Which Health Professionals and How Many Are Needed to reorient the Health Care Model?

Abstract: During the 20th century there have been three overlapping generations of health systems reforms. The greater the orientation towards primary care, the better the outcomes of care in relation to costs. Needs assessment is mainly the role of primary care, and that is where the structure of the health care system can frustrate or facilitate exploitation of the specialized fields, the functions of each level of clinical care and of public health are presented hare, along with the respective administrative levels. Human resources management in a health system, including primary care, requires some 50% of Family practitioners. The others specialties - more than 60 - normally involve relatively smaller proportions of general specialists, and public health personnel. This means not only a change of paradigm (rather than merely adding one more specialist to others), but also charges in medical training meanwhile giving rise to countless conflicts that can only be resolved through broad agreements by all protagonists , including the lay public.

摘要：20世纪以来，卫生系统改革先后出现了三次相互重叠的发展阶段。医疗服务越侧重基层医疗（primary care），其诊疗效果与成本投入的匹配表现就越好。需求评估主要是基层医疗的核心职能范畴，而卫生系统的架构既可能制约也可能助力专科领域的价值释放。本文阐述了各层级临床诊疗与公共卫生的职能定位，以及与之对应的行政层级设置。在涵盖基层医疗的卫生系统人力资源配置中，全科医师（Family practitioners）的占比需达到约50%。其余六十余个专科领域的从业人员中，全科专科医师与公共卫生人员的占比通常相对偏低。这不仅意味着诊疗范式的变革（而非单纯新增一类专科医师），还涉及医学培训体系的调整，同时会引发诸多矛盾，这些矛盾唯有通过包括普通民众在内的所有相关方达成广泛共识才能得以解决。