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中国的基层医疗保健系统。

The primary health-care system in China.

机构信息

National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Institute of Applied Health Research, University of Birmingham, Birmingham, UK; General Practice Development and Research Center, Peking University Health Science Center, Beijing, China.

出版信息

Lancet. 2017 Dec 9;390(10112):2584-2594. doi: 10.1016/S0140-6736(17)33109-4. Epub 2017 Dec 8.

Abstract

China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes). As China deepens its health-care reform, it has the opportunity to build an integrated, cooperative primary health-care system, generating knowledge from practice that can support improvements, and bolstered by evidence-based performance indicators and incentives.

摘要

中国在加强基层医疗体系方面取得了显著进展。然而,该体系在结构特点、激励机制和政策以及医疗质量方面仍面临挑战,这些挑战降低了其为世界五分之一的人口提供服务的准备程度,这些人口正在老龄化,慢性非传染性疾病的患病率也在不断上升。这些挑战包括其劳动力教育和资格不足、乡村医生老龄化和更替、分散的卫生信息技术系统、日常临床实践数字化数据匮乏、财务补贴和激励措施不能鼓励节约成本和良好表现、保险政策阻碍了医疗服务的效率、质量衡量和改进系统不足以及在控制危险因素(如高血压和糖尿病)方面表现不佳。随着中国深化医疗改革,它有机会建立一个综合的、合作的基层医疗体系,从实践中获取支持改进的知识,并通过基于证据的绩效指标和激励措施得到加强。

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