Page 10 - 2022-01-中国全科医学

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practice educators and trainers；special development of general practice characterized by the integration of medical sciences and
Chinese traditional humanistic theories. （5）The development of general practice in China has been facing limitations similar to
those in other countries. Besides that，its special limitations include late development of the discipline，unsatisfactory quality of
workforce，high work pressure and high prevalence of burnout in the workforce，as well as impact of generation gap on education
and practice among GPs. In addition，the relation between specialists and GPs is on transition of from undifferentiated attachment
to self-recognised uniquity，and further seeking transdisciplinary. The teaching competences of GPs teachers，especially those
teaching community and clinical care，are inadequate. GPs team building and management need to advance from the formation to
the storming and performing phases. （6）Opportunities for further development of general practice in China include strategies for
achieving the goals of Healthy China，and an all-round well-off society，the important role of primary health care in sustainable
development and universal health coverage reaffirmed by the Declaration of Astana，as well as significantly improved health
literacy of people. （7）Challenges for the development of general practice in China include population ageing，and aging-related
changes in burden of disease and socio-economic status，the aging and dynamic changes of GPs human resources，the variation
of urban and rural areas and regional differences，and the inverted pyramid structure of allocation of medical and health resources
（namely，the largest part is allocated to tertiary care while the smallest to primary care）. Relevant recommendations to address
these challenges comprise strengthening the advocacy of the development of general practice services，establishing a wide-ranging
community collaborative network，and developing general practice professional organizations. Conclusion The development
of general practice in China is advancing，which is manifested as rapidly increased number of general medical workers，strong
government promotion，quickly improved accessibility of essential medical services，and notably increased utilization rate of
primary care services. However，the development is facing challenges，such as high discipline and social expectations regarding
general practice，instability in the workforce due to high work pressure of the knowledge- and labor-intensive job，GPs'
insufficient recognition of their self-identity，and unclear status of financial funding for general practice development. Given that
there are unprecedented favorable conditions for general practice development，medical industries and general medical workers
are suggested to make efforts to turn challenges into opportunities to develop general medical services，thereby universal health
outcomes will be improved.
【Key words】 General practice；General practitioners；Industry report；Outcome and process assessment，health
care；Health policy；Health manpower；Health expenditure

强大的全科医学服务系统对于实现并增强医疗 势分析法（SWOT 分析法）为框架，分析中国全科医
卫生服务系统的公平、公正、效率和有效性而言， 学发展的内部和外部条件。数据来源于公开发布的
是至关重要的。国际研究和经验也反复证实，好的 2010—2020 年卫生健康统计报告、发表在学术期刊
初级保健系统可以给人民带来更好的健康 ［1］ 。中国 的研究报告、政府部门发布的卫生政策和工作指南。
的全科医学是一门方兴未艾的临床医学二级学科， 对全科系统内部和外部条件的分析，参考正式发表
自 1993 年成立中华医学会全科医学分会开始算起， 的相关学术报告。
至今已有近 30 年的发展历程。中国的全科医学事业 2 基于 Donabedian 概念模型的中国全科医学行业
是一项充满无限希望，同时也面临艰巨挑战的事业。 发展现状
其是实现健康中国战略、改革和发展医疗卫生系统的 2.1 全科医学的资源结构
基础，也是实现全民健康的必由之路。本文是《中国 2.1.1 全科医学相关政策 本报告涉及的政策指政
全科医学》杂志第一次提供中国全科医学行业报告， 府部门和行业组织发布的政策和工作指导，包括针
文章以近 10 年（2010—2020 年）为阶段，梳理了中 对全科医学领域发展的政策，也包括与全科医学发
国全科医学行业的自身优势和不足，并分析了其发 展有关的宏观政策。根据政策内容，可具体划分为
展面临的环境机会和挑战。在分析行业现状的同时， 人力资源政策（教育与培训、师资发展等相关政策）、
文章也提出了尚未有明晰答案的问题，在此邀请致 财政政策、设施设备政策、管理政策、循证指南等。
力于中国全科医学发展的学者、医生、教育者们共 2010—2020 年的全科医学相关政策是以往相关
同讨论和解答。 政策的承袭和发展。10 年前具有标志性意义的政策
1 资料与方法 包括：1997 年的《中共中央、国务院关于卫生改革
以 Donabedian 的概念模型为框架 ［2］ ，检验和评 与发展的决定》（中发〔1997〕3 号）；1999 年原卫
估中国全科医学基本医疗服务系统的质量特征；以态 生部等十部门《关于发展城市社区卫生服务的若干