Exploration and Practice of Primary Health Care during the Construction of County-level Medical Alliance

doi:10.12114/j.issn.1007-9572.2020.00.188

Abstract

Abstract: The construction of county-level medical alliance（CMA） is an important breakthrough to improve the ability of health care at grassroots level and deepen the medical reform. However，there is currently no unified operation mode of CMA in China. Zhejiang Province carried out the pilot construction of CMA in September 2017，and determined the pilot reform path of "three unifications" of unified institutional setting，staff recruitment and allocation，and medical and health resource allocation，"three integrated plans" for fiscal and financial management，medical insurance payment，and information sharing，and "three emphasis" on hierarchical diagnosis and treatment，contracted family doctor services，and public health. Zhejiang Province comprehensively promoted the above reform plan in the whole province in September 2018，and has made some positive progress. This paper summarizes and analyzes the main methods of health-related work in Zhejiang Province under the background of comprehensively promoting the construction of medical alliance. It mainly includes the work responsibilities and tasks of relevant departments，contracted services of family doctors，basic public health services，and the reform of compensation mechanism of primary health care institutions. In addition，this paper reports in detail the achievements that Zhejiang Province has made in terms of the grassroots service ability，CMA pattern，and the enthusiasm of primary health care staff since the construction of medical alliance. It is hoped that the practice of "Zhejiang Mode" in this paper can provide reference for the construction of medical alliance in other regions.

Key words: Medical alliance, County-level medical services, Primary health care, Practice, Effect, Health care reform

摘要： 县域医疗共同体（医共体）建设，是提升基层医疗卫生服务能力和深化医改的一个重要突破口，目前我国尚无统一运行模式。浙江省于2017年9月开展县域医共体建设试点，确定了医共体内机构设置、人员招聘使用、医疗卫生资源调配“三统一”，财政财务管理、医保支付、信息共享“三统筹”，分级诊疗、家庭医生签约服务、基本公共卫生服务“三强化”的改革试点路径，并于2018年9月全面推进，目前已取得积极进展。本文汇总分析了浙江省在全面推进医共体建设背景下开展基层卫生相关工作的主要做法，涉及相关方的工作职责和任务、家庭医生签约服务、基本公共卫生服务及基层医疗卫生机构补偿机制改革等。同时，本文对浙江省自开展医共体建设以来，在基层服务能力、县域医疗卫生服务格局及基层医务人员工作积极性方面取得的成效进行了较为详细汇报。希望本文针对“浙江模式”的实践探讨，能够为其他地区开展医共体建设提供参考与借鉴。

关键词: 医疗共同体, 县域医疗服务, 基层医疗卫生, 做法, 成效, 卫生保健改革

DAI Wenyun,HU Ling. Exploration and Practice of Primary Health Care during the Construction of County-level Medical Alliance　[J]. Chinese General Practice, 2021, 24(1): 23-29. DOI: 10.12114/j.issn.1007-9572.2020.00.188.
戴文芸,胡玲. 县域医疗共同体建设中做好基层医疗卫生工作的探索与实践[J]. 中国全科医学, 2021, 24(1): 23-29. DOI: 10.12114/j.issn.1007-9572.2020.00.188.

References

［1］吕超飞．基于文献计量的国内外医疗机构整合研究［D］．太原：山西医科大学，2019.
［2］黄佳培．江苏省县域医共体建设及趋势走向研究［D］．苏州：苏州大学，2018.
［3］顾昕．财政制度改革与浙江省县域医共体的推进［J］．治理研究，2019，35（1）：12-20．DOI：10.15944/j.cnki.33-1010/d.2019.01.002.
GU X．Reform of Zhejiang financial system and promotion of county medical community［J］．Governance Studies，2019，35（1）：12-20．DOI：10.15944/j.cnki.33-1010/d.2019.01.002.
［4］刘也良，孙梦．县域医共体：浙江医改“金名片”［J］．中国卫生，2019，26（4）：14-17．DOI：10.15973/j.cnki.cn11-3708/d.2019.04.002.
［5］浙江省人民政府办公厅．浙江省人民政府办公厅关于推进责任医生签约服务工作的指导意见［Z］．2015.
［6］胡玲，吴燕萍．浙江省关于推进责任医生签约服务的实践探讨［J］．中国全科医学，2017，20（31）：3835-3840．DOI：10.3969/j.issn.1007-9572.2017.31.001.
HU L，WU Y P．Practice of contracting service with doctors in primary care institutions project in Zhejiang Province［J］．Chinese General Practice，2017，20（31）：3835-3840．DOI：10.3969/j.issn.1007-9572.2017.31.001．
［7］浙江做实做细家庭医生签约服务［EB/OL］．（2018-04-28）［2019-10-01］．http://www.xinhuanet.com/health/2018-04/28/c_1122756464.htm.
［8］人民网．浙江省推进家庭医生签约服务近3年　家庭医生，如何签而有约［EB/OL］．（2018-04-26）［2019-10-01］．http://zj.people.com.cn/n2/2018/0426/c186806-31508678.html.
［9］东阳发布．看病就医不用愁！东阳大力推进家庭医生签约服务［EB/OL］．（2018-08-18）［2019-10-01］．http://dy.163.com/v2/article/detail/DPG9VVR40514TPKQ.html.
［10］东阳市人民政府．15个模块，332名基层医疗机构医生我市开展医共体全科医生培训［EB/OL］．（2018-03-16）［2019-10-01］．http://www.dongyang.gov.cn/11330783K15043025N/xxgkml/bmxxgk/11330783337028607C/03/201803/t20180316_2104633_2.html.
［11］余姚市人民政府．医共体“融合式”培训　打造“同质化”医生［EB/OL］．（2018-04-16）［2019-10-01］．http://www.yy.gov.cn/art/2018/4/16/art_21236_6612942.html.
［12］邱宝华，黄蛟灵，梁鸿，等．家庭医生签约服务利用与满意度的比较研究［J］．中国卫生政策研究，2016，9（8）：31-36．DOI：10.3969/j.issn.1674-2982.2016.08.006.
QIU B H，HUANG J L，LIANG H，et al．A comparative study on the health services utilization and satisfaction of the family doctor service［J］．Chinese Journal of Health Policy，2016，9（8）：31-36．DOI：10.3969/j.issn.1674-2982.2016.08.006.
［13］浙江在线．浙江基本公共卫生服务考核结果列全国第一
［EB/OL］．（2018-11-07）［2019-11-01］．http://www.yy.gov.cn/art/2018/4/16/art_21236_6612942.html.
［14］浙江省财政厅，原浙江省卫生和计划生育委员会．浙江省财政厅　浙江省卫生和计划生育委员会关于开展基层医疗卫生机构补偿机制改革试点的指导意见［Z］．2015.
［15］浙江省财政厅，原浙江省卫生和计划生育委员会．浙江省财政厅　浙江省卫生和计划生育委员会关于全面推进基层医疗卫生机构补偿机制改革的实施意见［Z］．2017.
［16］健康浙江．浙江省委书记车俊在全省县域医共体建设现场推进会上的讲话［EB/OL］．（2018-10-23）［2019-11-01］．https://www.sohu.com/a/270688760_374902.
［17］国家卫生健康委员会．卫健委举行介绍浙江省县域综合医改等方面经验发布会［EB/OL］．（2019-04-12）［2019-11-01］．http://www.scio.gov.cn/xwfbh/gbwxwfbh/xwfbh/wsb/Document/1651941/1651941.htm.
［18］浙江基层补偿机制改革（上）：“买比拨好”背后的改革逻辑［EB/OL］．（2019-10-29）［2019-11-01］．http://szb.jkb.com.cn/jkbpaper/html/2019-10/29/content_260956.htm.
［19］共产党网．浙江全面推进县域医共体建设的探索［EB/OL］．（2019-10-29）［2019-11-01］．http://www.12371.cn/2019/07/19/ARTI1563512917660579.shtml.
［20］刘文生．解剖县域医共体“阜南样板”［J］．中国医院院长，2018，14（11）：68-71.
［21］郑英，胡佳，代涛，等．安徽省天长市和福建省尤溪县县域医联体建设研究［J］．中国卫生政策研究，2019，12（5）：11-17．DOI：10.3969/j.issn.1674-2982.2019.05.002.
ZHENG Y，HU J，DAI T，et al．Study of the construction of medical alliances in Tianchang City of Anhui Province and Youxi County of Fujian Province［J］．Chinese Journal of Health Policy，2019，12（5）：11-17．DOI：10.3969/j.issn.1674-2982.2019.05.002.
［22］代涛，郑英，甘戈，等．全国县级公立医院综合改革第一批示范县改革进展研究［J］．中国卫生政策研究，2019，12（5）：1-10．DOI：10.3969/j.issn.1674-2982.2019.05.001.
DAI T，ZHENG Y，GAN G，et al．Study of the reform progress and effects of the first pilot counties of comprehensive reform of county-level public hospitals［J］．Chinese Journal of Health Policy，2019，12（5）：1-10．DOI：10.3969/j.issn.1674-2982.2019.05.001.
［23］申丽君，黄成凤，李乐乐，等．县域医共体模式的探索与实践：以安徽省天长市为例［J］．卫生经济研究，2018，35（12）：7-11．DOI：10.14055/j.cnki.33-1056/f.2018.12.002.
SHEN L J，HUANG C F，LI L L，et al．Exploration and practice of county medical community model：taking Tianchang City，Anhui Province as an example［J］．Health Economics Research，2018，35（12）：7-11．DOI：10.14055/j.cnki.33-1056/f.2018.12.002.
［24］如何补齐全科医生这块短板？全国政协这次调研不一般！［EB/OL］．（2019-01-17）［2019-11-01］．http://www.yidianzixun.com/article/0L76DdQf.
［25］稳住村医队伍　不妨试试这几招［EB/OL］．（2019-10-24）［2019-11-01］．http://www.jkb.com.cn/sjcws/sjcws/2019/1024/463554.html.

[1]	CHAI Zhihao, ZHANG Weisen, LUO Jiaoling, ZHU Feng, ZHU Tong, JIN Yali, PAN Jing, LU Yingjun, JIANG Chaoqiang. The Mediation Effect of Socioeconomic Status in Childhood Parental Literacy and Cognitive Function in Middle-aged and Older People: Based on Guangzhou Biobank Cohort Study [J]. Chinese General Practice, 2026, 29(21): 2959-2966.
[2]	ZHANG Zhenglu, WU Yihan. International Experience in the Development of Mental Health Special Interest in General Practice and Its Implications for China [J]. Chinese General Practice, 2026, 29(20): 2775-2780.
[3]	ZHAO Xinxin, SUN Xiaoting, LUO Xinhao, SUN Jin, PENG Derong, ZHENG Jialin. Research on the Localization of the Patient-centered Medical Home Model in China: Adaptation Mechanisms, Challenges, and Pathway Analysis [J]. Chinese General Practice, 2026, 29(19): 2608-2613.
[4]	AN Xian, HUANG Peng, REN Jingjing. Investigation on the Cognition and Current Status of General Practitioners in the Multidisciplinary Diagnosis and Treatment of Medically Unexplained Symptoms [J]. Chinese General Practice, 2026, 29(18): 2472-2481.
[5]	HEI Moran, MA Hui'e, XU Zecheng, YAN Shiyan, LI Ziyan, YANG Yi, JIN Jun, CHEN Zelin, GUO Yi, ZHAO Xue, ZHAO Tianyi. Comparison, Analysis and Considerations of Methods for Determining Clinical Questions in Domestic and International Clinical Practice Guideline Development Manuals [J]. Chinese General Practice, 2026, 29(18): 2554-2560.
[6]	FAN Meixiang, YAN Yunyun, HUANG Yanyan. Interpretation and Discussion of Guidelines for Preventive Activities in General Practice: Bladder Cancer [J]. Chinese General Practice, 2026, 29(18): 2450-2453.
[7]	MENG Zixi, ZHAO Huiduo, LIU Ruidong, WANG Beibei, JIANG Mingqiang, CHENG Xufeng. Guidelines for Diagnosis and Treatment of Acute Mastitis with Integrated Traditional Chinese and Western Medicine [J]. Chinese General Practice, 2026, 29(17): 2273-2281.
[8]	YOU Lili, LIU Lu, CHEN Ying, KANG Qixue, WANG Yuxing, WANG Jingbo, ZHANG Bingli. Fifteen Years Review and Future Prospects of China's National Essential Public Health Services [J]. Chinese General Practice, 2026, 29(17): 2282-2295.
[9]	WANG Yang, JIN Hua, YANG Sen, YANG Hui, YU Dehua. Reconfiguring the Functional Features of Primary Care in a Non-gatekeeping Context: a 15-Year Mixed-methods Systematic Review from China [J]. Chinese General Practice, 2026, 29(16): 2140-2155.
[10]	GUO Jiao, ZHANG Gaojing, LIU Xincan. Quality Evaluation of TCM Clinical Practice Guidelines/Consensus: Based on Two Guideline Evaluation Tools [J]. Chinese General Practice, 2026, 29(15): 2100-2106.
[11]	Nephrology Branch of China Association of Chinese Medicine, Nephrology Committee of Guangdong Provincial Association of Chinese Medicine, SU Peiling, YANG Lihong, BAO Kun. Diagnosis and Treatment Guideline of Integrated Traditional Chinese and Western Medicine for Idiopathic Membranous Nephropathy (2025) [J]. Chinese General Practice, 2026, 29(15): 1953-1970.
[12]	JIAO Shuting, ZHAO Yali. A Qualitative Study on the Current Status of Chronic Pruritus Services for the Elderly in Community [J]. Chinese General Practice, 2026, 29(13): 1682-1687.
[13]	LIU Juanjuan, SHI Guoqing, REN Jingjing. Application of Teaching Feedback and Reflective Learning in Standardized Training for General Practitioners [J]. Chinese General Practice, 2026, 29(13): 1732-1738.
[14]	ZHANG Hanyu, GU Jie, LIN Yingnan, HUANG Yanyan. Discussion on the Application of AI-based Simulated-scenario Standardized Patients in the Standardized Training Teaching of General Practice Resident Physicians [J]. Chinese General Practice, 2026, 29(13): 1726-1731.
[15]	LI Jing, JI Yan, SUN Liu, WANG Hanting, WU Jidong, LIU June. Summary of Best Evidence on the Management of Hearing Loss in Older Adults in Primary Health Care Settings [J]. Chinese General Practice, 2026, 29(13): 1713-1719.