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卫计委:将在200个公立医院试点家庭医生签约服务

2016-06-07 大鹏 医学界

“家庭医生”时代真的要来了?6月6日,国家卫计委发布《关于印发推进家庭医生签约服务指导意见的通知》,要求到2017年,家庭医生签约服务覆盖率达到30%以上,重点人群签约服务覆盖率达到60%以上。根据《通知》要求,截止到年底前,我国将在200个公立医院试点家庭医生签约服务。消息传来,各大媒体纷纷进行报道。不少行业媒体表达肯定态度,认为这是医疗改革的进步,“曾被视为‘高档生活方式’的家庭医生,而今正逐

“家庭医生”时代真的要来了?

6月6日,国家卫计委发布《关于印发推进家庭医生签约服务指导意见的通知》,要求到2017年,家庭医生签约服务覆盖率达到30%以上,重点人群签约服务覆盖率达到60%以上。根据《通知》要求,截止到年底前,我国将在200个公立医院试点家庭医生签约服务。

消息传来,各大媒体纷纷进行报道。不少行业媒体表达肯定态度,认为这是医疗改革的进步,“曾被视为‘高档生活方式’的家庭医生,而今正逐步走入寻常百姓家,到时候,老百姓可以实现‘看病就医足不出户’。”

不过这一在诸多媒体口中听起来似乎很完美的医疗模式,在不少医护眼里并没有那么理想。

“初衷是好的,但真的实施起来现实难度大,医疗资源明显不足,再要负担这些,只怕流于形式。”一位医务工作者表示了担忧,更有悲观者甚至认为:“在现有医务人员严重不足,政府层面盲目承诺的环境下,所谓的家庭医生制只会是又一个畸胎。”

当然,也有医生给出了肯定,“向西方医疗模式靠近,初衷是好的,也是未来医疗的走向。”他认为,“我们不要一开始就一味去抵抗和嘲讽,虽然实施起来困难,但可以先在一线城市试点,一步一步的推行,毕竟这么大国家,想要十年二十年实现全民都有家庭医生不现实,但一步一步走,是可以解决一些实际问题的。”

北京7年前即提出“家庭医生”

实际上,早在2010年,北京就率先在全国提出了“家庭医生”的概念。2015年,北京出台家庭医生服务模式新政,市民一旦签约“家庭医生”,可直接找签约医生预约就诊。就医时也将被“分配”到签约医生处,届时,患者可享受从预约到诊疗的全程“一对一”服务。

无独有偶,作为全国的特大型城市,去年6月,上海也启动新一轮社区卫生服务综合改革,建立了家庭医生制度。居民在选择社区卫生服务中心家庭医生签约的基础上,可以再选择一家区级医疗机构、一家市级医疗机构进行签约,形成“1+1+1”的签约医疗机构组合,让家庭医生成为居民健康的“守门人”。

分析人士认为,北京和上海的“家庭医生”先例,可以看成是此次全国性试点家庭医生签约服务的“先行版”,京沪两地的经验或将为全国提供借鉴。

基层卫生机构可能“接不住”

根据卫计委的文件精神,基层卫生机构“接得住”是实现分级诊疗模式的重要基础,其突破口便是实施符合中国国情的家庭医生签约服务。然而,在笔者看来,要实现家庭医生签约服务,基层卫生机构不一定能“接得住”,而且很有可能“接不住”!

文件要求,到2017年,家庭医生签约服务覆盖率达到30%以上,重点人群签约服务覆盖率达到60%以上。到2020年,力争将签约服务扩大到全人群,形成与居民长期稳定的契约服务关系,基本实现家庭医生签约服务制度的全覆盖。

在笔者看来,当前,中国的基层医疗机构普遍偏弱,不仅缺乏同质化的医生,更缺乏先进的诊疗设备,基层医疗基础十分薄弱,在这样的情况下,要想“接住”分级诊疗的落地,笔者表示存疑。不仅如此,到2017年这短短一年多时间里,要建设完成一个覆盖四亿多人口的基层医疗网络,其难度可想而知。

“家庭医生”还有很长路要走

正如基层医改专家徐毓才所言,“家庭医生是一种信托关系,必须建立在十分信任的基础上。就目前我国基层医生的水平,而要取得辖区居民的充分信任,完成全科医生的任务,恐怕还有不小的差距。”

“推广家庭医生签约服务,让居民和医生之间签订协议,这个想法本身是很好的。但目前最大的问题是基层医生的医疗水平落后,满足不了老百姓的需求。说白了,老百姓一旦生了病,他们往往不相信这些基层的医生,反倒宁愿往大医院里面挤。”在徐毓才看来,医疗改革“上层建筑”的构建固然重要,但提高基层医生的待遇和医疗水平,也同样刻不容缓。“家庭医生在中国,还有很长的路要走。”

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    2016-08-28 ylzr123

    深度好文,值得学习,赞!

    0

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    2016-06-09 yuanming8
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    2016-06-07 stomach

    家庭医生的模式期待能快速实施。

    0

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    2016-06-07 gyczyxy

    很难,主要是没人加不信任

    0

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