摘要
目的探索县域医疗卫生共同体(以下简称医共体)建设对分级诊疗体系的影响机制。方法基于社会网络理论, 从医共体参与主体的网络位置、医共体的内部社会结构和医共体的整体特征3个方面构建医共体建设影响分级诊疗体系的分析框架。2018年6月至2023年2月, 对云南省S县进行田野调查, 通过梳理该县的医共体建设经验, 分析县域医共体建设对分级诊疗体系的影响机制。结果对S县医共体建设情况的分析结果显示, 位于社会网络中心位置的医共体牵头医院能够在识别和利用资源方面促进其他医疗机构间的互动, 处在枢纽位置的乡镇卫生院以特殊网络位置串联彼此不相连的主体;通过约束县级医疗卫生机构"虹吸"基层资源、引导县级医疗卫生机构下沉优质医疗资源、激励基层医疗卫生机构参与分级诊疗体系构建可增强参与主体间的联系, 加强信息共享, 促进团体合作, 提高组织效率, 从而促进分级诊疗;医共体建设增加了网络密度和牵头单位的中心势, 进而提高分级诊疗体系的整体性治理能力, 并通过制度约束、资源整合和利益再分配综合推动分级诊疗体系的建设。结论 S县的医共体建设改变了原有的社会网络结构, 通过"约束-引导-激励"机制, 在牵头医院的积极推动下, 供需双方合力引导社会网络主体合理配置资源及患者合理利用资源, 助力实现分级诊疗的目标。
Objective To explore the impact mechanism of the construction of county medical communities(hereinafter referred to as medical communities)on the hierarchical diagnosis and treatment system.Methods Based on social network theory,an analytical framework for the impact of medical community construction on the hierarchical diagnosis and treatment system was constructed from three aspects:the network location of participating entities in medical communities,the internal social structure of medical communities,and the overall characteristics of medical communities.From June 2018 to February 2023,a field survey was conducted in S county,Yunnan province.By reviewing the experience of medical community construction in the county,the impact mechanism of medical community construction on the hierarchical diagnosis and treatment system was analyzed.Results The analysis of the construction of the medical community in S county showed that the leading hospital of the medical community located at the center of the social network could promote interaction between other medical institutions in identifying and utilizing resources,while the township health centers located at the hub connected unrelated entities through special network positions;By constraining county medical institutions to"siphon"grassroots resources,guiding county medical institutions to sink high-quality medical resources,and encouraging grassroots medical and health institutions to participate in the construction of a hierarchical diagnosis and treatment system,the connection between participating entities could be strengthened,information sharing could be strengthened,group cooperation could be promoted,organizational efficiency could be improved,and hierarchical diagnosis and treatment could be promoted;The construction of the medical community has increased network density and the central position of the leading unit,thereby improving the overall governance capacity of the hierarchical diagnosis and treatment system,and comprehensively promoting the construc
作者
李乐乐
鲜逸峰
古德彬
Li Lele;Xian Yifeng;Gu Debin(School of Labor and Human Resources,Renmin University of China,Beijing 100872,China;School of Public Policy and Management,Tsinghua University,Beijing 100084,China;Science and Education Department,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2024年第2期86-92,共7页
Chinese Journal of Hospital Administration
基金
国家自然科学基金(72204251)。
关键词
卫生保健联合体
县域医疗卫生共同体
分级诊疗
社会网络理论
利益分配
资源整合
Health care coalitions
County medical community
Hierarchical diagnosis and treatment
Social network theory
Benefit distribution
Resource integration
