卫生服务体系发展不充分不平衡与有效治理:一个理论分析框架

The insufficient and unbalanced development of the Chinese healthcare system and efficient governance:A conceptual framework

新医改十年以来,我国卫生服务体系发展不充分不平衡问题仍较为突出,无法充分有效地适应新时代居民的健康需要。在国家治理现代化的大背景下,卫生服务体系的有效治理得到了广泛的呼吁。但是,目前尚未有成熟的理论分析框架。因此,建构卫生服务体系有效治理的理论分析框架具有重要的研究、政策和实践意义。首先,本研究通过文献综述、概念辨析,基于多学科视角界定了卫生服务体系发展不充分不平衡的层次和维度。其次,结合其与卫生治理的逻辑关系,初步探讨了有效治理的内涵逻辑、作用路径和机制,提出了一个“制度—结构—过程—结果”的理论分析框架。最后,基于卫生治理的三大作用靶点,为相关问题的研究和实践提供了新的思路。

Since the new health reform launched in 2009,the insufficient and unbalanced development of China's health service system is still prominent,which is key factor to the full inability to meet the health needs of residents currently.Under the background of modernization of national governance,the effective governance of healthcare system has been widely appealed.However,no theoretical and analytical framework has ever existed.Therefore,it is of great significance to establish a theoretical framework considering the effective governance of healthcare system from the perspective of research,policy making and implementation.First of all,based on the literature review and concept discrimination,this study defined the levels and dimensions of insufficient and unbalanced development of healthcare system from the perspective of multiple disciplines.Secondly,the logical relationship and mechanism within the framework were preliminarily investigated.An“institution-structure-process-outcome”framework with the logical relationship between healthcare governance and elements of insufficient and unbalance development was proposed.Last but not least,the attempt of new prospective for the research and practice of related issues was provided.