长顺| 禄劝| 密云| 阿拉尔| 独山子| 奉贤| 门头沟| 阜康| 普定| 正定| 滁州| 岐山| 明光| 唐河| 西平| 德令哈| 金沙| 河池| 东阳| 岳阳县| 锦州| 榆林| 伊金霍洛旗| 隆昌| 鄂州| 屏山| 长宁| 三水| 阜宁| 民丰| 石棉| 永修| 阜新市| 乌马河| 吴川| 封开| 连州| 南安| 喀什| 东兴| 达日| 东西湖| 临夏县| 泸水| 湟源| 克东| 古蔺| 五通桥| 温泉| 容城| 昌平| 金州| 夷陵| 集安| 纳雍| 易门| 峨边| 莱山| 三台| 渭南| 赣州| 永春| 新民| 尚义| 淇县| 耒阳| 湟源| 大关| 威海| 岚山| 镇沅| 明水| 迭部| 名山| 新野| 红安| 邛崃| 贞丰| 泾阳| 上思| 新丰| 崇仁| 和平| 龙海| 平远| 疏勒| 沙洋| 理塘| 东西湖| 黄龙| 镇原| 台山| 缙云| 察哈尔右翼中旗| 六合| 巴楚| 泰兴| 鼎湖| 宁晋| 襄汾| 淮阴| 略阳| 泰和| 滨海| 靖江| 宁波| 天祝| 隰县| 徐闻| 昂昂溪| 湖北| 嘉义县| 门源| 富川| 贞丰| 绥德| 隆安| 策勒| 威远| 广水| 通城| 江苏| 乌拉特中旗| 腾冲| 永城| 江城| 秦安| 无为| 玉屏| 班戈| 安县| 张家口| 金塔| 灵山| 济南| 茶陵| 永年| 平度| 平江| 林周| 磴口| 头屯河| 荣成| 奉节| 图木舒克| 台北市| 康定| 泰来| 宜川| 岢岚| 邵东| 阳东| 常宁| 和顺| 金平| 承德县| 利川| 龙胜| 嘉义市| 隆安| 德安| 大连| 新宾| 烈山| 洞头| 云林| 南昌县| 吉水| 双江| 方城| 临武| 应城| 贡山| 荆州| 邵东| 吴堡| 深州| 咸宁| 阳朔| 万州| 绍兴县| 畹町| 连云港| 屏东| 茂港| 长葛| 乌什| 理县| 甘肃| 湘乡| 勐海| 察哈尔右翼前旗| 弓长岭| 大连| 青白江| 富锦| 磐安| 徐州| 陈巴尔虎旗| 镇雄| 坊子| 房山| 菏泽| 黑山| 斗门| 新都| 米脂| 阆中| 和龙| 达坂城| 安达| 普陀| 额济纳旗| 二连浩特| 诏安| 湟源| 兴城| 嘉兴| 桃江| 修武| 大同县| 清苑| 郫县| 乌什| 兴城| 天津| 卢龙| 兰西| 鄄城| 桂阳| 长丰| 岳池| 三穗| 理塘| 丰城| 新野| 齐河| 城阳| 铁岭县| 科尔沁左翼中旗| 辽宁| 张家界| 宁国| 随州| 亳州| 高安| 衡水| 奈曼旗| 双峰| 巴林右旗| 涠洲岛| 安龙| 洋山港| 化隆| 长沙县| 郴州| 禹州| 志丹| 东山| 洪洞| 洋县| 芮城| 尼玛|

国足能否防住贝尔?竞猜中国杯答题赢超值好礼

2019-07-19 11:28 来源:华股财经

  国足能否防住贝尔?竞猜中国杯答题赢超值好礼

  ADSLRcameraofNASAphotographerBillIngallsgotmeltedasitcapturedSpaceX’slaunchofarecycledFalcon9rocketwithfiveIridiumsatellitesatopitintoorbitinCaliforniaonMay22,,buttheCanon5DSDSLRandpriceyLlensusedfortheclose-upgotmeltedastheresultofafire.(Photo/VCG)ThecamerawasdestroyedasaresultofabushfireneartheperimeterofthelaunchpadinCalifornia.(Photo/VCG)ThelastclearframecapturedbyacameraofNASAphotographerBillIngallsbeforeitgotmelted.(Photo/VCG)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantswavehandsbeforeadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)

English-LanguageNewsWebEditorRequirements::Aminimumofabachelor’sdegreeatanaccreditedcollegeoruniversitywithamajorinjournalism,English,economics,internationalpolitics,,:Haveathoroughunderstandingandappreciationfortheroleofjournalismandaccurate,ftWord,AdobePhotoshop,Dreamweaver,:Previousjoborinternshipexperienceinan:Responsibleforconductingnewsinterviews,andcompiling,editingandrevisingnewsmanuscriptsfromothersourcesforwebsitenews,dupdates,andproducingspecialnewspackages,aswellasothe,:’sdegreeatanaccreditedcollegeoruniversitywithamajorinjournalism,English,economics,internationalpolitics,andaccurate,,:-Thejobisfull-time.-rewritingandcopy-editingstorieswrittenbystaffandfromothermediaresources;-writingoredittingheadlines,readingprovesandcontributingideasinstoryselectionandlayoutandsoon;-helpingproductionanddevelopmentofothereditorialmaterials,whichincludewritingstories,columns,reviewsandrecordings【相关词汇】中国制造2025MadeinChina2025工匠精神thespiritofworkmanship/craftsmanship知识产权强国IPRpowerhouse发展新动能newdriverofgrowth创新驱动发展战略innovation-drivendevelopmentstrategy(中国日报网英语点津马文英)  

  Europeslargestwoodenbuildingandsecondlargestintheworld,locatedonIstanbulsBüyükadaisland,isnowamongthesevenmostendange,thePrinkipoG,theagingPrinkipoGreekOrthodoxorphanageisindangerofcollapse.(Photo/Agencies)Europeslargestwoodenbuildingandsecondlargestintheworld,locatedonIstanbulsBüyükadaisland,isnowamongthesevenmostendange,thePrinkipoG,theagingPrinkipoGreekOrthodoxorphanageisindangerofcollapse.(Photo/Agencies)Europeslargestwoodenbuildingandsecondlargestintheworld,locatedonIstanbulsBüyükadaisland,isnowamongthesevenmostendange,thePrinkipoG,theagingPrinkipoGreekOrthodoxorphanageisindangerofcollapse.(Photo/Agencies)Europeslargestwoodenbuildingandsecondlargestintheworld,locatedonIstanbulsBüyükadaisland,isnowamongthesevenmostendange,thePrinkipoG,theagingPrinkipoGreekOrthodoxorphanageisindangerofcollapse.(Photo/Agencies)MajorLeagueBaseballandTencentHoldingsLimitedhaveformedanewstrateg,aleadingproviderofcomprehensiveInternetServicesinChina,alsowillsupportandbro,Tencentwilllivestream125gamesincludingMLBJewelEventsonanexclusivebasisinthecountryonTencentPC,,TencentsschedulewilllaunchwithSuperBaseballWeek,fiveconsecutivedaysofgamesfeaturingsomeofbaseballstopstarsincludingMikeTrout,FranciscoLindor,KrisBryant,,TencentwilllivestreamregularseasongamesonWednesday,Thursday,SaturdayandSundayaswellastheAll-StarGamepresentedbyMastercard,T-MobileHomeRunDerby,ncludingMLBBest,MLBVideoClipsandaChineseversionofThisWeekinBaseball."Tencenthascontinuedtocollaboratewiththeworldstopsportsleaguessecuringbroadcastrightsforbasketball,soccer,tennis,wintersports,footballandnowbaseball,"saidTencentVicePresidentCaitlynChen."Inrecentyears,baseballhasdevelopedrapidlyinChina,whichwouldnthappenwithoutMLB,withtheadvantageofTencentsproductionandbroadcasting,refinedoperationalexcellenceandpowerfulsocialplatforms,wewillbringtheattentiontoMLBandbaseballinChinatoanewlevel."Aspartofthebroadalliance,TencentwillworkcloselywiththeleaguetohelpgrowbaseballinChinabysupportingandstreamingMLB,abaseballroadsh,TencentwillbroadcasttheMLBrealityshowPerfectPitch,CollegeLeaguegames,theMLBPlayBall!DiamondCupandotherMLBPlayBall!youthevents."AsMLBcontinuestoexpandtheparticipation,viewingandengagementofbaseballinChina,itiscriticaltopartnerwiththebestorganizationsinthecountrytoformmutuallybeneficialco-operations,"saidJimSmall,MLBVicePresident,AsiaPacific."WearethrilledtoteamwithTencent,thelargestandbestdistributorofdigitals,showsandeventsthatTencentwillstreamwillentertainmillionsofsportsfansinChinaandhelpcontinuetogrowthesport."Tencentwillsup,,TencentwilldevelopandhostanMLBFanClubwherefansacrossChinacandiscuss,debateandcelebrateallaspectsofMajorLeagueBaseball.  

  GermanChancellorAngelaMerkel(C)visitsSiemens(Shenzhen)MagneticResonanceCo.,LtdinShenzhen,southChinasGuangdongProvince,May25,2018.(Xinhua/MaoSiqian)GermanChancellorAngelaMerkel(C)attendstheopeningcere,southChinasGuangdongProvince,May25,2018.(Xinhua/MaoSiqian)GermanChancellorAngelaMerkel(L)visitsiCarbonX,astartupcompanyfocusingoncombininggenomicswithotherhealthfactorstocreateadigitalizedformoflife,inShenzhen,southChinasGuangdongProvince,May25,2018.(Xinhua/MaoSiqian)GiantpandaMengMenggavebirthtotwinfemalecubsattheChengduResearchBaseofGiantPandaBreedinginSouthwestChinasSichuanProvinceonMay23,2018.(Photo/ChengduResearchBaseofGiantPandaBreeding)GiantpandaMengMenggavebirthtotwinfemalecubsattheChengduResearchBaseofGiantPandaBreedinginSouthwestChinasSichuanProvinceonMay23,2018.(Photo/ChengduResearchBaseofGiantPandaBreeding)GiantpandaMengMenggavebirthtotwinfemalecubsattheChengduResearchBaseofGiantPandaBreedinginSouthwestChinasSichuanProvinceonMay23,2018.(Photo/ChengduResearchBaseofGiantPandaBreeding)GiantpandaMengMenggavebirthtotwinfemalecubsattheChengduResearchBaseofGiantPandaBreedinginSouthwestChinasSichuanProvinceonMay23,2018.(Photo/ChengduResearchBaseofGiantPandaBreeding)

研究:男性长期看电视更易患肠癌ToomuchTVmayraisemenscolorectalcancerriskMenwhowatchmorethanfourhoursofTVadaysignificantlyincreasetheirriskofdevelopingbowelcancer,researchershavefound.研究人员发现,男性每天看电视超过4小时,患肠癌的风险明显增加。

  Regulatorsareworkingonapolicyframeworkforarealestateinvestmenttrusts(REIT)opentopublicinvestmentinChina,butuncertaintiesabouttaxpoliciesandthefutureresponsibilitiesshoulderedbydifferentregulatorybodiesmaydelayitsofficialintroduction,accordingtopeoplefamiliarwiththematter."TheoveralltrendisChinaisworkingtowardsintroducingREITsinthefuture,butrelatedpoliciesmightnotcomeoutasquickasexpected,say,inthecomingmonths,"saidasourceclosetotheregulators."Themajorregulatorybodieshaveyettoreachanagreementonfutureresponsibilitiesonsupervision,andinparticular,preferentialpoliciestolowertransactiontaxes,whichneedfurtheractionfromthenationstaxationadministration,"tedasearlyas2007,duringwhichtimethePeoplesBankofChinaandtheMinistryofHousingandUrban-RuralDevelopmentagronthedevelopmentofrealestateinvestmenttrustsinChina,asthegovernmenthopestopromotethegrowthoftherentalmarketaspartofe,theinvestmentschemeisabletoletshareholdersenjoythereturnsfromrentalincome,haveledtoexpectationsthatapolicyframeworkmaycomeoutverysoontosupportREITs,wheretheoverallscaleoftheinvestmentschemeisexpectedtoexceed4trillionyuan,locallevels,andhaslaunchedsomequasiREITsthatcouldonlybeheldbyprivateequityfunds."ThethingisthatallquasiREITsintroducedsofarareequivalenttobondissuance,whichmeanstheycannotleadtohighyieldstolureinvestors,"OuyangJie,vice-presidentofFutureLandHoldings,sonthedevelopmentoftheREITmarket,accordingtoNieMeisheng,als.  

  StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)StudentsfromYunnanUniversityDi(PhotobyZhuYuhangandXuYuya/)“3D打印”(3Dprinting)的专业名称为增材制造(additivemanufacturing,AM),是以数字模型为基础,将材料逐层堆积制造出实体物品的新兴制造技术(anewtechnologythataddsmaterialtogethertocreatearealobject)。

  Amodelofthetravellingfrogstandsattheentrancetogreetcustomers.(Photo:XiangJun/GT)Chinasfirst"travellingfrog"themedpostofficeopenedinShanghaionMay21,"travellingfrog"isadigitalcharacterfromaJapanesemobilegame,w(Photo:XiangJun/GT)Customerscanpurchaseafolderoftravellingfrogstamps.(Photo:XiangJun/GT)Aboy,accompaniedbyhismother,stampshissouvenirtravellingfrogstampfolder.(Photo:XiangJun/GT)Aboyposesinfrontofatravelling-frogthemedbackground.(Photo:XiangJun/GT)

  (CNS),astate-levelnewsagencysponsoredandestablishedbyChinesejournalistsandrenownedoverseasChineseexpertsonOctober1,(),,,includingin-depthcoverage,featurestoriesandvisualcontent,withtopicssuchascurrentevents,art,lifestyle,(CNS)isnotonlyastate-levelnewsagencyspreadingnewsworldwide,butalsoaninternationalnewsagencywithsubscribersinTaiwan,HongKongandMacao,,formervicechairmanoftheStandingCommitteeoftheNationalPeoplesCongress,,therewereothermajorsponsorsandbuilders,suchasJinZhonghua,HuYuzhi,,awell-knownexpertoninternationalissues,,CNSwastheInternationalNewsService,,adatabaseofinforma(includingwritings,photosandspecialarticles)andamodernmethodofreporting(mainlythroughinternet,videosandSMS)providedtooverse,,HongKongandMacao,aswellasbranchesorreportstationsinTokyo,Bangkok,KualaLumpur,NewYork,Washington,LosAngeles,SanFrancisco,Vancouver,London,Paris,,andnewsreleasecentershavebeenestablishedinBeijing,,multi-levelandmulti-functionnewsreleasesystem,CNSprovidesallkindsofnewsandinformation,’,,1999,theheadquartersofCNSlauncheditsofficialwebsite,namedChinanews().ChinanewsisconsideredoneofChina’smostimportantonlinenewssources.ThereputationofChineseairtravelhasreceivedyetanotherblowafteroff’sleastpunctualflights,datareleasedonMondaybytheCivilAviationAdministrationofChina(CAAC)showedaverageflightdelaysincreasedto24minuteslastyear,,punctualityrateshavegotworseandworse,withth,’,“airtrafficcontrolreasons.”“otherreasons,”whi,militaryactivityaccountedforasmuchasaquarterofallflightdelaysinthefirsthalfof2017,,demandforairtravelinChinahasskyrocketed,with4,,theriseindelayssuggeststhatauthoritiisfirmOAGrankedtheworld’s20biggestairlines,andnamedAirChinatheworstforpunctuality,,,andUnitedAirlines,tryafterrapidgrowthinthepastdecade,,withtheNationalDevelopmentandReformCommi’slargestairportnextyear,CAAChasimplementedseveralmeasurestoboostpunctual,CAACorderedBeijingCapitalandShanghaiPudongairportstoreduceflightnumbersto75percentofcapacity,,withnationalon-timetakeoffrateshitting88percentinDecember,accordingtoCAAC’nsistentdelays,withshedafterfailingpunctualitystandardsforfiveconsecutivemonths,(55billionUSdollars),duetopassengers’  

  PhototakenonMay28,2018showsrubblesofacollapsedwallinquake-hitYamutuVillageofSongyuanCity,northeastChina,SongyuanCityofJilinProvinceinearlyMondaymorning.(Xinhua/ZhangNan)PhototakenonMay28,2018showsadamagedhouseatquake-hitYamutuVillageofSongyuanCity,northeastChina,SongyuanCityofJilinProvinceinearlyMondaymorning.(Xinhua/ZhangNan)Rescuersworkatquake-hitYamutuVillageofSongyuanCity,northeastChinasJilinProvince,May28,,SongyuanCityofJilinProvinceinearlyMondaymorning.(Xinhua/ZhangNan)PhototakenonMay28,2018showsadamagedhouseatquake-hitYamutuVillageofSongyuanCity,northeastChina,SongyuanCityofJilinProvinceinearlyMondaymorning.(Xinhua/ZhangNan)

  ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantswavehandsbeforeadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)ContestantstakepartinadragonboatmatchatawaterparkofHuichanglakeinWenzhou,eastChinasZhejiangProvince,May26,2018.(Xinhua/SuQiaojiang)

  TheOrbitalATKAntaresrocket,withtheCygnusspacecraftonboardlaunchesatNASAsWallopsFlightFacilityinVirginia,May21,,theCygnusismakingOrbitalATK’’sothersupplier.(Photo/Agencies)TheOrbitalATKAntaresrocket,withtheCygnusspacecraftonboardlaunchesatNASAsWallopsFlightFacilityinVirginia,May21,,theCygnusismakingOrbitalATK’’sothersupplier.(Photo/Agencies)TheOrbitalATKAntaresrocket,withtheCygnusspacecraftonboardlaunchesatNASAsWallopsFlightFacilityinVirginia,May21,,theCygnusismakingOrbitalATK’’sothersupplier.(Photo/Agencies)TheOrbitalATKAntaresrocket,withtheCygnusspacecraftonboardlaunchesatNASAsWallopsFlightFacilityinVirginia,May21,,theCygnusismakingOrbitalATK’’sothersupplier.(Photo/Agencies)PeopledressedincostumesposeforaphotoattheMCMComicConattheExCelcenterinLondon,Britain,onMay27,,attactinglotsofcomicfanstothepopularculturegathering.(Xinhua/TimIreland)PeopledressedincostumesposeforaphotoattheMCMComicConattheExCelcenterinLondon,Britain,onMay27,,attactinglotsofcomicfanstothepopularculturegathering.(Xinhua/TimIreland)PeopledressedincostumesposeforaphotoattheMCMComicConattheExCelcenterinLondon,Britain,onMay27,,attactinglotsofcomicfanstothepopularculturegathering.(Xinhua/TimIreland)PeopledressedincostumesareseenattheMCMComicConattheExCelcenterinLondon,Britain,onMay27,,attactinglotsofcomicfanstothepopularculturegathering.(Xinhua/TimIreland)

  

  国足能否防住贝尔?竞猜中国杯答题赢超值好礼

 
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全科医生不够用 分级诊疗落实难
2019-07-19 作者: 记者 黎华玲/重庆报道 来源: 经济参考报

  2016年,重庆入选国家分级诊疗试点城市。记者采访发现,重庆綦江区去年初率先在隆盛镇推广家庭医生签约服务,在家庭医生的基础上探索出“驻村医生”模式。一年来,在助推分级诊疗工作上取得一定成效。但通过梳理綦江的医改实践不难发现,落实分级诊疗工作在基层依旧面临着全科医生缺口大、医保杠杆作用不明显、双向转诊缺乏配套细则、基层药品种类不足等多重掣肘。

  重庆綦江试点分级诊疗初显成效

  随着城镇化进程的推进,年轻力壮的纷纷外出打工,留在农村的多数是老人和儿童。他们在身体出现健康异常后,常常不知道如何就医、到哪儿就医或者选择哪个医院和科室。除此外,在诊疗过程中,也容易因为误解造成医患纠纷。基层老百姓缺乏一个“指路”的医生朋友。如今,这一现象在重庆基层得到改善。

?

今年5月1日起,广西南宁市城市公立医院综合改革正式启动,同城共32家公立医院纳入本次综合改革,旨在逐步实现“公立医院回归公益性,医生回归看病角色,药品回归治病功能”的目标。

  据悉,本次改革将着力做好七项重点任务:一是破除公立医院以药补医机制。二是改革公立医院管理体制,建立现代医院管理制度。三是强化医保支付和监控作用,逐步减轻群众医药费用负担。四是建立符合医疗行业特点的人事薪酬制度。五是构建各类医疗机构协同发展的服务体系。六是推动建立分级诊疗制度。七是加快推进医疗卫生信息化建设,全面实施“智慧健康医疗工程”,方便群众看病就医。图为在广西南宁市第六人民医院,患者及其家属在排队填写病历信息。记者 陆波岸 摄

  重庆市一些区县先行先试,纷纷开展以分级诊疗为导向的医疗集团、医疗联合体、协作医疗及一体化医疗改革。服务体系布局的优化、医疗机构上下联动和分工协作的激励措施、基层首诊和急慢分治的保障性制度、以患者为核心的引导政策、标准化的医疗行为规范与监管等成为各地试点的主题。

  早在2015年,綦江区人民医院、綦江区中医院为牵头单位,结合“三级四区”医疗服务体系建设规划,分别联合4个中心镇卫生院,每个中心镇卫生院辐射带动周边镇卫生院,自上而下组成医疗联合体开展分级诊疗工作。目前,綦江区初步形成“大病不出区 小病不出镇(街道) 康复在社区(村)”的就医格局。

  前些日子,63岁的綦江区隆盛镇石渠村村民王兴兰不小心摔了一跤,导致肱骨骨折,急需送到上一级医院手术。得益于医联体建设,綦江区中医院对口支援隆盛镇卫生院,患者被及时送至中医院进行手术。经过3天的治疗,下转回卫生院进行康复治疗。“放在以前,患者家属、卫生院都要四处联系接收医院,这样耗费了大量时间,有可能延误病情,现在这些时间都省下来了,大家也更安心了。”隆盛镇中心卫生院院长王宇说,老百姓更愿意相信大医院,很多怕下转后得不到好的治疗,这是分级诊疗落实过程中面临的障碍之一。通过老百姓熟悉的“家庭医生”做工作,部分村民也意识到康复治疗期没必要在大医院,回到卫生院更方便实惠。

  患者王兴兰的儿子吴华果拿出两张中医院和卫生院的住院医药费专用收据,分别显示花费13788.36元和 3243.16元。“这次节约了五六千元的住院费,深刻体会到了分级诊疗政策的实惠。”吴华果说,如果没有上下转诊,还要花掉很多冤枉钱。

  从“家庭医生”到“驻村医生”撬动分级诊疗

  “卫生院临床医生不仅是‘家庭医生’,更是‘驻村医生’”。隆盛镇中心卫生院的医生蒲晓东说。家庭医生不能坐等患者上门,而是组建服务团队,提供主动连续的上门服务。他认为,只有走村入户,掌握老百姓的身体健康情况,才能更大程度改善基层百姓就医的盲目性,提高百姓对基层医生的信任度,最后才能逐步实现首诊在基层、双向转诊的目标。

  据了解,重庆市计划在2017年全面启动家庭医生签约服务工作。綦江区卫生计生委主任张家伦介绍,隆盛镇从2016年3月开始试点家庭医生签约服务,按照“一名医生搭配一名镇卫生院公卫人员一名乡村医生一名计生专干”的模式,组建8个家庭医生医疗组,每组负责两至三个村(居),对隆盛镇18个村(居)实行分片负责制。

  根据签约协议规定,“家庭医生”必须定期给签约村民体检,尤其是签约对象中的残疾人、老年人、慢性病患者,如果他们要求上门服务,“家庭医生”必须随叫随到,当病情需要转到大医院诊治时,应帮助村民转诊预约。“家庭医生”这种点对点、零距离、全方位的医疗保健服务受到基层老百姓的欢迎。

  2017年,綦江区计划开展家庭医生签约服务的街镇实现全覆盖,实施家庭医生签约服务32.58万人,常住人口签约覆盖率达40%,其中城镇常住人口签约覆盖率30%,实现11.92万城镇居民签约家庭医生,农村地区常住人口签约覆盖率50%,实现20.66万农村居民签约家庭医生,重点人群签约覆盖率达60%以上,建卡贫困户、计划生育特殊家庭签约服务实现全覆盖。

  家庭医生签约服务面临多重掣肘

  截至今年2月底,綦江区已组建家庭医生签约服务团队154个,团队人员总数467人,城镇签约1642人,覆盖率为0.41%,农村签约3387人,覆盖率0.70%,重点人群签约2915人,覆盖率1.70%。数据显示,目前家庭医生签约服务工作虽然取得成效,但仍然呈现“叫好不叫座”的局面。究其原因,业内人士分析,目前全科医生缺口大、医保杠杆作用不明显、双向转诊缺乏配套细则、基层药品种类不足等多重掣肘。

  一是全科医生缺口大,制约分级诊疗的落实。在基层,百姓最需要全科医生,有研究报告显示,目前全国全科医生比例约为5.6%,而在英国、加拿大等国家,这一数字为50%以上。以綦江隆盛镇中心卫生院为例,该院在临床行医的医生13名,其中有8名医生参与家庭医生服务工作,这其中仅2名为全科医生。镇中心卫生院院长王宇说,现实工作中,医院对全科医生的需求为18名。

  二是医保杠杆作用不明显。綦江区卫计委主任张家伦指出,现行的医保制度对社区首诊、双向转诊没有明确的限制,不足以推动分级诊疗。根据起付点费用标准,有些地区三二一级医院可报销比例的最大极差不过10%,报销差别没多大,患者宁可多花一点钱去大医院看病。

  三是缺乏统一的转诊标准制度和监督机制。张家伦指出,当前我国的转诊体系各地区标准不一,而且没有明确的向上转诊和向下转诊的标准,造成转诊系统混乱、双向转诊标准的不完善,易导致医疗行为的不规范,很难明确哪些疾病、哪种病发程度需要转诊。此外,转诊制度也缺乏明确的监督管理机制,难以对医患保三方的行为进行约束,因此不可避免地影响到分级诊疗制度的有序开展。

  对此,专家认为,应制定适合我国国情的分级诊疗的标准和规范,使各地各级医疗机构对分级诊疗有章可循,避免随意性,缩小不同地区之间的差异性,使基本医疗服务逐步达到同质化和分级诊疗标准化。

  四是基层用药范围过窄。“有时患者不愿来卫生院看病,不仅和缺少人才有关,有时候也和少药的现状有关。”王宇告诉记者,曾有一名医生的小孩急性伤口感染,急需一种抗感染的药物,然而卫生院没有,只能紧急将孩子送至上级医院,基层经常缺药、少药,尤其是许多慢性病的治疗用药不在基本药物目录内。基层医疗卫生机构药物的缺乏使许多患者不得不选择在大医院就诊,严重阻碍了分级诊疗的落实。鉴于此,应改善基层药物目录,使基层用药目录与大医院目录同畴,确保患者特别是慢性病患者在大医院诊断和治疗方案确定后,转回基层医疗机构接受治疗和管理,能够满足其用药需求。

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