我国分级诊疗的实施困境及对策建议
Implementation difficulties and countermeasures of hierarchical diagnosis and treatment in China

近些年政府积极推动分级诊疗，各地也采取多种举措进行探索，但总体上实施效果不佳。究其原因 主要是缺乏分级诊疗的技术标准、法律法规及考核机制；医师多点执业政策与现行的法律制度和人事管理制度相 冲突；基层医疗机构服务能力弱；医疗机构间转诊协作和利益分享机制的缺乏等因素阻碍了分级诊疗在我国的开 展。因此，只有建立和完善双向转诊的技术标准和管理规范，以及医疗机构间分工协作和利益分享机制；改革和 完善人事制度及医师多点执业政策，增强基层医疗机构服务能力，才能确保分级诊疗的有序开展。
In recent years, the government has actively promoted the hierarchical diagnosis and treatment and adopted a variety of measures to explore it, but the effect is not that good. The reasons are from the following aspects: the lack of related technical standards, laws and regulations, and assessment mechanism; the conflicts between the multiple-site physician practice policy and the current legal system and personnel management system; the weak service capability of primary-level medical institutions; and the lack of referral cooperation and benefit share mechanism among medical institutions, etc. Therefore, to ensure the orderly development of hierarchical diagnosis and treatment in our country, measures should be taken including establishing and improving the technical and management standards of two-way referral, making clear the division of labor cooperation and the interest share among medical institutions, reforming and improving the personnel system and the multiple-site physician practice policy, and strengthening the service capability of primary-level medical institutions