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人口老龄化、参保患者数量增加、付费模式由为服务付费的传统模式向基于价值的模式转变等,均要求医疗服务模式的创新。为了以优质低价的治疗满足患者群的需求,须将专科治疗整合进入家庭医疗团队,以提高跨学科治疗的连续性并控制医疗费用,从而实现“改善医疗水平和患者体验、提升人群健康水平、降低医疗费用”的三大目标。将专科治疗整合进入家庭医疗团队的策略包括增加在基层执业点的治疗量、培养有专业特长的家庭医生、设立社区专科医生(ICS)。本文总结了梅奥诊所(Mayo Clinic)贯彻执行上述3个策略的经验和成果,认为ICS模式在医生收入以工资制为基础的体系内是可行的。
An aging population, an increase in the number of insured patients, the transition from a traditional payment-for-service model to a value-based model, all require innovation in the medical service model. In order to meet the needs of the patient population with high quality and low cost treatment, specialists should be integrated into the family medical team to improve the continuity of interdisciplinary treatment and control the medical expenses so as to achieve the goal of “improving medical treatment and patient experience, and improving people’s health Level, lower medical costs ”the three goals. Strategies to integrate specialist treatment into the family medical team include increasing the amount of treatment at the primary practice level, developing family doctors with specialized expertise and setting up community specialists (ICSs). This paper summarizes the experience and achievements of the Mayo Clinic in implementing the above three strategies and argues that the ICS model is viable within a pay-based system for physicians.