【中图分类号】R197【文献标识码】A DOI：10.12114/j.issn.1007-9572.2025.0065

【Abstract】Inpatientcareandambulatorycareconstitute the nationalandregional healthcare system.Therelationship betweenthetwosubsystemsisasignificanttopicthatneeds tobestudied.UsingpubliclyreleaseddataofChinaandinteational agencies，thispaper preliminarilyanalyses the statusand trendsofhospital inpatient service provisionandutilizationand potential influencingfactors，aswellastherelationshipbetweenprimarycareandinpatientcare.Theresultsshowthathospital admisionratesinChinaarepositivelycorrelatedwiththedegreeofpopulationagingandtheavailabilityofhospitalbeds，with synchronousgrowthobservedinbedavailability，utilzationrates，andgeneralpractitionerresoures.Hospitaladmiionates varysignificantlyacrossprovinces.Thehospitalizationratecannotbesatisfactorilyexplainedwithcommonlyusedindicatorssuch associoeconomic，populationstructure，and healthresourceallocation，butgeographicdensityof hospitalbedsisrelatedto socioeconomicandpopulationindicatorsandotherresouestructures.Internationally，thesupplyofhospitalbedsisdecreasing inhigh-incomecountries，increasing inmidle-incomecountries，andremainingatalowlevelinlow-incomecountries；the hospitalizationateisrelated topopulationaging，economicdevelopment，andhospitalgovernancepolicies.Ithasbeenwidely realizedthatexcesive provisionof expensive inpatientcare willmakethehealthsystemunsustainable.Thehealthcareystem reformsare focusingonearlydiseaseprevention，consolidatingand strengthening primaryhealthcareandbasic medical care， andchangingthetraditionalroleofhospitals.High-incomecountrieshavereducedthesupplyandutilizationofhospitalization services through various measures，midle-incomecountriesareexploring thegovernanceofhospitalizationservices，andlowincomecountriesareexploringhowtoincreasesupplyandutilizationof inpatientcare.Strengthening basicmedical services does not necessarilyleadtoarductionininpatintservices，buttoimprovethecosteffectivenessandfirnesofregionalmedical servicesandoptimize theuseof inpatientresources.Efective govermanceof inpatient careand primarycare，establishmentand developmentoflarge-scale andcompetentbasic medical services，implementationofsharedcare acrossthe subsystems andaply gatekeper systems，and measures to reduce avoidable hospitalizations for specific diseasesand specific populations can help primary care contribute more rational inpatient care.

【Key Words 】Primary care；General practice；Hospital beds；Inpatient care；Supply；Utilisation

我国医疗卫生系统的改革和发展进入“深水区”，其中一个重要的考量和博弈，是怎样在医院住院服务（inpatientcare）的提供和利用上，与非住院服务（ambulatorycare，包括基层社区的全科服务和各类门诊专科服务）平衡，促进和实现区域医疗卫生服务资源更好的配置效率和价值，从而在实现可持续发展的同时，维护和提高我国居民的健康水平和生活质量。

住院服务是昂贵的服务，几乎所有国家的医疗卫生系统在报告和强调这个令人担忧的事实。人口老龄化、慢性疾病快速增长、多病共存和复杂疾病、医疗新技术发展和涌现、人们对医疗服务的期望的提升，以及强有力的以医院为基础的专科发展，均是推动医院病床扩张及其费用增长的重要因素。我国的住院服务利用率的增长是极快速的[1]，其原因和长期影响，是医疗服务提供者和购买者关心的问题。作为非住院服务的全科医学服务，是否能降低过高的住院服务利用率，是否能对合理使用住院服务资源有所贡献，值得思考和研究。

1住院服务供给和利用

住院服务是重要的医疗服务提供和利用形式。人院（admission）是住院服务的起点，出院（discharge，separation）是住院服务的结束点，因死亡、出院、转院、自行离开医院，均属于出院。按病情性质，住院服务可以分成急症服务（紧急情况人院）和择期服务（非紧急入院）。按患者是否在医院过夜，可分成正常住院（至少住一夜）和当日住院。

住院服务统计中的出院人数是衡量住院服务利用的最常用数据，通常基于患者出院时收集的信息，疾病诊断国际疾病分类（ICD）［2]。……