基于米特-霍恩模型的北京市紧密型医联体政策执行影响因素分析

Mitt-Horn model-based analysis of influencing factors for policy implementation in Beijing integrated medical alliance

目的:分析北京市紧密型医联体政策执行的影响因素。方法:基于深入访谈和问卷调查,利用米特-霍恩模型,从政策目标与标准、政策资源、执行组织间沟通和执行活动、执行机构特性因素、执行人员的价值取向,以及政治、经济和社会环境等方面分析北京市紧密型医联体政策的执行情况。结果:医疗机构和医务人员的内在动力不足是进一步推进医联体发展的主要障碍;部门间合作机制不畅通,未形成合力,导致医联体的发展受到一定约束。结论:探索医联体内医保总额打包支付,并完善人员激励机制,促进紧密型医联体形成利益共同体、责任共同体和发展共同体。

Objective To analyze the influencing factors for policy implementation in Beijing integrated medical alliance.Methods The policy implementation in Beijing integrated medical alliance was analyzed in aspects of policy objectives and standards,policy resources,communication and implementation activities between policy implementation organizations,specific characteristics of policy implementation organizations,value acceptance of policy implementers,and political,economic,social environment based on in-depth interview,questionnaire investigation and Mitt-Horn model.Results The insufficient internal motive force of medical institutions and medical staff was the main obstacle to the development of medical alliance.The development of medical alliance was restricted by unsmooth cooperation mechanism and unformed pool efforts between different departments.Conclusion It is suggested for medical alliance to carry out the package payment of medical insurance payroll,improve the incentive mechanism for medical staff,and promote the integrated medical alliance to establish its interest community,responsibility community and development community.