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中国初级医疗服务所面临的难题,已成为制约分级诊疗实现的重要障碍。各种经验资料证明,目前基层医疗机构无法充当居民健康“守门人”的预定角色。这根本上是因为基层医疗机构没有居民所认可与信赖的医生,也因此“百度问医”或“关系问医”现象泛滥。破除这种尴尬的“倒金字塔”形就医结构,必须从医生职业缺乏法团自主性、依旧在很大程度上依附于公立医院这一基本的结构性特征中寻找根源。也因此,“强基层”必须强医生,强医生必须改革僵化的公立机构事业单位人事体制,使医生能够自由流动,真正从大医院下沉到基层机构。
The problems facing China’s primary medical services have become an important obstacle to the implementation of the grading of clinics. Various empirical data show that the current primary health care institutions can not serve as resident health “gatekeeper ” scheduled role. This is basically because there is no physician approved or trusted by the residents in the grass-roots medical institutions, and therefore “Baidu Medical Treatment” or “Relationship Medical Treatment” phenomenon flooded. To get rid of this embarrassing “inverted pyramid ” medical treatment structure, we must find the root causes from the lack of self-determination of the doctor’s profession and largely dependent on the basic structural features of public hospitals. Therefore, “strong grassroots” doctors must be strengthened, and strong doctors must reform the rigid personnel system of public institutions and public institutions so that doctors can flow freely and truly sink from large hospitals to grassroots organizations.