Improve the urban medical service system of China's Countermeasures Community health service is to urbanization with Chinese characteristics with the health care system an important component of Community health services in community work as an important component of the various parts are actively promoting this work， and some have achieved good However， the construction of the current community health service there are still major problems to the following: First， the development of community awareness of the importance of health services is not in Community health services should be the basic medical insurance is a major commitment， and it can be a timely， convenient and economical way to provide insurance services， rational and effective use of medical insurance Only do a good job of community building can be the most direct and convenient for the general population， a good， efficient However， some of the staff of local health services to develop community awareness of the importance of also not Some think that hospitals， health centers， abundant resources， has been able to meet the need， and there is no need for further development of community health service organizations; Some think we should go with the flow development， it is not necessary to vigorously promote the development of awareness of less than In recognition of the bias， a number of local community health service lags behind the building of socio-economic development lags behind medical insurance and health， medicine circulation system reform， health services lags behind the demand for urban Secondly， the expansion of community health service functions are not in Community health service as a product of urbanization， the demand for its functions as the guide is based on the residents， for residents to provide preventive， medical， health， rehabilitation， health education， family planning， "Six in One" integrated health However， in actual operation， there is understanding in some areas of Some believe that the community health services similar to the grass-roots hospitals， but is set by the district offices， for more than a brand; some believe that the community health services is only secondary and tertiary hospitals to district offices sent a number of In the provision of services， and some believe that the main headache for the treatment of patients with influenza， vaccination for children， such as disease This function of community health services， one-sided understanding of the impact of a community health service institutions and functions of standardized construction brought into full Third， the community health care measures are not in The development of community health services， not only to keep up with the hardware construction， and the need for sound policies and At present， the absence of a unified planning or planning is not scientific， in some areas of community health service agencies， hospitals or the streets from the hospital transfer form to send agencies， personnel， shortage of funds， facilities， backward， obsolete equipment; affected the normal work Not even a lot of community health services， development is very In terms of software development， taxation， prices and other preferential policies in place， two-way referral system is established， not covered by medical insurance institutions， the limited community health services， economic difficulties， the slow Fourth， inadequate personnel training Community health service need is general practitioners， and the establishment of China's medical education system in At present， engaged in community health services， health care workers， mainly low-level specialist qualifications or other industries to switch from non-school medical staff， some staff had only received a small number of special Whether it is health care personnel or nursing staff， in terms of quantity and quality are far failed to meet the development needs of community health Strategies to address these problems: First， the practical importance of community health services The development of community health services， not only can effectively satisfy the growing urban demand for health services， but also conducive to urban health service system to adjust the structure， function and layout， to improve efficiency， reduce costs and at the same time， the stability of the urban basic medical insurance system operation， but also plays an important supporting Governments at all levels of development should be fully aware of the importance of community health services， a deep understanding of its meaning， the correct positioning of its functions will be integrated into the local economy and social development of the overall planning， overall Community work as a civil affairs departments of the main functions of departments， should be actively in community health service agencies do a good job of layout and the allocation of resources and so Health， planning， finance， labor and social security， education and other relevant departments should work closely with their duties to develop and perfect the supporting policies and measures to promote community health service in the healthy and orderly Second， the law in a market economy， the community health service development In the socialist market economy， the development of community health services， must follow the rules of market Not only to foster the development of components， services， regardless of the concept under the new ownership， the government's macro-control， micro-enliven， encourage competition， the survival of the For the broad masses of people who can provide quality， convenient and affordable basic health services， whether public or private community-based WHO (primary health care institutions)， should support and encourage its Of course， since as a community health service organizations， health authorities must accept the guidance of the business， the management of medical institutions in accordance with the relevant provisions to regulate them， including the establishment of examination and approval， staffing， technology standards， services， service content， service， service And there is a charitable enterprise investment in the capacity of units or individuals may participate in this investment and services for the community so as to create conditions of Third， under the guidance of regional health planning， set up community health service Community health service organizations as the urban medical service system an important component of the approval and distribution in the set must be consistent with the principles of regional health According to the characteristics of community health services， general offices to the streets to set the scope of community health service centers， community health service area is too large or inaccessible areas， could be considered appropriate to send additional community health service agencies (stations) Can also break the administrative divisions set up institutions by geographical In order to make full use of existing health resources around a specific operation， such as by way of open tender， the existing primary and secondary hospitals， hospitals in the streets， anti-Paul Hospital， enterprises and institutions such as hospitals and individual out-patient primary health care transformation of institutions， restructuring， formed by the Excess of the community， do not meet the health planning should be medical institutions merge， reorganize or shut down on its own for the new institutions to prevent redundant construction， blind Fourth， the establishment of "two-way referral system" and improve the medical insurance To achieve the "minor illness in the community， serious split H" First， the establishment of "two-way referral " Community health service agencies in an emergency ambulance to be able to critically ill patients after the referral for the For this reason， two requirements all over the district general hospitals， Chinese medicine hospitals， specialist hospitals and community health services should establish a two-way referral relationship between the commitment of community health services， operational guidance， technical support， personnel training and referral， such as two-way Second， community health services will be included in the scope of the basic medical insurance， the true realization of "one card in hand， large， medium and small medical institutions I can " Community residents suffering from minor ailments such as headaches cold， there is no need to go to major hospitals， medical insurance card with the nearest access to basic medical Fifth， implement the principle of multi-funding to expand community health service organizations， funding In the development of community health services， it is necessary to adhere to the principle of multi-financing to encourage investment in all aspects of community health In the government's preferential policies on a wide range of community health services to non-discriminatory Community health services of public organizations， at present， local governments should be based on the actual situation and make full use of existing resources on the basis of appropriate arrangements should be community health service management information systems and public community health services and other aspects of equipment start-up funds and personnel training， health education， as well as funding for community health services for retirees health care costs and health Sixth， the establishment of mechanisms to protect Community health service organizations with medical care， prevention， health care and many other functions， to perform these functions requires a large amount of general medical and nursing Around in the development of community health services， general medical and nursing staff should develop training programs to take full-time training and job training a combination of approaches， to increase training， and training community health workers to adapt to the needs of health Provincial medical colleges and universities to set up base in medical education in The health sector to serve in accordance with the general eligibility criteria for health care workers， general practitioners do a good assessment of the work of technical Community health service agencies in the talent selection， we should not stick to one pattern， breaking all geographical unit for all personnel attached to， such as household ownership of ideas， the implementation of an open recruitment， recruitment， there will be technical， there are substantial medical staff medical ethics to the community health service --------------------------------------------- 完善我国城市医疗服务体系对策研究 社区卫生服务是具有中国特色的城镇医疗服务体系的重要组成部分。社区卫生服务作为社区工作的重要组成部分，各地都在积极地推动此项工作，有的已取得较好的成绩。但当前社区卫生服务建设中还存在着以下方面的主要问题： 第一，对发展社区卫生服务重要性的认识不到位。社区卫生服务应是基本医疗保险的主要承担者，它可以及时、方便、经济地为参保人员提供服务，合理有效地使用医疗保险基金。只有搞好社区建设，才能最直接地为广大民众提供便捷、良好、高效的服务。但一些地方的有关人员对发展社区卫生服务的重要性还认识不够。有的认为现在的医院、卫生院，资源比较雄厚，已能够满足需要了，没有必要再发展社区卫生服务组织；有的认为应顺其自然地发展，没有必要大力推动，认识不到其发展的紧迫性。由于认识上的偏差，一些地方的社区卫生服务建设滞后于社会经济的发展，滞后于医疗保险及卫生、药品流通体制的改革，滞后于城市居民卫生服务需求的发展。 第二，社区卫生服务职能扩展不到位。社区卫生服务作为城市化的产物，其职能是以居民需求为导向，为城市居民提供预防、医疗、保健、康复、健康教育、计划生育技术"六位一体"的综合卫生服务。但在实际操作中，一些地方存在认识上的误区。有的认为，社区卫生服务机构类似于基层卫生院，只不过是按街道办事处设置、换一块牌子而已;有的认为，社区卫生服务机构只不过是二级、三级医院向各街道办事处派出一些分支机构等。在提供的服务上，有的认为，主要是为患者治疗头痛感冒、为小孩接种、防疫等病。这种对社区卫生服务职能的片面理解，影响了社区卫生服务机构的规范化建设和职能的充分发挥。 第三，社区卫生服务的配套措施不到位。发展社区卫生服务，不仅需要硬件建设跟上，而且需要完善的配套政策和措施。目前由于没有统一的规划或规划不科学，一些地方的社区卫生服务机构，由原来的街道卫生院或医院的派出机构转制而成，人员不足，资金紧缺，设施落后，设备陈旧；影响了正常工作的开展。甚至很多社区没有卫生服务机构，发展很不平衡。在软件建设方面，税收、价格等优惠政策不到位，双向转诊制度未建立，未纳入医疗保险定点机构等，使得社区卫生服务业务受限、经济困难、发展缓慢。 第四，人才培养机制不完善。社区卫生服务需要的是全科医师，而当前我国尚末建立全科医学教育体系。目前，从事社区卫生服务的医护人员，主要是学历层次较低的专科医生或其他行业转行而来的非学医人员，部分人员只接受过很少一些专门教育。无论是医疗保健人员，还是护理人员，在数量和质量上，都远未能满足发展社区卫生服务的需要。 解决上述问题的对策： 第一，切实重视社区卫生服务建设。发展社区卫生服务，不仅可以有效地满足城市居民日益增长的卫生服务需求，而且有利于调整城市卫生服务体系的结构、功能和布局，提高效率，降低成本，同时，对稳定城镇基本医疗保险制度的运行，也起着重要的支撑作用。各级政府应充分认识发展社区卫生服务的重要性，深刻理解其内涵，正确定位其职能，将其纳入当地经济和社会发展总体规划，统筹规划。民政部门作为社区工作的主要职能部门，应积极抓好社区卫生服务机构的布点及资源配置等工作。卫生、计划、财政、劳动保障、教育等有关部门，应密切配合，各负其责，制定和完善配套政策与措施，促进社区卫生服务健康、有序发展。 第二，在市场经济法则下，谋划社区卫生服务发展。在社会主义市场经济条件下发展社区卫生服务，必须遵循市场经济法则。要树立发展不唯成份、服务不分隶属的全新所有制观念，在政府宏观调控下，搞活微观，鼓励竞争，优胜劣汰。凡是能够为广大群众提 供优质、便捷、价格合理的基本卫生服务，不论是公立的还是私立的的社区卫生组织(基层医疗机构)，都应支持鼓励其发展。当然，既然作为社区卫生服务组织，就必须接受卫生行政部门的业务指导，按医疗机构管理的有关规定予以规范，包括设置审批、人员配备、技 术标准规范、服务对象、服务内容、服务项目、服务价格等。有慈善事业心且有投资能力的单位或个人可以参与这方面的投资和服务，为社会、为居民创造服务条件。 第三，在区域卫生规划指导下，设置社区卫生服务组织。社区卫生服务组织作为城市医疗卫生服务体系的重要组成部分，在设置审批和布局上必须符合区域卫生规划原则。根据社区卫生服务的特点，一般以街道办事处为范围设置社区卫生服务中心，在社区卫生服务区域过大或交通不便的区域，可考虑适当增设社区卫生服务派出机构(站)。也可以打破行政区划按地理区域设置机构。为了充分利用现有卫生资源，各地在具体操作中，可通过公开招标等方式，对现有的一、二级医院、街道卫生院、防保院、企事业单位医院及个体门诊部等基层医疗机构进行改造、改组，由其转制而成。对社区内多余的、不符合卫生规划的医疗机构要予以撤并、改组或自行关闭，对新增的机构要 防止重复建设，盲目发展。 第四，建立 “双向转诊制度”，完善医疗保险政策。要实现“小病在社区，大病迸医院”。一是建立“双 向转诊制度”。社区卫生服务机构要能够在紧急救护后为危重病人提供转诊上的便利。为此，要求市辖区内所有二级以上综合医院、中医院、专科医院都要与社区卫生服务组织建立双向转诊关系，承担社区卫生服务的业务指导、技术支持、人才培养及双向转诊等任务。二是将社区卫生服务机构列入基本医疗保险定 点范围，真正实现“一卡在手，大、中、小医疗机构任我 走”。社区居民患头疼感冒等小病，没有必要去大医 院，凭医疗保险卡可以就近获得基本医疗服务。 第五，贯彻多方筹资的原则，扩展社区卫生服务 组织的经费来源。在发展社区卫生服务中，要坚持多 方筹资的原则，鼓励社会各方面投资社区卫生服务。在政府出台的优惠政策上，各类社区卫生服务组织要一视同仁。对公立社区卫生服务组织而言，目前，各地政府要根据实际情况，在充分利用现有资源的基础上，应适当安排社区卫生服务管理信息系统及公立社区卫生服务机构设备更新等方面的启动经费和人才培养、健康教育经费以及社区卫生服务机构的离退休人员费用和卫生人员的医疗保险费。 第六，建立人才保障机制。社区卫生服务组织具有医疗、预防、保健等多项职能，履行这些职能需要大量的全科医护人员。各地在发展社区卫生服务中，应制定全科医护人员培训计划，采取脱产培训和岗位培训相结合的办法，加大培训力度，培养尽快适应社区卫生工作需要的卫生工作人员。省属高等医学院校要建立全科医学教育基地。卫生部门要按照全科医护人员任职资格标准，做好全科医生技术职务评定工作。在社区卫生服务机构的人才选拔上，要不拘一格，打破地域所有、单位所有、人事隶属、户籍归属等观念，实行公开招考、招聘，将有技术、有医德的医护人员充实到社区卫生服务机
