| 引用本文：陈军, 牛佳苗, 易泽宇, 段晖.松散型医联体优质医疗资源下沉驱动机制探究——微观合作理论视角下的定性比较分析[J].中国卫生政策研究,2024,17(8):50-57 |
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| 松散型医联体优质医疗资源下沉驱动机制探究——微观合作理论视角下的定性比较分析 |
| 投稿时间：2024-07-11 修订日期：2024-08-10 PDF全文浏览 HTML全文浏览 |
| 陈军1, 牛佳苗2, 易泽宇3, 段晖3 |
1. 北京大学人民医院 北京 100044;
2. 清华大学医院管理研究院 广东深圳 518055;
3. 中国人民大学公共管理学院 北京 100872 |
| 摘要:目的：旨在探究并激发松散型医联体中作为优质医疗资源的核心医院医生主动下沉基层并持续参与合作的路径机制，为提升医联体合作效能提供有益参考。方法：采用fsQCA的方法，运用微观层面的合作关系承诺理论、合作动机理论、社会交换理论与合作强化理论，对B市X区松散型医联体核心医院205位医生进行调查。结果：医联体核心医院医生主动下沉参与合作的关系承诺水平受到医生对合作的工作意义感知、机会成本感知、组织支持以及团队合作经历等多因素的影响，形成了合并驱动效应、经验强化效应、利他触发效应等三种并发驱动机制路径。其中，工作意义感知是必要条件，合作经历对医生持续参与有重要作用。结论：医生下沉参与合作的关系承诺水平受到多种因素组合的驱动，不同路径的激励机制在松散型医联体内具有异质性。针对具体情境设计适宜的激励和支持策略，可有效驱动松散型医联体核心医院优质医疗资源的主动下沉。 |
| 关键词:松散型医联体 医疗合作 关系承诺 医生行为 模糊集定性比较 |
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| Exploration of the driving mechanisms for the downward flow of high-quality medical resources in loose medical alliances: A qualitative comparative analysis from the perspective of Micro-cooperation theory |
| CHEN Jun1, NIU Jia-miao2, YI Ze-yu3, DUAN Hui3 |
1. People's Hospital of Peking University, Beijing 100044, China;
2. Institute for Hospital Management of Tsinghua University, Shenzhen Guangdong 518055, China;
3. School of Public Administration and Policy, Renmin University of China, Beijing 100872, China |
| Abstract:Objective: To explore and stimulate the pathway mechanism for doctors from core hospitals, which are the high-quality medical resources in loose medical alliances, to sink to the grassroots level on their own initiative and continue to participate in the co-operation, so as to provide useful references for improving the effectiveness of cooperation within medical alliances. Methods: The fuzzy set Qualitative Comparative Analysis (fsQCA) method was used to investigate 205 doctors in the core hospitals of a loose medical alliance in District X of City B. This investigation was grounded in relationship commitment theory, motivation theory, social exchange theory, and cooperation reinforcement theory. Results: The level of relationship commitment of doctors in the core hospitals to proactively participate in cooperation was influenced by multiple factors, including doctors perception of job significance, opportunity cost perception, organizational support, and teamwork experience. This resulted in the formation of three concurrent driving mechanism pathways: merger-driven effect, experience-enhancing effect, and altruistic trigger effect. Among these factors, the perception of work significance was a necessary condition, and cooperative experience played an important role in doctors continuous participation. Conclusion: The level of relational commitment of doctors to participate in cooperative efforts is driven by a combination of various factors, with different incentive mechanisms exhibiting heterogeneity within loose medical alliances. Designing appropriate incentive and support strategies tailored to specific contexts can effectively drive the proactive downward flow of high-quality medical resources from core hospitals within loose medical alliances. |
| Key words:Loose medical alliance Medical cooperation Relationship commitment Physician behavior Fuzzy set qualitative comparative analysis(fsQCA) |
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