| 引用本文：李琦, 袁蓓蓓, 何平, 马晓晨, 孟庆跃, 徐进.英国“购买与提供分开”下的健康服务整合改革及启示[J].中国卫生政策研究,2020,13(9):22-26 |
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| 英国“购买与提供分开”下的健康服务整合改革及启示 |
| 投稿时间：2020-04-29 修订日期：2020-06-19 PDF全文浏览 HTML全文浏览 |
| 李琦, 袁蓓蓓, 何平, 马晓晨, 孟庆跃, 徐进 |
| 北京大学中国卫生发展研究中心 北京 100191 |
| 摘要:以人为本的整合型卫生服务体系是当前国际卫生体系发展的重要方向。鉴于英国卫生体系综合绩效在发达国家中的领先地位，在"购买与提供分开"的框架下政府同时负责筹资和服务组织的结构，这与我国卫生体系具有相似性，本文根据文献研究和现场调查，分析英国近年建设以人为本整合型卫生服务体系的内在逻辑和实践进展，并探讨其对我国的启示。研究发现，改革主要体现在三个层面：区域层面推动卫生部门内部各机构与跨部门服务的统一规划，并辅以转型基金、绩效考核和整合式的预算分配与决策机制；地方层面以公共卫生和医疗服务的筹资整合推动服务围绕人群健康进行协调，应对人群层面的健康问题；社区层面通过对全科医生执业模式进行再组织，在基层卫生网络基础上结合社区服务，综合应对个体和社区层面的健康决定因素。根据英国经验，本文提出：整合改革涉及多个层面，应当明确各自权责；统一的决策问责、协调的资源分配是推动整合的关键抓手；基层卫生发展需要在专业化基础上进行组织化。 |
| 关键词:整合型卫生服务 以人为本 购买与提供分开 内部市场 |
| 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”；国家自然科学基金项目（71804004） |
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| Analysis of the integration reform of the UK health services in the context of “purchaser-provider split” and its implications |
| LI Qi, YUAN Bei-bei, HE Ping, MA Xiao-chen, MENG Qing-yue, XU Jin |
| China Center for Health Development Studies, Peking University, Beijing 100191, China |
| Abstract:The people-centered integrated care is an important direction on the international development of health system. The comprehensive performance of the British health system stays ahead of other developed countries, and the British "purchaser-provider split" framework in which the government is responsible for financing and organizing is similar to its in China. For the above reasons and based on the information gained by the literature research and field investigation, this study analyzed the logic and practical progress of the people-centered integrated care system in the UK in recent years, and discussed the enlightenment to China. This study found that the integration reform in the UK is mainly represented in three aspects:At the regional level, the reform promotes integrated planning of various institutions within the health sector and cross-sectoral services, and the transformation fund, performance assessment, integrated budget allocation and decision-making mechanism are supplemented; At the local level, the financing integration of public health and medical services promotes the coordination of services around the local population and addresses the problems at the population level. At the community level, the reform addresses the determinants of health at the individual and community levels comprehensively by re-organizing the practice patterns of general practitioners and combining community services on the basis of the primary care network. Based on the experience of the UK, this study proposes following three enlightenments to China:The integration reform involves multiple levels and the respective rights and responsibilities should be clarified; the integrated decision-making and accountability, and coordinated resource allocation are the key to promoting integration; The development of community-level healthcare needs to be organized on the basis of professionalization. |
| Key words:Integrated health care People-centered Purchaser-provider split Internal market |
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