基层整合型医疗服务的国际经验和中国实践

随着全球人口老龄化进程的加速、慢性病井喷式的爆发，居民对医疗卫生服务的需求不断增加，医疗卫生服务的“碎片化”问题日益突出，为此，整合型医疗服务成为21世纪医疗卫生改革的世界性趋势。全球多个国家和地区先后开展了不同形式和内容的探索。我国基层整合型医疗服务起步晚，发展迅速，但也尚面临一些问题。本文将从体系层面、机构层面、专业层面、临床服务层面等分析我国基层整合型医疗服务实践，并总结和借鉴美国凯撒医疗集团、英国国家医疗服务体系、德国黑森林模式的典型经验。在对比国际经验的基础上审视我国目前的基层整合型医疗服务现状，并对比梳理出服务中存在的主要问题，具体表现在6个方面即政策的制定、规范的实施、机构间协调、专业间协作、信息化建设以及服务效果的综合评价。同时，本文也提出建立健全整合机制、网格化医联体建设和全-专协同是我国基层整合型医疗服务的新动向。我国基层整合型医疗服务需要将服务中心从三级医院转向基层医疗机构，服务重点从“机构整合”向“服务整合”转变，以全科医生驱动资源整合。未来应从政策保障、机构间协作以及专业人员间协作机制、基层信息整合的技术支持等多方面进行提升和改善，以期促进我国基层整合型医疗服务的发展。 

International experience and practice of integrated primary care in China

With the acceleration of the global aging process and the outbreak of chronic diseases, the demand for health services is increasing, and the "fragmentation" of health services is becoming increasingly prominent. Therefore, integrated health service has become a worldwide trend of health system reform in the 21st century. Many countries and regions have carried out different forms and contents of exploration. Integrated primary care started late and developed rapidly in China, but it still faces some problems. From system level, organizational level, professional level, clinical level, this review analyze the current situation of integrated primary care in China, summarize and draw lessons from typical experience of Kaiser permanente, National Health Service, German Black Forest model. Based on the comparison of international experience, we examine the current situation and sort out China's main problems of integrated primary care in China. Problems include six aspects: policy formulation, standard implementation, inter agency coordination, inter professional cooperation, information construction and comprehensive evaluation. At the same time, we analyze the new trend of integrated primary care: the establishment and improvement of the integration mechanism, the construction of the gridded medical alliance and the specialty-general practice collaboration are the new trends of integrated primary care in China. It is necessary for China to shift service centers from tertiary hospital to primary care, and shift the focus of service from "organizational integration" to "clinical integration". In the future, we should promote and improve policy support, inter agency cooperation, inter professional cooperation mechanism and information integration technology to develop integrated primary care in China.