社区首诊制研究

As the core element of classified medical care, the system of first contact care at community health institutions is essential for setting up a well structured and functional reasonable health service system, promoting rational use of health resources and controlling the unreasonable increasing of health cost. In this study, we mainly adopt the method of evidence-based health policy. The objective of this study is to explore the focus of first contact care system at community health institutions, the association between health service system, health reform and community health service development, and to analyze the effect and necessity, conditions and feasibility, obstacles and difficulties of the first contact care system at community health institutions. At the same time, by carrying out observational study in pilot population, we aim to explore the main elements of policy design such as the key point and process of implementing the first contact care system. At last, we plan to comprehensively survey the influence factors of first contact care system at community health institutions . The main innovations of this study include grasping the accurate opportunity for researching, more comprehensive and depth than previous studies, as well as more advanced research method. The prospective findings include defining the function and meaning, basic conditions and determinants, institutional elements, operation mode, referral processes and norms, interests of residents, responsibilities of health service providers and managements of the first contact care system at community health institutions. The achievements of this study may also be significant for national health and social security departments to determine whether or not to establish first contact care system at community achievements for all population or all people with health insurances.

社区首诊制是分级医疗制度的核心要素，对于建立层次分明、功能合理的卫生服务体系、合理使用卫生资源、控制卫生费用不合理增长，至关重要。本课题主要采用循证卫生政策学方法，明确社区首诊制与医改重心、卫生服务体系和社区卫生服务发展的关系，分析建立社区首诊制的作用与必要性、条件与可行性、障碍与困难；利用现有特殊人群社区首诊制试点进行现场观察研究，探索实行社区首诊制的关键环节、路径等政策设计要素；全面调查社区首诊制的影响因素。主要创新点在于：本选题把握住研究的良好时机，内容比同类研究全面、深入，研究方法先进。预期成果主要包括社区首诊制的作用和意义、基本条件与决定因素、制度要素、运作模式、转诊流程与规范、居民权益、服务机构和管理部门职责等，对国家卫生及社会保障等部门在是否建立全（医保）人群社区首诊制的决策方面具有重要价值。