| 引用本文：赵阳, 王虎峰.县域医疗共同体建设的溢出效应：行为、时间与情境——基于A省6市8个县乡村案例的分析[J].中国卫生政策研究,2024,17(12):1-6 |
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| 县域医疗共同体建设的溢出效应：行为、时间与情境——基于A省6市8个县乡村案例的分析 |
| 投稿时间：2024-09-22 修订日期：2024-11-26 PDF全文浏览 HTML全文浏览 |
| 赵阳1, 王虎峰2 |
1. 中国人民大学公共管理学院 北京 100872;
2. 中国人民大学医改研究中心 中国人民大学健康与医改政策实验室 北京 100872 |
| 摘要:同一政策下，不同地区“医疗共同体”的利益何以集成？不同地区医共体建设效果为何参差不齐？本文从溢出视角切入，构建“行为、时间、情境”的溢出分析框架，基于A省6市8个县乡村的医共体建设案例，探究中国情景下医共体建设得以推进或遭遇阻滞的原因。研究发现，医共体政策目标的实现深受利益溢出影响，医共体政策得以发挥效能优势的关键在于医共体如何应对不同层级医院间的正负溢出现象。基本行为溢出能够有效实现多级医院态度与行为的双向调适；跨时间与跨情境溢出能够解释同一行为如何在不同时空下对患者就医、医院发展提供正向溢出；负向溢出可能带来道德风险。研究认为，破解医共体建设阻滞问题需要运用分层分类治理思维，本文基于溢出效应理论，对中国场景下的案例进行分析，为医共体建设与基层医疗服务能力提升提供理论参考与选择依据。 |
| 关键词:县域医共体 溢出效应 政策选择 案例分析 |
| 基金项目:国家社会科学基金重大项目(22ZDA096) |
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| The spillover effects of county medical alliance: Behavior, time, and situation: An analysis of 8 rural counties in 6 cities of A province |
| ZHAO Yang1, WANG Hu-feng2 |
1. School of Public Administration and Policy, Renmin University of China, Beijing 100872, China;
2. Health Reform and Development Center of Renmin University of China, Health and Reform Policy Sub-Laboratory, Renmin University of China, Beijing 100872, China |
| Abstract:Under the same policy, how can the interests of different regional “medical alliances” be integrated? Why are the effects of country medical community construction uneven across different regions? Previous studies have mostly evaluated policy effects based on outcome indicators and rarely discussed the internal mechanisms of policies within the context of China's practical scenarios. This paper, starting from the perspective of policy spillover, builds a spillover framework of “behavior, time, and situation” based on cases from six cities and eight rural counties in A province, exploring the reasons for the promotion or obstruction of medical alliances construction in China. It is found that the realization of the policy objectives of the medical alliance is deeply affected by the spillover of benefits. The key to achieving the efficiency advantage of the medical alliance policy lies in how to manage the positive and negative spillovers between hospitals at different levels. Basic behavior spillover can effectively facilitate the bidirectional adjustment of attitudes and behaviors among multilevel hospitals. Cross-time and cross-context spillover can explain how the same behavior provides positive spillover to patients' medical treatment and hospital development in different times and spaces. However, negative spillovers may lead to moral hazards. According to this research, it is necessary to employ hierarchical and classified governance thinking to address the challenges obstructing the construction of the medical alliance. Based on case analysis within the Chinese context and the theory of dialogue spillover effects, this paper provides theoretical references and selection criteria for the construction of county medical alliances and the enhancement of primary medical service capabilities. |
| Key words:County medical alliance Spillover effect Policy options Case study |
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