| 引用本文：胡丹, 吉小晗, 何平, 马晓晨, 刘晓云, 孟庆跃, 徐进.加拿大单一支付方制度下的基层卫生强化机制：实践与启示[J].中国卫生政策研究,2020,13(8):37-42 |
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| 加拿大单一支付方制度下的基层卫生强化机制：实践与启示 |
| 投稿时间：2020-06-12 修订日期：2020-07-29 PDF全文浏览 HTML全文浏览 |
| 胡丹, 吉小晗, 何平, 马晓晨, 刘晓云, 孟庆跃, 徐进 |
| 北京大学中国卫生发展研究中心 北京 100191 |
| 摘要:本文结合文献综述和现场调查分析了加拿大一系列强化基层卫生服务的改革实践及其对我国的启示。研究发现，加拿大基层卫生发展取得进展主要有三方面原因：第一，重视家庭医学学科和人才队伍建设，使得许多医学生选择家庭医学执业。第二，组建家庭医学联合诊所，提高了基层医疗机构规模和管理水平，使得服务效果明显改善。第三，医院的改革为基层卫生发展起到了助推动作用。加拿大的经验提示：医疗保障、卫生服务和医学教育的政策协调是单一支付方的制度优势，是推动强基层的关键；“一专多能”的全科医学执业轨道是增加居民和专科医生对基层医生信任的有效路径；同时，应进一步推动公共卫生、医疗服务和社区服务在基层的整合。 |
| 关键词:基层卫生 家庭医学 单一支付方 加拿大 |
| 基金项目:国家卫生健康委员会体改司“以人为本整合型医疗卫生服务体系框架研究”；国家自然科学基金（71804004） |
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| Mechanism of strengthening primary healthcare under single-payer system in Canada: Practice and enlightenment |
| HU Dan, JI Xiao-han, HE Ping, MA Xiao-chen, LIU Xiao-yun, MENG Qing-yue, XU Jin |
| China Center for Health Development Studies, Peking University, Beijing 100191, China |
| Abstract:Having combined literature review with on-site investigations, this article analyzed Canada's series of reforms in the strengthening of its primary healthcare services and then drew its enlightenments for China. The study found that progress in Canada's primary healthcare development is mainly attributable to three factors. Firstly, emphasizing the importance of family medicine and its representation in the healthcare professional team construction has encouraged many medical students to choose family medicine. Secondly, the establishment of Family Medicine Groups in the province of Québec has enhanced the scale and management capacity of primary healthcare institutions, thereby significantly improving service effect and output. Finally, hospital reforms have helped to promote the development of primary healthcare. Key insights from the Canadian experience include the coordination of policies relevant to medicare, healthcare services and health education is the institutional advantage of a single payer system, and the key to promoting a strong primary healthcare system; the general practice track of “One specialty with multiple abilities” trains well-rounded physicians and is an effective way to boost the resident-specialist trust among primary healthcare doctors; and at the same time, the integration of public health, healthcare services and community services at the primary healthcare level should be further promoted. |
| Key words:Primary healthcare Family Medicine Single payer system Canada |
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