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健康中国战略下县域医共体高质量发展:基本内涵、策略基础与优化方向

Fundamental connotation, strategic basis, and optimization direction for the high-quality development of county medical service communities under the Healthy China initiative

  • 摘要: 高质量发展作为供给侧改革的重要导向,在我国卫生服务体系层面的研究与实践仍处于探索阶段,尚难契合整合型服务体系建设进程。本研究在健康中国战略实施背景下,选择县域医疗服务共同体(简称医共体)为对象,基于“结构—过程—结果”分析框架,结合医共体运行过程中最为核心的服务、体制、机制3个维度对其高质量发展进行解读,构建“三维四阶”的内涵框架。通过对22个样本地区政策文件进行政策一致性(PMC)指数测算与比较,以反映相关策略的布局。结果呈现出服务、体制、机制的发展架构,并突破了机构的边界,但三者融合程度不足,未理顺策略要素间主动与从动的关系,服务维度严重滞后,且短期发展色彩较重。综合内涵框架及策略基础,提出了县域医共体高质量发展应当塑造“一体两制”的发展格局,以健康为中心建设供需均衡的服务提供模式,以权责适配为导向推进多元协同治理,以同向发力为目标构建多机制联动的优化方向。

     

    Abstract: High-quality development, as a key objective of supply-side reform, is still in the early stage of exploration within the research and practice of China′s health service system. There remains a challenge in aligning it with the construction of an integrated service system. In the context of the implementation of the Healthy China initiative, this study focuses on county medical service communities (MSC) as the subject of analysis. Using the "structure-process-result" framework, this study examines the three core dimensions of services, systems, and mechanisms in the operation of the MSC, and constructed the connotation framework. The policy documents from 22 sample regions are assessed via the policy modeling consistency index to reflect the strategic layout. The findings indicate that the services, systems, and mechanisms have transcended institution boundaries, while the integration of these three dimensions is still insufficient and the relationship between active and passive strategic elements is not rationalized, with the service dimension particularly lagging and the focus on short-term development. According to the connotation framework and strategic foundation, we suggest that the high-quality development of MSC should aim to shape a "one body, two systems" development pattern, develop a supply-demand balanced service delivery mode, promote collaborative governance among multiple stakeholders under the matching of power and responsibility, and establish a multi-mechanism linkage tailored to the same objective.

     

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