“嵌入式协同”:一个跨域卫生资源合作治理的解释性框架——基于成渝地区双城经济圈的案例研究

“Embedded coordination”:An explanatory framework for cooperative governance of regional health resources:Based on a case study of the Chengdu-Chongqing twin-city economic circle

跨域卫生资源合作实质上是一个资源重新整合配置与治理流程再造的过程。现有文献多从政府或市场单一视角进行讨论,致使分析范式与理论框架陷入科层制“府际协同”和市场型“政社协同”非此即彼的话语旋涡。本文利用2019年7月—2021年8月共计87份项目数据,采用社会网络分析法对成渝地区跨域卫生资源合作模式进行分析。结果发现,随着区域一体化持续深化,政府、医院和高校等多元主体间互动关系变迁与动态策略选择,呈现出从属地自治到同频共振、从单一利益联结到多重邻近协同、从有限被动合作到多维主动嵌入的特征。进一步引入“嵌入式协同”框架,将区域环境压力与主体关系重构的嵌入动力机制、多维因素叠加的嵌入作用机制和推进区域优质卫生资源整合的嵌入实现机制融入跨域卫生资源合作研究体系,尝试为相关议题提供一个解释性框架。

Inter-regional health resource cooperation is essentially a process of resource reintegration and redistribution and governance protocol reengineering.It was discussed in most existing literature from a single perspective of the government or market,causing the analysis paradigm and theoretical framework to be constrained in the literal“vortex”of following either bureaucratic“intergovernmental coordination”or market-based“government-community coordination”.This article used data from a total of 87 projects from July 2019 to August 2021 and analyzed the inter-regional health resource cooperation model in the Chengdu-Chongqing region with social network analysis method.The results found that as the regional integration continued to progress,the interactive relationship change and dynamic strategy selection of the government,hospitals and universities have manifested a pattern shift from territory autonomy to co-frequency resonance,from single-interest connection to multiplexed proximity coordination,and from limited and passive cooperation to multi-dimensional active embedded cooperation.By further introducing the“embedded collaboration”framework,this work integrated the embedding dynamic mechanism of regional environmental pressure and subject relationship reconstruction,the embedding effect mechanism of multi-dimensional factor superposition,and the embedding realization mechanism that promotes the integration of regional high-quality health resources into the research system of inter-regional health resource cooperation,thereby trying to provide an explanatory framework for related topics.