| 引用本文：崔兆涵, 王虎峰, 张子楠.多重制度逻辑视角下紧密型县域医共体的治理机制与组织协同：理论机理与实证检验[J].中国卫生政策研究,2025,18(1):2-9 |
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| 多重制度逻辑视角下紧密型县域医共体的治理机制与组织协同：理论机理与实证检验 |
| 投稿时间：2024-08-26 修订日期：2024-12-04 PDF全文浏览 HTML全文浏览 |
| 崔兆涵1,2,3, 王虎峰3, 张子楠1,2 |
1. 南京医科大学医政学院 江苏南京 211166;
2. 南京医科大学数智技术与健康治理实验室 江苏南京 211166;
3. 中国人民大学医改研究中心 北京 100872 |
| 摘要:目的： 探究紧密型县域医共体中的治理机制与组织协同的作用机理。方法： 基于制度逻辑理论，对县域医共体中的科层、市场、社区等多重制度逻辑进行分析，明确对应形成的行政机制、竞争机制、关系机制等治理机制，构建治理机制对组织协同的作用机理框架；以全国范围内县域医共体中的235个乡镇卫生院作为样本，运用路径分析法对县—乡协同、乡—村协同两个模型进行实证检验。结果： 在县—乡协同模型中，共存在7条路径，行政机制和竞争机制直接影响组织协同，同时利益认知和需要认知在其中起到部分中介作用；组织认知在关系机制和组织协同之间起到完全中介作用。在乡—村协同模型中共存在4条路径，行政机制和竞争机制直接影响组织协同；利益认知在竞争机制和组织协同之间起到部分中介作用，在关系机制和组织协同之间起到完全中介作用。结论： 行政机制是组织协同的基础；竞争机制对组织协同起到较大负向影响；关系机制是组织协同的重要保障；组织利益的提升能够直接提升组织协同。 |
| 关键词:县域医共体 多重制度逻辑 治理机制 组织协同 |
| 基金项目:教育部人文社会科学研究青年基金项目(23YJCZH030)； 江苏省高校哲学社会科学研究一般项目(2023SJYB0291); 国家自然科学基金面上项目(71874086、72174093) |
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| Governance mechanism and organizational collaboration of county medical community from the perspective of multiple institutional logics: Theoretical mechanism and empirical test |
| CUI Zhao-han1,2,3, WANG Hu-feng3, ZHANG Zi-nan1,2 |
1. School of Health Policy & Management, Nanjing Medical University, Nanjing Jiangsu 211166, China;
2. Laboratory for Digital Intelligence & Health Governance, Nanjing Medical University, Nanjing Jiangsu 211166, China;
3. Health Reform and Development Center of Renmin University of China, Beijing 100872, China |
| Abstract:Objective: To explore the mechanism by which governance mechanisms within the county medical community affect organizational collaboration. Methods: Based on institutional logic theory, this study analyzes the bureaucratic logic, market logic, and community logic within the county medical community, clarifies the administrative mechanisms, competitive mechanisms, relational mechanisms, and other governance mechanisms arising from different logics, and constructs a framework for the role of governance mechanisms in organizational collaborative behavior. Using 235 township health centers within the county medical communities across the country as a sample, the study employs path analysis to empirically test the mechanism framework for county-township collaboration and township-village collaboration models. Results: In the county-township collaboration model, there are a total of 7 pathways. Administrative mechanism and competitive mechanism directly influence collaborative behavior, while organizational interests and need cognition play a partial mediating role; organizational cognition fully mediates between relational mechanism and collaborative behavior. In the town-village collaboration model, there are a total of 4 pathways. Administrative mechanism and competitive mechanism directly influence collaborative behavior, with organizational interest cognition partially mediating between competitive mechanism and collaborative behavior; organizational interest cognition fully mediates between relational mechanism and collaborative behavior. Conclusions: Administrative mechanism serve as the foundation for organizational collaborative behavior; competitive mechanism have a significant negative impact on organizational collaborative behavior; relational mechanism are an important safeguard for organizational collaboration; enhancing organizational interests can directly enhance collaborative behavior. |
| Key words:County medical community Multiple institutional logics Governance mechanisms Organizational collaboration |
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