谢飞 谢斌

[摘要] 根据医改政策要求，我国各地医疗机构纷纷组建医联体，并取得了阶段性成效，但需要解决的问题仍然很多，不少“试水破冰”的医联体呈现出一种“联而不合”状态，不仅影响了医联体诸多功能充分发挥，也影響到分级诊疗体系格局形成。上海市精神卫生管理和服务中存在政府投入不足、专科医院之间各自为政、协调不力以及资源配置不合理等诸多问题，开展精神专科医联体建设是解决这些问题有效途径之一，且具有现实意义。建议在医联体建设中，政府发挥主导和统筹作用，负责顶层设计与组织协调，明确公平性、可及性、分级医疗以及大型公立医院主导的四项基本原则，根据不同需求给予不同配套措施和政策支持，增加对医联体建设的投入，使精神专科医联体最终回归于分级诊疗政策制订的初衷，从而实现有效缓解群众“看病难、看病贵”新医改目标。

[关键词] 精神专科医院；医疗联合体；资源整合；政策建议

[中图分类号] R197 [文献标识码] A [文章编号] 1673-7210（2018）02（a）-0151-05

The exploration for development of medical alliance in psychiatric hospitals in Shanghai

XIE Fei XIE Bin

Department of Administration Office， Shanghai Mental Health Center， Shanghai Jiao Tong University School of Medicine， Shanghai 200030， China

[Abstract] According to medical reform policy requirements， medical alliances in China were established one after another in health institutions and achieved the initial success. But there are still many problems to be solved， a number of "test water breaking" medical couplet presents a state of "incompatibility"， which led to the alliances could not play the functions completely， even affected the formation of the domestic hierarchical medical system. There are many problems between insufficient government investment， self-governance among specialist hospitals， poor coordination and unreasonable distribution of mental health resources in Shanghai city mental health management and service， to carry out establish psychiatric medical alliances is one of the effective ways to solve these problems， and it has realistic significance. It is suggested that in the establish psychiatric medical alliances， government should play a leading and coordinating role in the construction of the psychiatric medical alliances， it is responsible for the top-level design and coordination of the organization， clarifying the four basic principles of fairness， accessibility， hierarchical medical care and the leading role of public hospitals. Give different supporting measures and policy support according to different needs， and increase the investment on the construction of medical alliance. So that the psychiatric medical alliances can return to the initial purpose of the establishment of the hierarchical medical system and reach the goal of the new medical reform， which aims to effectively alleviate "difficulties and expensive medical treatment".

[Key words] Psychiatric hospital； Medical alliance； Resource integration； Policy recommendations

我国医疗卫生资源总量不足、质量不高、结构与布局不合理、服务体系碎片化、部分公立医院单体规模不合理扩张等问题[1]，在精神卫生领域尤为突出。上海市面临的人口老龄化以及竞争压力加剧等对疾病谱和精神卫生服务需求带来明显影响，但政府对精神卫生机构投入相对不足、社区缺乏后续服务、患者家庭负担过重等问题仍较突出。开展精神专科医联体建设，提升优质医疗资源的可及性[2]，实现分级诊疗，使患者享受到全程的健康管理和医疗护理服务[3]，可能是解决上述矛盾的途径之一。……