优质医疗资源下沉基层的路径研究

Research on the Pathway for the Downward Transfer of High-Quality Medical Resources to the Grassroots Level

摘要: 优质医疗资源下沉基层是深化医药卫生体制改革、推动区域医疗资源均衡配置、提升基层医疗卫生服务能力的重要抓手，也是促进分级诊疗制度落地的关键路径。近年来，我国围绕分级诊疗、医联体、紧密型县域医共体、远程医疗、数字健康和人才帮扶等持续推进制度创新，基层医疗服务体系建设取得明显进展。然而，从现实运行看，优质医疗资源下沉基层仍面临资源下沉与能力沉淀不同步、组织协同不够紧密、数字赋能碎片化、人才留用机制不足以及基层首诊吸引力偏弱等问题。本文在系统梳理相关研究与政策文献的基础上，围绕优质医疗资源下沉基层的政策逻辑、实践进展、现实困境与优化路径展开综述。研究认为，优质医疗资源下沉基层不应被简单理解为人员、技术和设备向基层的单向转移，而应进一步关注基层医疗机构是否形成稳定的服务承接能力、连续服务能力和协同转诊能力。其关键在于通过县域服务协作、基层能力建设、数字技术应用、支付方式引导和人才保障机制，推动资源支持转化为基层持续服务能力。未来应从组织协作优化、服务功能完善、数字技术融合、利益联结机制和人才保障体系等方面细化实施路径，推动基层医疗机构由单纯承接上级资源支持，转向具备常见病、多发病、慢性病管理和康复随访等综合服务能力的区域健康服务节点。

Abstract: The distribution of high-quality medical resources to grassroots levels is an important means to deepen the medical and health system reform, promote the balanced allocation of regional medical resources, and enhance the service capabilities of grassroots medical institutions. It is also a key path to implement the tiered medical system. In recent years, China has continuously advanced institutional innovations in areas such as tiered medical care, medical alliances, tight county-level medical consortia, remote medical services, digital health, and talent assistance. The construction of grassroots medical service systems has made significant progress. However, from the perspective of actual operation, the distribution of high-quality medical resources to grassroots levels still faces issues such as the imbalance between resource distribution and capacity accumulation, insufficient organizational collaboration, fragmented digital empowerment, insufficient talent retention mechanisms, and weak attractiveness of primary care at the grassroots level. This paper conducts a review based on a systematic analysis of relevant research and policy literature, focusing on the policy logic, practical progress, current dilemmas, and optimization paths of the distribution of high-quality medical resources to grassroots levels. The study holds that grassroots distribution should not be simply understood as the physical transfer of medical resources, but should be regarded as a systematic governance process centered on county-level integration, with the improvement of grassroots capabilities as the core, supported by digital technology, guided by payment methods and performance evaluations, and oriented towards continuous health services. In the future, efforts should be coordinated from aspects such as organizational restructuring, functional reshaping, technological collaboration, interest linkage, and talent guarantee to promote a shift from “passive acceptance” to “active service” and from “short-term blood transfusion” to “continuous hematopoiesis” in grassroots medical services, and to build a sustainable, evaluable, and replicable new model of grassroots medical services.