| 郝伟,杨甫德.我国精神卫生服务体系转型中的运行风险与治理路径[J].四川精神卫生杂志,2026,(3):193-198.Hao Wei,Yang Fude,Operational risks and governance approaches in the transformation of China's mental health service system[J].SICHUAN MENTAL HEALTH,2026,(3):193-198 |
| 我国精神卫生服务体系转型中的运行风险与治理路径 |
| Operational risks and governance approaches in the transformation of China's mental health service system |
| 投稿时间：2026-04-16 |
| DOI：10.11886/scjsws20260416006 |
| 中文关键词: 精神卫生 服务体系 质量治理 医保支付 连续照护 专业胜任力 患者权利 |
| 英文关键词:Mental health Service system Quality management Medical insurance payment Continuous care Professional competence Patients' rights |
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| 中文摘要: |
| 我国精神卫生服务正由主要解决资源不足和服务可及性的扩张阶段，逐步进入更加重视服务质量、运行效率、患者权利和长期结局的体系成熟阶段。现阶段的主要矛盾已不再只是精神卫生资源总量不足，而是服务目标、供给结构、支付激励、责任配置和专业能力之间尚未充分匹配。近年来，个别精神卫生医疗机构发生的违规收治和医保基金违规使用事件须依法严肃处理；此类事件虽不能代表整个行业，却也暴露出住院主导型服务模式中的若干结构性风险，包括住院服务与医保支付激励方向不完全一致，机构和床位扩张快于专业能力与质量治理建设，医疗机构承担过多的社会风险管理责任，以及医院、社区和家庭之间的连续照护不足。精神科住院在现实中有时同时承担临床治疗、机构补偿和社会风险承担等多重功能，当这些功能缺乏清晰边界，而门诊、日间服务、社区康复和社会支持又缺少稳定保障时，住院便可能被制度性地过度使用。下一阶段应推动精神卫生服务由医院和住院主导转向以患者需要为中心的分层连续服务体系，建立兼顾成本、质量、患者功能结局和长期价值的医保支付与评价机制，明确医疗、社区、家庭及相关部门的责任边界，并将专业胜任力、伦理规范、患者权利和机构治理作为质量建设的基础。我国精神卫生服务高质量发展的关键，不是简单地增加或减少床位，也不只是加强事后监管，而是使制度激励与患者利益相一致，促进症状改善、功能恢复和社会参与。 |
| 英文摘要: |
| China's mental health service system is transitioning from an expansion-oriented stage focused primarily on addressing resource shortages and improving access to care toward a more mature stage that places greater emphasis on service quality， operational efficiency， patients' rights， and long-term outcomes. The principal challenge is no longer merely an insufficient overall supply of mental health resources， but rather inadequate alignment among service goals， the structure of service provision， payment incentives， allocation of responsibilities， and professional capacity. Recent incidents involving inappropriate psychiatric admissions and misuse of medical insurance funds in a small number of institutions， although not representative of the mental health sector as a whole， have exposed several structural risks within an inpatient-dominated service model. These include misalignment between inpatient services and medical insurance payment incentives， expansion of institutions and beds outpacing the development of professional capacity and quality governance， excessive concentration of social-risk management responsibilities in medical institutions， and inadequate continuity of care across hospitals， communities， and families. In practice， psychiatric hospitalization may simultaneously serve the multiple functions of clinical treatment， institutional financing， and the management of social risks. When the boundaries among these functions are unclear， and outpatient care， day services， community-based rehabilitation， and social support lack stable institutional and financial support， hospitalization may become systematically overused. The next stage of reform should shift mental health services from a hospital- and inpatient-dominated model toward a stratified and continuous system centered on patients' needs； establish medical insurance payment and evaluation mechanisms that balance costs， quality， functional outcomes， and long-term value； clarify the responsibilities of medical institutions， communities， families， and relevant government sectors； and make professional competence， ethical standards， patients' rights， and institutional governance the foundations of quality improvement. The key to the high-quality development of mental health services in China lies neither in simply increasing or reducing the number of psychiatric beds nor solely in strengthening post hoc regulation， but in aligning institutional incentives with patients' interests and promoting symptom improvement， functional recovery， and social participation. |
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