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我国医防融合理论内涵及实践探索

Integration of medical services and public health in China: theoretical connotation and practical exploration

  • 摘要: 医防融合是推动“以治病为中心”向“以健康为中心”转型的核心机制,也是健康中国建设的战略抓手。本文基于2020年以来的实地调研与政策文本分析,系统梳理医防融合的理论内涵、政策演进及实践模式,揭示其面临的深层制度困境。研究发现:(1)我国医防融合历经“应急协作–基层整合–系统改革–体系跃迁”四阶段政策演变,地方实践呈现权责清单嵌入型、组织体系重构型与数字赋能整合型三类模式;(2)当前改革面临价值认知偏差、管理体系割裂、经济激励失衡、人才断层及制度执行脱节五大困境,根源在于传统“治疗中心主义”与健康治理目标的系统性冲突;(3)需通过重构健康绩效导向的补偿机制、构建协同治理体系、创新筹资模式、重塑人才培养路径及完善动态监管五维路径,推动我国医防融合的高质量发展。

     

    Abstract: AbstractIntegrating medical services and public health is a key to shifting from a treatment-centered to a health-centered approach. It is also a strategic lever for building a Healthy China. Based on field research and an analysis of policy documents from 2020 onwards, this paper systematically examines the theoretical implications, policy evolution, and practical models of this integration. The paper also reveals the deep-seated institutional challenges that this integration faces. Key findings include: (1) China's integration of medical services and public health has undergone a four-stage policy evolution: "emergency collaboration → grassroots integration → systemic reform → system leapfrogging." Regional practices have developed three models: embedded responsibility lists, organizational restructuring, and digitally enabled integration. (2) Current reforms face five major challenges: misaligned value perceptions, fragmented management systems, imbalanced economic incentives, talent shortages, and disjointed policy implementation. These challenges stem from systemic conflicts between traditional "treatment-centered" approaches and the goals of health governance. (3) To advance high-quality development, China must adopt a five-dimensional approach: 1) reforming health performance-based compensation mechanisms, 2) building collaborative governance systems, 3) innovating financing models, 4) reshaping talent development pathways, and 5) strengthening dynamic supervision.

     

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