醫(yī)聯(lián)體視角下農(nóng)村家庭醫(yī)生簽約服務(wù)的探討

吳媛媛　胡西影

[摘要] 醫(yī)聯(lián)體是合理分配醫(yī)療資源、緩解醫(yī)療資源緊張的重要舉措，體現(xiàn)了以人民為中心的思想，符合我國醫(yī)療服務(wù)體系的發(fā)展趨勢，對優(yōu)質(zhì)醫(yī)療資源的上下貫通有重要意義。《關(guān)于開展醫(yī)療聯(lián)合體建設(shè)試點(diǎn)工作的指導(dǎo)意見》（國衛(wèi)醫(yī)發(fā)〔2016〕75號）提出，要以醫(yī)聯(lián)體為載體推進(jìn)分級診療，而分級診療制度的核心是家庭醫(yī)生簽約服務(wù)。我國農(nóng)村居民眾多，重視基層首診，研究農(nóng)村地區(qū)家庭醫(yī)生簽約服務(wù)，對推進(jìn)分級診療制度有重要意義。該文從醫(yī)聯(lián)體視角出發(fā)，通過整理我國家庭醫(yī)生簽約服務(wù)發(fā)展的歷程和相關(guān)政策文件，對我國農(nóng)村地區(qū)家庭醫(yī)生簽約服務(wù)存在的問題、進(jìn)一步發(fā)展的建議等進(jìn)行了分析探討。

[關(guān)鍵詞] 醫(yī)聯(lián)體;農(nóng)村;家庭醫(yī)生簽約服務(wù);互聯(lián)網(wǎng)+醫(yī)療

[中圖分類號] R19 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1672-5654（2020）02（b）-0190-03

[Abstract] The medical federation is an important measure to rationally allocate medical resources and alleviate the shortage of medical resources. It reflects the people-centered thinking and is in line with the development trend of China's medical service system. The "Guiding Opinions on the Pilot Work on the Construction of Medical Consortia" （National health service medical department [2016] no. 75） proposed that the medical consortia should be used as a carrier to promote hierarchical diagnosis and treatment， and the core of the hierarchical diagnosis and treatment system is family doctor contracting services. There are many rural residents in China. It is important to pay attention to the first consultation at the grassroots level and to study the service of contracting family doctors in rural areas， which is of great significance to promoting the hierarchical diagnosis and treatment system. From the perspective of the Medical Association， this article analyzes and discusses the problems and suggestions for further development of family doctor contracting services in rural areas of China by sorting out the development process and related policy documents of family doctor contracting services in China.

[Key words] Medical association; Rural; Family doctor contract service; Internet+Medical

近年來，隨著互聯(lián)網(wǎng)技術(shù)的成熟，“互聯(lián)網(wǎng)+醫(yī)療”的模式推動了醫(yī)聯(lián)體和家庭醫(yī)生簽約服務(wù)的發(fā)展。醫(yī)聯(lián)體是指區(qū)域醫(yī)療聯(lián)合體，旨在解決百姓看病難的問題，構(gòu)建“小病在基層，大病去醫(yī)院，康復(fù)回社區(qū)”的就醫(yī)新格局。家庭醫(yī)生作為基層醫(yī)療的主要執(zhí)行者，起著健康守門人的作用，《健康中國2030規(guī)劃綱要》指出，要創(chuàng)新醫(yī)療衛(wèi)生服務(wù)供給模式，其中一個重點(diǎn)是完善家庭醫(yī)生簽約服務(wù)。目前，醫(yī)聯(lián)體發(fā)展過程中的一個難點(diǎn)是基層醫(yī)療機(jī)構(gòu)基礎(chǔ)薄弱，人們生病看病直接去往大醫(yī)院，在農(nóng)村地區(qū)，家庭醫(yī)生在發(fā)揮作用的同時，也存在著一定的局限性，且根據(jù)國家統(tǒng)計(jì)局顯示，2018年鄉(xiāng)村人口為56 401萬人，占全國總?cè)丝诘?0.42%，因此，研究農(nóng)村地區(qū)家庭醫(yī)生簽約服務(wù)，重視農(nóng)村地區(qū)家庭醫(yī)生的發(fā)展，對構(gòu)建完善的醫(yī)療服務(wù)體系有著重大意義。……