Implementation Status and Development Strategies of Specialty Services in Community Health Centers in China

doi:10.12114/j.issn.1007-9572.2019.00.284

Abstract

Abstract: Delivering specialty services is an important measure for improving the service capabilities of community health centers（CHCs） and for promoting the development of hierarchical medical system.We analyzed the status of specialty services delivered in CHCs in China by using data from China Health Statistics Yearbook 2018，and the results were summarized as follows：in CHCs，top priority is given to general practice department development，TCM department develops rapidly，rehabilitation department is promising，but pediatrics and other specialty departments lag behind.Along with the promotion of hierarchical medical system development，specialty services delivered by CHCs have been characterized to show crucial roles in improving healthcare service capabilities and revenues，promoting occupational development of healthcare providers，and enhancing residents' satisfaction with healthcare services.However，CHCs also face challenges in delivering specialty services，such as insufficient equipment allocation，specialists training，and drug use guidance，as well as lack of related supportive policies.The development of specialty services in CHCs is different from that of general hospitals，which should be promoted by developing and implementing a sound regional health plan，strengthening specialists training，increasing investment，reinforcing the implementation of incentives and medical insurance programs，improving healthcare prices，drug policies and medical environment.

Key words: Community health services, Community health centers, Specialist services, Delivery of health care, Service ability, Current situation, Development strategies

摘要： 开展专科服务是提升社区卫生服务中心医疗服务能力、促进分级诊疗制度建设的重要举措。本文利用《2018中国卫生健康统计年鉴》数据，分析我国社区卫生服务中心开展专科服务现状。数据显示，社区卫生服务中心的科室设置以全科医学科为主，中医科发展较快，康复医学科具有发展前景，儿科等其他专科发展滞后。随着分级诊疗制度的推进，社区卫生服务中心开展专科服务在提升医疗服务能力、增加医疗收入、促进医务人员职业发展、提高居民满意度等方面发挥重要作用，但是在基础设施配置、专科人才培养、用药及相关政策等方面面临困境。因而，社区卫生服务中心开展专科服务不同于综合医院，应从做好区域卫生规划，加强专科人才培养，完善投入、激励、医保、价格、药品政策环境等方面促进其发展。

关键词: 社区卫生服务, 社区卫生中心, 专科服务, 卫生保健提供, 服务能力, 现状, 发展策略

ZHANG Lifang,LIU Zhongyuan,LIN Chunmei, et al. Implementation Status and Development Strategies of Specialty Services in Community Health Centers in China　[J]. Chinese General Practice, 2019, 22(16): 1900-1903. DOI: 10.12114/j.issn.1007-9572.2019.00.284.
张丽芳,刘中元,林春梅等. 我国社区卫生服务中心专科服务开展现状及发展策略[J]. 中国全科医学, 2019, 22(16): 1900-1903. DOI: 10.12114/j.issn.1007-9572.2019.00.284.

References

［1］原国家卫生计生委，国家中医药局.基层医疗卫生服务能力提升年活动实施方案［Z］．2017.
［2］国家卫生健康委.2018中国卫生健康统计年鉴［M］．北京：中国协和医科大学出版社，2018.
［3］肖梦熊，郑格琳，杨永生，等．我国基层中医药服务能力分析及建议［J］．解放军医院管理杂志，2015，22（8）：786-789.
XIAO M X，ZHENG G L，YANG Y S，et al．Analysis and suggestions on Chinese traditional medicine service capacity in primary health care institutions of China［J］．Hospital Administration Journal of Chinese People's Liberation Army，2015，22（8）：786-789.
［4］体制改革司.国务院深化医药卫生体制改革领导小组简报（第10期）基层中医药服务能力提升工程“十三五”行动计划取得显著成效［EB/OL］．（2018-12-05）［2019-04-01］．http：//www.nhc.gov.cn/tigs/ygjb/201812/3a7115a956b74e6da828415638ea53ad.shtml.
［5］孟庆远.基层医疗机构康复科建设须加快步伐［EB/OL］．（2017-03-15）［2019-04-01］．http：//www.yywsb.com/article/15910.html.
［6］国务院.关于印发“十三五”卫生与健康规划的通知［Z］．2016.
［7］沈蔷，白永涛，赵海，等．社区卫生服务机构的专科建设［J］．中国全科医学，2016，19（25）：3074-3077．DOI：10.3969/j.issn.1007-9572.2016.25.015.
SHEN Q，BAI Y T，ZHAO H，et al．Specialized department construction of community health service institutions［J］．Chinese General Practice，2016，19（25）：3074-3077．DOI：10.3969/j.issn.1007-9572.2016.25.015.
［8］秦江梅，林春梅，张丽芳，等．我国基层医疗卫生机构儿科资源及医疗服务能力现状研究［J］．中国全科医学，2019，22（13）：1511-1515．DOI：10.12114/j.issn.1007-9572.2019.00.214.
QIN J M，LIN C M，ZHANG L F，et al．Pediatric resources and medical service delivery capability in primary healthcare institutions in China［J］．Chinese General Practice，2019，22（13）：1511-1515．DOI：10.12114/j.issn.1007-9572.2019.00.214.
［9］人力资源社会保障部，财政部，原国家卫生计生委.关于完善基层医疗卫生机构绩效工资政策保障家庭医生签约服务工作的通知［Z］．2018.
［10］赵立志，蔡惠，王丽，等．单病种协作体系在建设“大专科小综合”基层医院中的应用［J］．现代医院管理，2011，9（1）：27-28．DOI：10.3969/j.issn.1672-4232.2011.01.009.
ZHAO L Z，CAI H，WANG L，et al．The implementation of cooperative system of single disease in the construction of specialized and combined departments in primary health hospitals［J］．Modern Hospital Management，2011，9（1）：27-28．DOI：10.3969/j.issn.1672-4232.2011.01.009.
［11］杨书斌，张绍艳.基层医疗机构建设特色专科的必要性及可行性分析［J］．中国卫生产业，2018，15（20）：72-73．DOI：10.16659/j.cnki.1672-5654.2018.20.072.
YANG S B，ZHANG S Y.The necessity and feasibility of the specialized department construction in primary health service institutions［J］．Chinese Health Industry，2018，15（20）：72-73．DOI：10.16659/j.cnki.1672-5654.2018.20.072.
［12］张丽芳，刘治华，董亚丽，等．基层卫生综合改革重点联系点合理用药情况研究［J］．中国全科医学，2018，21（31）：3795-3797，3804．DOI：10.12114/j.issn.1007-9572.2018.31.003.
ZHANG L F，LIU Z H，DONG Y L，et al．Rational drug use in primary care in highly focused areas during the comprehensive reform of primary care system in China［J］．Chinese General Practice，2018，21（31）：3795-3797，3804．DOI：10.12114/j.issn.1007-9572.2018.31.003.

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