīng)驗(yàn)借鑒。本文在總結(jié)上海市家庭醫(yī)生制度的建立過(guò)程和特點(diǎn)的基礎(chǔ)上,科學(xué)地選取家庭醫(yī)生制度的“二元”行為主體——家庭醫(yī)生和簽約居民為調(diào)研對(duì)象,透過(guò)上海市8區(qū)21個(gè)街道的實(shí)地調(diào)查,對(duì)家庭醫(yī)生制度的實(shí)施效應(yīng)進(jìn)行剖析,總結(jié)出家庭醫(yī)生制度取得的成效:家庭醫(yī)生的簽約率和居民滿(mǎn)意度較高、社區(qū)居民就醫(yī)的便利性和有序性提高的同時(shí)也降低了醫(yī)療費(fèi)用支出、醫(yī)患關(guān)系得到了明顯改善、電子健康檔案建設(shè)初見(jiàn)成效等。但與此同時(shí),也存在著家庭醫(yī)生數(shù)量質(zhì)量缺口較大、內(nèi)在激勵(lì)不足、信息化平臺(tái)建設(shè)有待加強(qiáng)、簽約率與居民認(rèn)同度不匹配和缺乏相應(yīng)的配套政策等問(wèn)題。對(duì)此,本文從橫向和縱向兩個(gè)視域,提出了完善家庭醫(yī)生制度的系統(tǒng)化優(yōu)化模型:在“互聯(lián)網(wǎng)+”背景下,以完善體制機(jī)制建設(shè)為主體,以人力資源配置、管理體制設(shè)計(jì)和自上而下的制度保障為關(guān)鍵環(huán)節(jié),通過(guò)抓組織、抓管理、抓配套、抓人才等手段,確保家庭醫(yī)生制度的推進(jìn)能實(shí)現(xiàn)醫(yī)療服務(wù)供需相匹配、資源配置及醫(yī)療服務(wù)公平化、各類(lèi)政策、制度形成配套并協(xié)同進(jìn)步的目標(biāo)。此外,還需從“五條主線”入手逐步推進(jìn)家庭醫(yī)生制度的發(fā)展完善:(1)明確家庭醫(yī)生制各行為主體的職責(zé);(2)階梯式探索推進(jìn)“互聯(lián)網(wǎng)+家庭醫(yī)生”模式;(3)注重家庭醫(yī)生人才的培養(yǎng)和考核;(4)完善制度運(yùn)行事前、事中、事后的管理與監(jiān)督;(5)完善配套政策與機(jī)制設(shè)計(jì)。
[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.
【學(xué)位授予單位】：上海工程技術(shù)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R197.1

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本文編號(hào)：2110048