整体性治理视角下区域医疗机构纵向协作优化研究

Study on vertical collaboration optimization of regional medical institutions from the perspective of holistic governance

近年来,我国新医改通过分级诊疗服务体系建设,旨在促进医疗服务网络分工协作。但由于政府治理的分散化,区域医疗机构间纵向协作尚缺乏外部支撑环境:监管主体单一化、协作体制不顺畅、激励约束机制不匹配、缺乏有效的法制保障,而区域医疗机构之间的纵向协作松散,又导致协作缺少统一的管理组织、稳健的协作机制、共同的利益凝聚,从而导致区域纵向医疗服务提供陷入裂解性困境。本文以整体性治理理论为视角,深度剖析了我国区域医疗机构纵向协作偏弱的现状,借鉴区域医疗机构纵向协作的国际经验,重新整合政府、社会和医疗机构等主体协作力量,优化区域医疗机构纵向协作的治理方式,重塑我国纵向医疗网络的系统使命。

In recent years,China's new medical reform aimed at promoting the division of labor and cooperation in the medical service network through the construction of hierarchical medical service system.Nevertheless,the government's decentralized governance,there is still a lack of external support environment in vertical collaboration among regional medical institutions in China,and this is explained by the simplification of regulatory body,unsmooth cooperation system,mismatched incentive constraint mechanism and a lack of effective legal protection guarantees.In addition,loose vertical collaboration between regional medical institutions lead to a lack of unified management organization,strong cooperation mechanism and common interests' cohesion,which brought about the decentralization of regional vertical medical services delivery.From the perspective of holistic governance theory,this paper profoundly analyzes the current situation of the weak vertical collaboration among regional medical institutions in China.Therefore,it draws on the international experience in the same domain as a reference to re-integrate the cooperative forces including the government,society and medical institutions.The vertical collaboration approach further optimized the governance mode of regional medical institutions and reshaped its systematic mission in the vertical medical network in China.