行动者中心制度主义视角下县域医疗卫生服务整合路径

国家卫生健康委《关于推进紧密型县域医疗卫生共同体建设的通知》(2019年5月)明确了构建县域紧密型医共体(以下简称“医共体”)建设的政策目标。从现有的医疗资源分配机制来看,在政策执行过程中,推动县域医共体行动者间的有效互动和协调行动才能顺利达成政策目标,并切实优化医疗资源配置,提升县域医疗服务能力。本文基于行动者中心制度主义理论框架,分析县域紧密型医共体建设相关行动者的关系,揭示县域医共体构建中不同行动者受利益诉求、动机选择等多重博弈关系的影响状况。探讨紧密型县域医共体的建构进程中,如何促成行动者之间达成利益相容和联动,最大限度满足县域人民群众获得优质高效的一体化医疗服务。

The integration path of county level medical consortium from the perspective of Actor-centered Institutionalism

In May 2019,the National Health Commission issued the notice on“Promoting the Construction of a Merged County Medical Community”,which made it a powerful starting point for the county-level medical and health reform.From the perspective of existing medical resource allocation mechanism,in the process of policy implementation,only by promoting effective interaction and coordination among the county-level medical community actors can the policy goals be successfully achieved,and can medical resources allocation be effectively optimized and medical service ability improved accordingly.This paper takes the Actor-centered Institutionalism as the theoretical framework,and highlights the system-actor relationship.Based on the theoretical framework of Actor-centered Institutionalism,the analysis results found that there are multiple game relationships implicit in the county medical consortium model,such as different interest demands and motivation choices among actors of country-level medical community.Based on this,this paper explores the construction path of weak to strong medical consortium,and discusses how to promote interest compatibility and linkage between actors,and maximize the satisfaction of the people’s demand for high-quality and efficient integrated medical services.