县域医共体改革进展情况分析及政策建议——基于2019年200家县级医院的调研

目的：分析县域医共体改革进展情况，提出推进县域医共体建设的政策建议。方法：选取200个县级医院作为样本医院，采用问卷调查和聚类分析方法，从资源整合、管理协同、激励约束三个方面，分析2019年县域医共体改革进展情况。结果：51.5%的医院实现药品统一采购，32.0%的医院实现规章制度统一，72.0%的医院颁布了医共体实施方案，60.5%的医院出台了医共体考核机制。聚类结果表明，缓慢推进型医共体占27.6%，中间型医共体占53.1%，积极推进型医共体占19.3%，县域医共体整体推进效果较好。结论：推进紧密型县域医共体建设，可注重从县域医共体资源整合、管理协同、建立激励相容机制入手，集中资源逐步提高基层县域医共体医疗服务能力。

Reform development and policy recommendations of county medical community: Based on survey of 200 county hospitals in 2019

Objective:To analyze the development of county medical community reform and put forward policy recommendations to promote the construction of the county medical community. Methods:200 county hospitals were selected as sample hospitals. Through questionnaire surveys among the research objects and cluster analysis, the development of county medical community reform in 2019 was analyzed from the aspects of resource integration, management synergy, and incentives and restraints as well. Results:51.5% of sample hospitals achieved unified medicine procurement, 32.0% enforced unified rules and regulations, 72.0% promulgated the implementation plan of medical community, and 60.5% introduced evaluation mechanisms of medical community. The clustering results showed that the slow-advancing medical community accounted for 27.6%, the intermediate medical community accounted for 53.1%, the active medical community accounted for 19.3%, and the county medical community had a better overall promotion effect. Conclusions:In order to promote the construction of compact county medical community, it is suggested to put more emphasis on resources integration, management coordination and establishment of an incentive compatibility mechanism, and to concentrate resources to gradually improve the medical quality and capacity of county medical community.