Gauld Robin, Asgari-Jirhandeh Nima, Patcharanarumol Walaiporn, Tangcharoensathien Viroj
Otago Business School, University of Otago, Dunedin, New Zealand.
Asia-Pacific Observatory on Health Systems and Policies, World Health Organization, Delhi, India.
BMJ Glob Health. 2018 Nov 28;3(6):e001168. doi: 10.1136/bmjgh-2018-001168. eCollection 2018.
Hospitals in the Asia-Pacific today face the 'triple aim' challenge, proposed by the Institute for Healthcare Improvement, of how to improve quality of care and population health, while at the same time controlling healthcare costs. Yet, pursuing these challenges in combination is presently a remote prospect for many hospitals and, indeed, in a majority of countries in the region. The roles and functions of the public hospital sector within local health systems need redefinition and reform in the context of demographic and epidemiological transitions. Policymakers, managers and health professionals have an obligation to reshape the future of public hospitals. This article outlines actions for how public hospitals can be reshaped from a health system perspective. First, hospitals should be integrated into the fabric of the local health system; they can lead in this through working in alliances with other healthcare facilities, including primary care and private hospitals. Policymakers have a role in facilitating this as it contributes to health improvement of the population. Second, investments in system innovation, management improvement and information systems are required and their impact assessed. Such investments can contribute to cost control and efficiency. Public hospital sector investments should be strategic, efficient and should not bias investment in broader determinants of health. Third, reorienting health workforce competencies and appropriate skills should be central to hospital sector reforms, from policy to frontline services delivery. Creative thinking is needed to build and support flexible care delivery arrangements for services designed to respond to patients ' and providers' needs. Pivotal to achievement of each of these three areas of reform is good governance and leadership.
如今，亚太地区的医院面临着医疗保健改善研究所提出的“三重目标”挑战，即如何提高医疗质量和人群健康水平，同时控制医疗成本。然而，对该地区许多医院乃至大多数国家而言，同时应对这些挑战目前仍是一个遥远的前景。在人口结构和流行病学转变的背景下，当地卫生系统中公立医院部门的角色和职能需要重新定义和改革。政策制定者、管理人员和卫生专业人员有义务重塑公立医院的未来。本文概述了从卫生系统角度重塑公立医院的行动。首先，医院应融入当地卫生系统的架构之中；它们可以通过与包括初级保健机构和私立医院在内的其他医疗设施结成联盟来引领这一进程。政策制定者在推动此事上发挥着作用，因为这有助于提高人群的健康水平。其次，需要对系统创新、管理改进和信息系统进行投资，并评估其影响。此类投资有助于控制成本和提高效率。公立医院部门的投资应具有战略性、高效性，且不应偏向于对更广泛健康决定因素的投资。第三，从政策制定到一线服务提供，重新调整卫生人力的能力和适当技能应是医院部门改革的核心。需要创造性思维来构建和支持灵活的护理服务提供安排，以满足患者和提供者的需求。实现这三项改革领域中的每一项，关键都在于良好的治理和领导力。
