脱域共同生产:村民参与乡村智慧医疗卫生服务治理的个案研究

Disembeding and Co-production:A Case Study of Rural Smart Medical and Health Services

如何吸引患者参与医疗卫生服务的共同生产已成为理论界与实务界高度关注的焦点。但是,现有研究主要集中于城市传统"在地化"的共同生产,较少研究基于乡村网络平台的智慧医疗服务的共同生产;虽然开始关注患者参与共同生产的影响因素,但仍不足以解释村民参与乡村智慧医疗共同生产的因果机制。本文基于共同生产、脱域治理理论,通过15个典型案例、10个典型视频和1个村庄的田野调查,运用个案研究方法,构建乡村智慧医疗卫生服务共同生产的解释框架。研究发现,乡村智慧医疗共同生产的诱发因素包括行动性因素(村民的社会交换心理、自我效能感、归属感)和结构性因素(公共部门助推、智慧文化、数字鸿沟);共同生产过程包含共同设计、培训、服务输送、评估;共同生产有助于减少看病贵看病难麻烦、塑造新型医患关系、创造公共价值、推进公共服务公平。研究结论在理论上可拓展共同生产、脱域治理理论的应用范围,在实践上为地方政府、乡村社区在促进乡村智慧医疗的共同生产提供经验借鉴。

How to attract patients to participate in the co-production of medical and health services has become the focus of great attention in the theoretical and practical circles.However,the existing research mainly focuses on the co-production of traditional"localization"in the city,and seldom studies the co-production of smart medical services based on the rural network platform;although the influencing factors of patients’participation in co-production are beginning to be concerned,it is still not enough to explain Villagers participate in the causal mechanism of Co-production of rural smart medical care.Based on the theory of co-production and Disembeding governance,through 15 typical cases,10 typical videos,and field surveys in 1 village,using case study,construct an explanatory framework for the co-production of rural smart medical and health services.The study found that the predisposing factors for co-production of rural smart medical care include villagers’social exchange psychology,self-efficacy,sense of belonging,and public sector assistance.The co-production process includes joint design,training,service delivery,and evaluation.Co-production will contribute to reducing the trouble of expensive and difficult medical treatment,shaping a new type of doctor-patient relationship,creating public value,and promoting fairness in public services.The research conclusions can theoretically expand the application scope of co-production and disembeding governance theory,and can provide experience and reference for local governments and rural communities to promote rural smart medical co-production in practice.