公立医院与基层医疗卫生机构分工协作影响因素研究——基于定性比较分析方法

目的：分析公立医院与基层医疗卫生机构分工协作机制的主要影响因素及其发挥作用的机制，提出完善分工协作机制的建议。方法：运用理论分析和文献综述构建分工协作机制影响因素的框架，通过访谈收集9家建立分工协作机制的公立医院的定性资料，并运用定性比较分析方法进行分析。结果：公立医院分工协作的主要影响因素包括体制因素、制度因素、管理因素和技术因素等，并可转化为行政命令、医保制度、协作形式、利益分配机制、技术能力等具体变量。协作形式的紧密程度、基层医疗卫生机构技术水平、政府行政指令、利益协调机制在促进分工协作中发挥了重要的作用，而医保政策作用不明显。结论与建议：在继续推进协作机制建立过程中，应适当运用行政手段，促进不同层级机构的利益协调，并通过制度设计以更好的发挥医保政策的作用。

Influencing factors of the division and cooperation mechanism between public hospitals and primary health care service institutions: A qualitative comparative analysis

Objective: To analyze the main factors that influencing cooperation between public hospitals and primary health care institutions and to make policy recommendations. Methods: We established a theoretical framework by literature interview, and collected qualitative data from nine public hospitals. We also conducted QCA based on the qualitative data. Result: Factors influencing cooperation between public hospitals and primary health care institutions are systemic factors, institutional factors, managerial factors, and technical factors. These can be further specified as the government administrative directives, health insurance system, forms of collaboration, the mechanism for distributing benefits, and technical capacity. The result shows that close collaboration, technical capacity of the primary health organization, government administrative directives, and the interests of the coordination mechanism play an important role. However, the role of health insurance policy is not obvious. Conclusion: Appropriate administrative means should be used to promote the mechanism for coordinating and distributing interests and to strengthen the role of health insurance policy through systematic design.