中国全科医学 ›› 2026, Vol. 29 ›› Issue (01): 6-16.DOI: 10.12114/j.issn.1007-9572.2025.0379

• 中国深化医改十五年专题系列研究报告(一) • 上一篇    下一篇

中国深化医药卫生体制改革十五年以来出台的全科政策及效果研究

李思思1, 秦江梅2,*()   

  1. 1.100191 北京市,北京大学首都卫生与健康发展研究院
    2.100044 北京市,国家卫生健康委卫生发展研究中心
  • 收稿日期:2025-10-24 修回日期:2025-11-14 出版日期:2026-01-05 发布日期:2025-12-18
  • 通讯作者: 秦江梅

  • 作者贡献:

    秦江梅负责论文框架构思,摘要、前言和讨论等方面的撰写及结果描述修改,对文章整体负责;李思思负责政策文件/文献检索和摘录,以及《中国卫生健康统计年鉴》数据摘录、整理分析和结果描述。

Study on General Practice Policies and Their Effects since Fifteen Years of Deepening Medical and Healthcare System Reform in China

LI Sisi1, QIN Jiangmei2,*()   

  1. 1. Institute for Capital Health Development, Peking University, Beijing 100191, China
    2. National Health Commission Center for Health Development Research, Beijing 100044, China
  • Received:2025-10-24 Revised:2025-11-14 Published:2026-01-05 Online:2025-12-18
  • Contact: QIN Jiangmei

摘要: 中国深化医药卫生体制改革(以下简称深化医改)十五年,中央政府层面密集出台了一系列推动全科医生制度发展的政策,在政府的大力支持和指导下,我国全科医学在学科建设、培养培训、全科队伍建设等方面取得积极进展。我国设立全科教学机构的医学院校占比从2010年的21.1%提高到2019年的85.7%,提高了64.6个百分点,开设全科医学课程的医学院校占比从46.1%提高到81.1%,提高了35.0个百分点。多种途径培养的全科医生从2012年的10.98万人增加到2023年的56.18万人,年平均增长速度达到16.00%,远高于全国执业(助理)医师的增长速度(5.64%),全科医生占医生总数的比例从4.20%提高到11.75%,提高了7.55个百分点,其中2010—2024年农村订单定向医学生实际招生数达到8.9万人,中西部农村地区全科医生数得到提升、学历得到优化;全科床位从2009年的30.79万张增加到2023年的48.78万张,年平均增长速度为3.34%;全科门急诊人次从2009年的4.31亿人次增加到2023年的8.48亿人次,占全国门急诊总人次比例维持在13.00%左右,其中基层全科门急诊人次占基层门急诊人次比例从26.32%提升到33.07%;全科住院人次从1 127.52万人增加到1 224.79万人,占全国出院总人数比例从8.47%降低到4.07%,近2年占比有所增加(增加0.39个百分点)。与其他临床二级学科相比,全科医学依然存在着一些需要持续改进的方面,全科医生数量和质量仍然薄弱、科研能力不强,从全国层面看全科医生配置不均衡,高素质全科医生数量不足,全科医生岗位吸引力不够等,并面临老龄化和慢病化叠加带来健康需求增加的挑战。

关键词: 卫生保健改革, 全科医学, 初级卫生保健, 卫生政策

Abstract:

Over the fifteen years since the deepening of medical and healthcare system reform in China (hereinafter referred to as deepening healthcare reform in China), a series of policies have been intensively introduced by the central government to promote the development of the general practitioner system. With strong government support and guidance, general practice in China has made positive progress in discipline construction, training and education, and workforce development. The proportion of medical schools with general practice teaching institutions increased from 21.1% in 2010 to 85.7% in 2019, showing an increase of 64.6 percentage points. Meanwhile, the proportion of medical schools offering general practice courses increased from 46.1% to 81.1%, showing an increase of 35.0 percentage points. The number of general practitioners trained through various pathways increased from 109 800 in 2012 to 561 800 in 2023, with an average annual growth rate of 16.00%, far exceeding the growth of licensed (assistant) physicians nationwide (5.64%). The proportion of general practitioners in the total number of physicians increased from 4.20% to 11.75%, showing an increase of 7.55 percentage points. During 2010-2024, the actual enrollment of rural order-oriented medical students reached 89 000, displaying increased number of general practitioners and improved educational qualifications in rural areas of central and western China. General practice beds increased from 307 900 in 2009 to 487 800 in 2023, with an average annual growth rate of 3.34%. General practice outpatient and emergency visits increased from 431 million in 2009 to 848 million in 2023, maintaining approximately 13.00% of the national total outpatient and emergency visits. Among them, the proportion of primary-level general practice outpatient and emergency visits to total primary-level outpatient and emergency visits increased from 26.32% to 33.07%. General practice inpatient admissions increased from 11.275 2 million to 12.247 9 million. The proportion of national total discharges decreased from 8.47% to 4.07%, while the proportion has increased in the past two years by 0.39%. Compared with other secondary clinical disciplines, general practice still has a room for continuous improvement, including weak quantity and quality of general practitioners, limited research capacity, unbalanced distribution of general practitioners at the national level, insufficient numbers of high-quality general practitioners, and inadequate attractiveness of general practitioner positions. Moreover, increased health demands brought by the overlapping effects of population aging and chronic disease prevalence are great challenges to be solved. Based on in-depth analysis, this paper proposed targeted recommendations.

Key words: Health care reform, General practice, Primary health care, Health policy

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