社区卫生服务改革的模式演进与版本升级研究——以上海市长宁区为例

任何改革在基层的实施都需要转换成一系列的制度安排或微观行为激励机制,不仅确保基层行动者之间的行为策略激励相容,还要确保基层行动者的行为模式与改革政策目标方向相一致。从上海市长宁区社区卫生服务改革的实践来看,其大致经过了四个阶段:标准化建设与组织确立、服务模式与机制改革、激励设计与内涵建设、平台打造与效能提升。长宁医改在不断深化政策试验与制度创新的过程中逐步化解新医改政策实施过程所产生的各类新问题及其与环境的相容性问题,以实现医改政策的制度化并为利益相关者的福利改进提供稳定的行为预期,从而不断降低基层行动者对政策实施的潜在抵制行为,逐步地将各类行动者的行为激励引导到与政策目标相一致的方向。

The model and version upgrade of community health care reform:A case study of Changning District of Shanghai

Any reform needs to be converted into a series of institutional arrangements or micro behavior incentive mechanism, not only to ensure basic behavioral strategies of incentive compatibility between actors are motivated, but also to ensure that the behavior mode of grass-roots actors and policy direction are consistent. From the practice of community health reform of Changning District of Shanghai, it has generally gone through four stages:standardization construction and organization establishment, service model and mechanism reform, incentive mechanism design and connotation construction,platform build and performance improvement. Changning medical reform in the continuous deepening of policy trials and solve all kinds of new problems in the new medical reform policy implementation generated by the process of policy and system innovation in the test (such as doctors weakened incentive problems after two lines of revenue and expenditure) and its compatibility with the environment problem. In order to realize the system of health care policy and provide stable behavioral expectations for the stakeholders to improve the welfare of stakeholders thereby continuously reducing the potential resistance to the implementation of the policy of grass-roots actors, and gradually guide the behavior of various actors to guide the direction consistent with the policy objectives