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医防融合符合成本效益原则，有助于形成健康服务的最优方案，有利于促进全民健康。然而目前，我国医防融合的医疗卫生服务体系尚未建立，医务人员医防融合意识不强，“以健康为中心"还未真正落实到行动上。对此，要加强宣传，提高社会各方对医防融合的认识；建立机制，引导医疗机构开展医防融合服务；加强人才培养，提升基层服务能力，改革医保支付方式，推动医防融合真正落地。
The integration of medical and preventive measures conforms to the principle of cost-effectiveness, which helps to form the optimal solution for health services and promotes the health of the entire population. However, at present, the medical and health service system of medical prevention integration in China has not been established, and the awareness of medical prevention integration among medical staff is not strong. The concept of "health as the center" has not been truly implemented in action. In this regard, it is necessary to strengthen publicity, improve the understanding of medical prevention integration among all sectors of society, establish mechanisms to guide medical institutions to carry out medical prevention integration services, strengthen talent training, enhance grassroots service capabilities, reform medical insurance payment methods, and promote the true implementation of medical prevention integration.
没有全民健康，就没有全面小康。构建大卫生、大健康体系，不仅要提高疾病救治的能力，更要为居民提供全方位、全周期的健康服务，提高人群健康水平。
Without universal health, there can be no comprehensive well-off society. Building a comprehensive health and wellness system not only requires improving the ability to treat diseases, but also providing residents with all-round and full cycle health services to enhance the health level of the population.
“健康中国”战略提出，实现“以健康为中心”，加强疾病预防和健康促进，使医疗和预防有效融合。日益复杂的疾病谱系与健康挑战，凸显了“医防融合”建设的重要性，也让我们认识到，仅仅在基层医疗卫生服务中实现“医防融合”是不够的，必须在各级各类医疗卫生服务中推进“医防融合”，使其成为一种新的健康服务模式。加快推进“以治病为中心”向“以健康为中心”转变，是实现全民健康目标的重要抓手。
The "Healthy China" strategy proposes to achieve a "health centered" approach, strengthen disease prevention and health promotion, and effectively integrate medical care and prevention. The increasingly complex disease spectrum and health challenges highlight the importance of "medical prevention integration" construction, and also make us realize that it is not enough to achieve "medical prevention integration" only in grassroots medical and health services. We must promote "medical prevention integration" in all levels and types of medical and health services, making it a new health service model. Accelerating the transition from a "disease centered" approach to a "health centered" approach is an important lever for achieving the goal of universal health.
本文分析医防融合的内涵及面临的困难，为构建有效的医防融合机制、实现全民健康目标提供决策参考。
This article analyzes the connotation and difficulties faced by the integration of medical and preventive measures, providing decision-making references for building an effective mechanism of medical and preventive integration and achieving the goal of national health.
医防融合的内涵1.何谓医防融合
The connotation of medical prevention integration: 1. What is medical prevention integration
“医防融合”就是将“治病”和“防病”结合起来，即医疗、预防相互渗透，融为一体，通过医疗服务与预防服务有效衔接、同时提供、相互协同等形式，最大限度地减少健康问题的发生，有针对性地控制健康问题的恶化，提高医疗卫生服务的适宜性和有效性，实现“以健康为中心”的目标。
The integration of medical treatment and prevention "refers to the combination of" treating diseases "and" preventing diseases ", that is, the mutual infiltration and integration of medical treatment and prevention. Through effective connection, simultaneous provision, and mutual cooperation between medical services and prevention services, the occurrence of health problems is minimized to the greatest extent possible, and the deterioration of health problems is controlled in a targeted manner, improving the suitability and effectiveness of medical and health services, and achieving the goal of" putting health at the center ".
可见，医防融合的核心要素：一是贯彻预防为主，服务关口前移，让公众不生病、少生病；二是根据个体的具体健康状况，同时提供医疗与预防服务，既有疾病诊疗，又有相关健康知识和技能的宣传教育；三是医疗与预防服务有效协同，根据患者的不同状况和疾病的不同阶段，采取不同的预防和治疗措施，将三级预防的思想真正融入健康服务的全过程。
It can be seen that the core elements of the integration of medicine and prevention are: firstly, to implement prevention as the main focus, to move the service gateway forward, and to prevent and reduce the incidence of illness among the public; Secondly, based on the individual's specific health condition, medical and preventive services are provided simultaneously, including disease diagnosis and treatment, as well as promotion and education of relevant health knowledge and skills; The third is effective collaboration between medical and preventive services, adopting different prevention and treatment measures based on the patient's different conditions and stages of the disease, truly integrating the concept of three-level prevention into the entire process of health services.
2.基层医疗卫生服务中的医防融合
2. Medical prevention integration in primary healthcare services
作为基层医疗卫生机构，乡镇卫生院和社区卫生服务中心的基本职能定位就是“医防一体”，提供医疗、预防、保健、康复等综合卫生服务。国家卫生健康委颁布的《关于做好2019年家庭医生签约服务工作的通知》，对医防融合的具体落实提出了要求：以家庭医生团队为载体，以高血压、糖尿病等慢性病管理为突破口，强化基层医防融合；家庭医生在为签约居民提供诊疗服务时，要将健康档案管理、慢性病随访、健康教育等公共卫生服务与临床治疗服务整合开展。
As grassroots medical and health institutions, the basic functional positioning of township health centers and community health service centers is "medical and preventive integration", providing comprehensive health services such as medical treatment, prevention, health care, and rehabilitation. The Notice on Doing a Good Job in Signing up Service for Family Doctors in 2019 issued by the National Health Commission puts forward requirements for the specific implementation of the integration of medical and prevention: strengthen the integration of medical and prevention at the grass-roots level by taking the family doctor team as the carrier and taking the management of chronic diseases such as hypertension and diabetes as the breakthrough; Family doctors should integrate public health services such as health record management, chronic disease follow-up, and health education with clinical treatment services when providing diagnosis and treatment services to contracted residents.
基层医疗卫生服务中的医防融合，核心要素主要包括：实施机构是基层医疗卫生机构，融合内容以慢性病健康管理为突破口，目标是实现健康服务的连续、协同。对此，要做好人才队伍、日常工作、信息数据、考核评价等工作的融合，重视慢性病患者的筛查，遵循早发现、早诊断、早治疗的原则，开展居民全生命周期的健康管理和健康教育，保障居民获得高质量的医疗与公共卫生相关服务。
The core elements of medical prevention integration in primary healthcare services mainly include: the implementing institution is the primary healthcare institution, the integration content takes chronic disease health management as the breakthrough point, and the goal is to achieve continuous and collaborative health services. In this regard, it is necessary to integrate talent teams, daily work, information data, assessment and evaluation, attach importance to the screening of chronic disease patients, follow the principles of early detection, diagnosis and treatment, carry out health management and education throughout the life cycle of residents, and ensure that residents receive high-quality medical and public health related services.
3.医院服务中的医防融合
3. Medical prevention integration in hospital services
防病不只是疾控部门的责任，更要发挥医院的重要作用，把健康服务的“战略关口”前移。社会老龄化与慢性病负担的日益加剧，更让我们意识到，要充分发挥医院的技术和能力优势，开展疾病预防服务，有效阻断疾病传播，使医防融合成为医院一种新的医疗服务模式。
Disease prevention is not only the responsibility of the disease control department, but also the important role of hospitals in moving the "strategic gateway" of health services forward. The increasing aging of society and the growing burden of chronic diseases have made us realize the need to fully leverage the technological and capacity advantages of hospitals, carry out disease prevention services, effectively block disease transmission, and make medical prevention integration a new medical service model for hospitals.
医院开展医防融合，主要是将临床治疗和预防服务进行有机结合。医院服务中的预防服务内容通常包括：针对患者健康问题的健康咨询和保健知识传播，针对当前流行疾病的健康宣教，针对具有某些高危因素患者的健康指导和健康干预，以及开展疾病筛检、化学预防和预防接种等。对患者而言，来自医生的健康教育和健康指导，通常会发挥更有效的作用。
Hospitals carry out the integration of medical treatment and prevention, mainly by organically combining clinical treatment and prevention services. The prevention services in hospital services usually include health consultation and dissemination of health knowledge for patients' health problems, health education for current epidemic diseases, health guidance and intervention for patients with certain high-risk factors, as well as disease screening, chemical prevention, and vaccination. For patients, health education and guidance from doctors usually play a more effective role.
医防融合的重要性和必要性
The Importance and Necessity of Medical Prevention Integration
1.预防是最具成本效益的健康维护措施
Prevention is the most cost-effective health maintenance measure
对健康的维护不仅仅是对疾病的治疗，更重要的是在没有疾病时的“防患”。从经济学角度看，卫生资源的稀缺性客观上需要医防融合，因为预防是最具成本效益的服务，可以有效降低维护健康的成本，提高卫生资源的使用效率。任何国家的卫生资源都无法完全满足居民的卫生服务需要，提高卫生资源效率是各国政府的基本管理目标。医防融合符合成本效益原则，将投入的重心向预防服务倾斜，将服务关口前移，从而提高资源效率。
Maintaining health is not just about treating diseases, but more importantly, about "preventing" when there is no disease. From an economic perspective, the scarcity of healthcare resources objectively requires the integration of medical and preventive measures, as prevention is the most cost-effective service that can effectively reduce the cost of maintaining health and improve the efficiency of healthcare resource utilization. No country's health resources can fully meet the health service needs of its residents, and improving the efficiency of health resources is the basic management goal of governments around the world. The integration of medical and preventive care conforms to the principle of cost-effectiveness, tilting the focus of investment towards prevention services and moving the service gateway forward, thereby improving resource efficiency.
另一方面，通过疾病预防，减少疾病的发生，延缓病情的恶化，也有助于使那些有卫生服务需要的重症患者看病不再困难。
On the other hand, through disease prevention, reducing the occurrence of diseases, delaying the deterioration of the condition, can also help make it easier for critically ill patients with health service needs to seek medical treatment.
此外，统筹公共卫生和医疗资源，加大资源配置服务前端和服务基层的力度，推进区域慢性病防治、医养结合、免疫规划管理和预防接种服务、筛查与体检平台、健康教育等公共卫生与医疗资源一体化管理，对解决卫生资源稀缺问题具有重要的意义。
In addition, coordinating public health and medical resources, increasing efforts to allocate resources for front-end and grassroots services, promoting integrated management of public health and medical resources such as regional chronic disease prevention and control, medical and elderly care integration, immunization planning and management, vaccination services, screening and physical examination platforms, and health education, is of great significance in solving the problem of scarce health resources.
2.医防融合有助于形成健康服务的最优方案
2. The integration of medical and preventive measures helps to form the optimal solution for health services
从健康保护角度看，预防对减少居民健康问题的发生、提高居民的健康水平，具有非常重要的作用。之所以要强调“医防融合”，而不是“医防结合”，就是希望促进医疗服务与预防服务的相互渗透，使医疗服务与预防服务更好地协同起来，从而使“医”和“防”均更有效。
From the perspective of health protection, prevention plays a very important role in reducing the occurrence of health problems among residents and improving their health level. The reason for emphasizing the integration of medical and preventive services, rather than the combination of medical and preventive services, is to promote the mutual penetration of medical services and preventive services, so as to better coordinate medical services and preventive services, and thus make both "medical" and "preventive" more effective.
预防与医疗相互依存，两者之间的辨证关系主要体现在三个方面。
Prevention and medical care are interdependent, and the dialectical relationship between the two is mainly reflected in three aspects.
一是预防的思想支持和指导着治疗服务，对形成临床治疗服务策略有直接的指导作用：一级预防是针对病因的预防，减少疾病发生；二级预防是采取有效的治疗手段，防止和控制疾病的发展和恶化；三级预防则是预防并发症和伤残的发生。
One is that the idea of prevention supports and guides treatment services, which has a direct guiding role in forming clinical treatment service strategies: primary prevention is aimed at preventing the causes of diseases and reducing their occurrence; Secondary prevention is the adoption of effective treatment methods to prevent and control the development and deterioration of diseases; The third level prevention is to prevent the occurrence of complications and disabilities.
二是医疗也是预防的有效手段之一，预防性治疗也是疾病预防的常用手段。如传染病防控中消灭传染源，就是通过控制和治疗患者，减少疾病的传播机会，从而实现控制传染病流行的目标。
Secondly, medical treatment is also an effective means of prevention, and preventive treatment is a commonly used method for disease prevention. Eliminating the source of infection in infectious disease prevention and control is to control and treat patients, reduce the opportunity for disease transmission, and achieve the goal of controlling the spread of infectious diseases.
三是加强预防有利于改善治疗，通过减少疾病发生，使医生有更多的精力开展治疗，消除“三长一短”的矛盾，减少患者抱怨。
Thirdly, strengthening prevention is beneficial for improving treatment. By reducing the occurrence of diseases, doctors have more energy to carry out treatment, eliminating the contradiction of "three long and one short", and reducing patient complaints.
随着疾病谱的改变，慢性病已成为影响人群健康最重要的公共卫生问题，以医防融合为基础的健康管理服务，是健康问题最优的解决方案，也是保障全体人民享有所需要的、有质量的、可负担的预防、治疗、康复、健康促进等健康服务的有效途径。
With the changing spectrum of diseases, chronic diseases have become the most important public health issue affecting population health. Health management services based on the integration of medicine and prevention are the optimal solution to health problems and an effective way to ensure that all people enjoy the necessary, quality, affordable prevention, treatment, rehabilitation, health promotion and other health services.
3.医防融合有利于促进全民健康
3. The integration of medical and preventive measures is conducive to promoting public health
当前，我国面临多种疾病威胁并存、多种健康影响因素交织的复杂局面。一方面，医防融合以常见病、多发病和重大疾病防治为重点，推行医疗处方和健康处方“双处方”制度，打破公共卫生和医疗服务分割、脱节的局面，将健康服务重心由后端的医疗向前端的预防转移，实现疾病早发现、早诊断、早治疗，从而促进全民健康。
Currently, China is facing a complex situation of multiple disease threats coexisting and multiple health influencing factors intertwined. On the one hand, the integration of medical and preventive measures focuses on the prevention and treatment of common, frequently occurring, and major diseases, implementing a "dual prescription" system for medical and health prescriptions, breaking the separation and disconnection between public health and medical services, shifting the focus of health services from back-end medical care to front-end prevention, achieving early detection, diagnosis, and treatment of diseases, and promoting national health.
另一方面，医防融合以家庭医生签约服务为载体，注重为慢性病、老年人等重点人群提供全面的“防、治、管”一体化的健康管理服务，将群体性预防和个性化预防工作有效协同起来，实现从胎儿到生命终点的全周期健康服务和健康保障，全面维护人民健康。
On the other hand, the integration of medical and preventive measures is carried out through family doctor contract services, focusing on providing comprehensive "prevention, treatment, and management" integrated health management services for key populations such as chronic diseases and the elderly. It effectively coordinates group prevention and personalized prevention work, achieving full cycle health services and health protection from the fetus to the end of life, and comprehensively safeguarding people's health.
医防融合的主要障碍1.共性障碍
The main obstacle to the integration of medicine and prevention is 1. Common obstacles
（1）医防融合的医疗卫生服务体系尚未建立：目前，我国仍然存在医疗与预防各司其职、信息难以共享的现象。在落实“大卫生”“大健康”理念、推动“治已病”向“治未病”转变的过程中，医疗机构、疾控机构在人员队伍、资源配置、健康服务等方面还未有效融合，导致预防、医疗、慢性病管理、康复为一体的服务链条没有实质形成。此外，以人为中心的全生命周期信息系统尚未建立，不同医疗卫生机构之间存在信息沟通障碍。
(1) The integrated medical and health service system of medical prevention has not yet been established: Currently, there is still a phenomenon in China where medical treatment and prevention have their own responsibilities and information is difficult to share. In the process of implementing the concepts of "big health" and "big hygiene", and promoting the transformation from "treating already sick" to "treating before sick", medical institutions and disease control institutions have not effectively integrated personnel teams, resource allocation, health services, etc., resulting in the lack of a substantial service chain integrating prevention, medical treatment, chronic disease management, and rehabilitation. In addition, a human centered full lifecycle information system has not yet been established, and there are communication barriers between different medical and health institutions.
（2）医务人员医防融合意识不强：在健康服务开展过程中，医务人员的医防融合意识还未真正建立，疾控机构和医疗机构提供的服务缺乏有效的协同和融合，有些时候甚至出现对立，以治病为主要收入来源的医疗机构在客观上也不会希望减少病人。对基层医疗卫生人员来说，在实施健康管理过程中常常存在医防融合能力不足的问题，加上群众重治轻防的理念，也影响了基层医疗卫生机构开展医防融合服务的效率和效果。
(2) Lack of strong awareness of medical prevention integration among medical staff: In the process of providing health services, the awareness of medical prevention integration among medical staff has not been truly established. The services provided by disease control institutions and medical institutions lack effective coordination and integration, and sometimes there is even opposition. Medical institutions that mainly rely on treating diseases as their main source of income objectively do not want to reduce the number of patients. For grassroots medical and health personnel, there is often a problem of insufficient ability to integrate medical and preventive measures in the implementation of health management. In addition, the concept of prioritizing treatment over prevention among the masses also affects the efficiency and effectiveness of grassroots medical and health institutions in providing integrated medical and preventive services.
（3）缺乏医防融合有效机制：一方面，疾控机构与医疗机构是相互分离的，职责分工、考核标准都存在差异，限制了医防融合工作的开展。另一方面，由于临床医师与公共卫生医师执业范围限制，开展的服务内容也受到限制，两者之间缺乏统一的操作规范和激励机制，无法在实际工作中真正实现医防融合。
(3) Lack of effective mechanism for medical prevention integration: On the one hand, disease control institutions and medical institutions are separated from each other, with differences in responsibilities and assessment standards, which limits the development of medical prevention integration work. On the other hand, due to limitations in the scope of practice of clinical physicians and public health physicians, the services they provide are also restricted, and there is a lack of unified operating standards and incentive mechanisms between the two, which makes it impossible to truly achieve the integration of medical and prevention in practical work.
（4）“以健康为中心”还停留在理念层面：医防融合是一项不能直接见到效益的“慢功夫”，要做好医疗和预防的协同服务，需要在观念上真正实现“以治病为中心”向“以健康为中心”的转变。但是目前， “以健康为中心”仍然只是一种理念，没有在实际工作中落到实处。
(4) The concept of "putting health at the center" still remains at the conceptual level: the integration of medical and prevention is a "slow work" that cannot directly see benefits. To do a good job in coordinating medical and prevention services, it is necessary to truly realize the transformation from "treating diseases as the center" to "putting health at the center" in terms of concept. However, at present, "putting health at the center" is still just a concept and has not been implemented in practical work.
2.医院医防融合存在的障碍
2. Obstacles to the integration of medical and preventive measures in hospitals
医院是“医防融合”一个重要的着力点和落脚点，在“防病”上有着天然的资源和技术优势，预防知识的宣传效果更好，尤其是针对患者的个性化指导。
Hospitals are an important focus and foothold for the integration of medical and prevention, with natural resources and technological advantages in disease prevention. The promotion of prevention knowledge is more effective, especially personalized guidance for patients.
目前，医院在开展医防融合上还存在诸多问题。一方面，医院重医轻防，在过去的医疗服务管理中，对医疗的重视程度一直很高，而防病职能却被忽视。医院在“治病挣钱”的运行机制下，没有动力开展预防工作；而在医疗卫生资源分布倒置和居民对基层医疗卫生机构不信任的双重作用下，患者就医向医院集中，导致医院的医生工作负荷大，很难抽出时间来提供预防服务。
At present, there are still many problems in the integration of medical treatment and prevention in hospitals. On the one hand, hospitals prioritize medical care over prevention. In past medical service management, the importance of medical care has always been high, while the function of disease prevention has been neglected. Hospitals have no motivation to carry out prevention work under the operating mechanism of "treating diseases and making money"; Under the dual effects of inverted distribution of medical and health resources and residents' distrust of grassroots medical and health institutions, patients tend to seek medical treatment in hospitals, resulting in a heavy workload for hospital doctors and difficulty in finding time to provide preventive services.
此外，目前的医保支付仍然是购买医疗服务而不是购买健康服务，也导致医院重视医疗服务的提供。
In addition, the current medical insurance payment still focuses on purchasing medical services rather than health services, which also leads hospitals to attach importance to the provision of medical services.
3.基层医疗卫生机构医防融合存在的障碍
3. Obstacles to the integration of medical and preventive care in primary healthcare institutions
（1）重医轻防、重防轻医的现象仍交替存在：基层医疗卫生机构承担着城乡居民的基本医疗卫生服务，应该是医防融合的主力军，必须将“医”、“防”贯穿于服务全过程。但是始终存在的生存压力，导致基层医疗卫生机构新医改前以医养防、新医改后重防轻医。此外，基层医疗卫生机构在开展医防融合服务时，主要关注慢性病的健康管理，并未整合促进健康、预防疾病、临床诊治、理疗康复等环节，难以满足基层群众对疾病防控的需要。
(1) The phenomenon of prioritizing medical treatment over prevention, and prioritizing prevention over medical treatment still exists alternately: grassroots medical and health institutions bear the basic medical and health services for urban and rural residents, and should be the main force in the integration of medical and prevention. They must integrate "medical" and "prevention" throughout the entire service process. However, the persistent pressure of survival has led to primary healthcare institutions prioritizing medical care over prevention before the new healthcare reform, and prioritizing prevention over treatment after the new reform. In addition, grassroots medical and health institutions mainly focus on the health management of chronic diseases when providing integrated medical and preventive services, without integrating the promotion of health, disease prevention, clinical diagnosis and treatment, physical therapy and rehabilitation, which makes it difficult to meet the needs of grassroots people for disease prevention and control.
（2）基层服务能力不足，难以承担医防融合任务：在医防融合过程中，基层医疗卫生机构的作用不可替代，全科医生、社区护士承担了大量的基层公共卫生工作。但是总体来看，全科医学服务仍以医疗服务和专科服务为主，传染病学、流行病学等专业能力存在“短板”；在目前实施的家庭医生签约制度中，家庭医生难以为居民提供全方位的服务，无法完全承担健康“守门人”角色和全科执业定位，难以承担起医防融合任务。
(2) Insufficient grassroots service capabilities make it difficult to undertake the task of integrating medical and preventive care: In the process of integrating medical and preventive care, the role of grassroots medical and health institutions is irreplaceable, and general practitioners and community nurses undertake a large amount of grassroots public health work. However, overall, general medical services are still dominated by medical services and specialized services, and there are "shortcomings" in professional abilities such as infectious diseases and epidemiology; In the current implementation of the family doctor contract system, it is difficult for family doctors to provide comprehensive services to residents, fully assume the role of health "gatekeepers" and general practice positioning, and undertake the task of integrating medical and preventive care.
实现医防有效融合的对策建议
Suggestions for achieving effective integration of medical and preventive measures
1.加强宣传，提高社会各方对医防融合的认识
1. Strengthen publicity and raise awareness among all sectors of society about the integration of medical treatment and prevention
为积极有效应对当前突出的健康问题，实现医防有效融合，必须加大宣传力度，提高社会各方对“全民健康”的认知，进而对实现“全民健康”需要的医防融合产生认同，树立“以健康为中心”的理念，使个人、家庭都自觉承担起维护健康的第一责任，而社会、政府则需要用更加宽广的眼光去关注人群的健康问题，将健康融入所有政策，并采取适宜的措施，人民共建共享，实现全民健康。
In order to actively and effectively address the current prominent health issues and achieve effective integration of medical and preventive measures, it is necessary to increase publicity efforts, raise awareness of "universal health" among all sectors of society, and gain recognition of the integration of medical and preventive measures needed to achieve "universal health". The concept of "health as the center" should be established, and individuals and families should consciously assume the primary responsibility of maintaining health. Meanwhile, society and the government need to pay more attention to the health issues of the population with a broader perspective, integrate health into all policies, and take appropriate measures. The people should jointly build and share, and achieve universal health.
2.建立机制，引导医疗机构开展医防融合服务
2. Establish mechanisms to guide medical institutions to provide integrated medical and preventive services
首先，应明确医疗机构在疾病预防方面的责任，改变医疗机构一直以来重医轻防的问题，在疾病治疗基础上，兼顾预防疾病危险因素，积极参与健康促进和疾病预防工作。
Firstly, it is necessary to clarify the responsibility of medical institutions in disease prevention, change the problem of medical institutions focusing more on medical treatment than prevention, and actively participate in health promotion and disease prevention work while taking into account the prevention of disease risk factors on the basis of disease treatment.
其次，卫生健康行政部门要充分发挥统筹协调作用，制定医疗机构开展医防融合服务的工作责任和服务内容，并争取医保、人社、财政等更多政策支持，引导医疗机构与其他机构协同开展全方位、全过程、全周期的医防融合实践，建设有中国特色的“资源整合、上下联动、信息互通”的卫生健康共同体，有效提升城乡居民的健康水平。
Secondly, the health administrative department should fully play its coordinating role, formulate the work responsibilities and service contents of medical institutions to carry out medical prevention integration services, and strive for more policy support from medical insurance, human resources and social security, finance, etc., guiding medical institutions to cooperate with other institutions to carry out comprehensive, full process, and full cycle medical prevention integration practices, and building a health community with Chinese characteristics of "resource integration, top-down linkage, and information exchange", effectively improving the health level of urban and rural residents.
第三，建立相关的服务标准和考核机制，依托信息化技术和健康大数据，将城乡居民健康水平、重大疾病筛查结果、重点慢性病规范管理和控制效果、辖区人均医疗费用作为核心指标，对医疗机构和疾控机构进行绩效考核。
Thirdly, establish relevant service standards and assessment mechanisms, relying on information technology and health big data, taking the health level of urban and rural residents, major disease screening results, standardized management and control effects of key chronic diseases, and per capita medical expenses in the jurisdiction as core indicators, to conduct performance evaluations of medical institutions and disease control institutions.
第四，将医防融合纳入基层医疗卫生机构工作规范和考核指标，考核结果与经费拨付、评先评优、人员岗位聘用、职称评聘、薪酬待遇等挂钩，确保医防有效融合，真正为基层百姓提供全方位、全生命周期的医疗与公共卫生服务。
Fourthly, the integration of medical care and prevention should be incorporated into the work norms and assessment indicators of grassroots medical and health institutions. The assessment results should be linked to funding allocation, priority evaluation, personnel position recruitment, professional title evaluation, salary and benefits, etc., to ensure effective integration of medical care and prevention, and truly provide comprehensive and full life cycle medical and public health services for grassroots people.
3.加强人才培养，提升服务能力，有效落实医防融合
3. Strengthen talent cultivation, enhance service capabilities, and effectively implement the integration of medical and preventive measures
在推进医防融合过程中，基层医疗卫生机构的能力建设是重中之重。但是从目前看，基层医疗卫生机构受经济发展、地理环境、工资待遇、职业发展、工作条件等多种因素影响，短期内难以在人才队伍建设上实现太大突破。县域医共体在破解这一难题方面具有较大的优势。
In the process of promoting the integration of medicine and prevention, the capacity building of grassroots medical and health institutions is of paramount importance. However, from the current perspective, grassroots medical and health institutions are affected by various factors such as economic development, geographical environment, salary and benefits, career development, and working conditions, and it is difficult to achieve significant breakthroughs in talent team building in the short term. The county-level medical community has significant advantages in solving this problem.
此外，还需推动现有人才政策尽快落地，实现人才引得进、留得住、能提高。一方面，加强全科医生、家庭医生培养，探索建立公共卫生医师规范化培训制度，培养更多懂预防、懂医疗、可预防、会治疗、能应急、能常态的复合型卫生人才。另一方面，通过提高福利待遇、灵活编制和职称评定办法等，为基层稳定和吸引人才创造条件，提升基层服务能力，为有效落实医防融合奠定人力基础。
In addition, it is necessary to promote the implementation of existing talent policies as soon as possible, in order to attract, retain, and improve talents. On the one hand, we will strengthen the training of general practitioners and family doctors, explore the establishment of a standardized training system for public health physicians, and cultivate more composite health talents who understand prevention, medical treatment, prevention, treatment, emergency response, and normalcy. On the other hand, by improving welfare benefits, flexible staffing, and professional title evaluation methods, conditions can be created for stabilizing and attracting talents at the grassroots level, enhancing grassroots service capabilities, and laying a human resource foundation for effectively implementing the integration of medical and preventive care.
4.改革医保支付方式，多方支持医防融合
4. Reform the payment method of medical insurance and provide multi-party support for the integration of medical treatment and prevention
医保部门在各地医联体和医共体建设的基础上，要逐步改革、完善医保支付政策，并转变对医联体（医共体）的考核评价内容，逐步探索基于服务人口的医联体（医共体）按人头总额预付的支付方式，并建立基于购买健康的医疗服务评价机制，引导医疗机构重视疾病预防、提供医防融合服务。同时，通过医保支付机制，赋予家庭医生健康“守门人”的职责，将大部分健康问题解决在基层，推动医防融合真正落地。
On the basis of the construction of medical consortia and medical communities in various regions, the medical insurance department should gradually reform and improve the medical insurance payment policy, and transform the assessment and evaluation content of medical consortia (medical communities), gradually explore the payment method of prepayment based on the total number of people served by medical consortia (medical communities), and establish a medical service evaluation mechanism based on purchasing health, guiding medical institutions to attach importance to disease prevention and provide integrated medical and preventive services. At the same time, through the medical insurance payment mechanism, family doctors are given the responsibility of being the "gatekeepers" of health, solving most health problems at the grassroots level and promoting the true implementation of medical prevention integration.
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