中小城市社区卫生体系建设的制度生态分析——以广东省Z市为例

The Ecology of Community Public Health Institutions Building in Small and Medium-sized Cities:an Empirical Study Based on Z City Case of Guangdong Province

对广东省Z市社区卫生体系建设的经验考察发现,中小城市社区卫生体系建设的制度生态总体上呈现出脆弱性特质,具体表现为资源投入不足、配置结构不合理;社区卫生站、居民、医疗保险三方缺乏无缝衔接;缺乏持续有效的激励机制等。在社区卫生体系建设中,制度嵌入的初始状态影响制度嵌入后的生存状况,理论上追求的制度有机嵌入与现实中制度自身有机性不足、外部条件不适的相互抵牾是导致制度生态脆弱的演变机理。

The empirical study on community public health institution building of Z city,Guangdong province,shows that,the institutional ecology has the characteristics of vulnerability,which includes the shortage of financial invest,unreasonable distribution,lack of seamless joint between community health clinics,patients and medical insurance,and the lack of effective incentive mechanism.In the building of the community public health institutions,the initial state of the institutions' involvement has great influence on their living conditions afterwards.The evolution mechanism of institutional vulnerability comes from the contradictions between the aim of institution organic involvement in theory and the lack of organic involvement in reality,and the inapplicability of the external conditions.So,the author suggests that the local government should adopt the tactics of 'one simultaneousness,two responses' to improve the community public health institution building.