委托代理理论和管家理论融合视角下三明市紧密型医共体治理研究

Research on the Governance of Merged County Medical Community in Sanming Based on the Integration of Principal-Agent Theory and Stewardship Theory

目的:分析三明市医共体模式取得成效的治理内核,为其他地区医共体建设提供治理思路。方法:对2016—2020年三明市政府、医共体和医务人员3个层面的利益诉求进行描述性分析,评价医共体改革成效,基于委托代理理论和管家理论融合视角探讨三明市医共体模式治理机制。结果:政府、医共体、医务人员间存在双层次委托关系,三者间呈现管家行为递减,代理行为增强的特点。三明市通过优化双层次委托关系,促进了多方利益主体协同。结论:要实现医疗服务公益性,在第1层委托关系,应积极促成“委托—管家”关系的建立,在严格的管控手段限制医共体代理行为的基础上,给予医共体足够的信任和权力,激发医共体管家行为和主观能动性;在第2层委托关系,医共体与医务人员之间以“委托—代理”关系为主,需要用严格的监管和约束手段来较好地解决因为目标异质和信息不对称出现的代理问题。

Objective:To analyze the effective governance model of the merged county medical community and provide governance ideas for the construction of the merged county medical community in other regions.Methods:It makes a descriptive analysis on the interest demands of the government,the merged county medical community and medical staffs from 2016 to 2020,evaluates the effectiveness of the reform of medical community,and discusses the governance mechanism of Sanming model from the perspective of the integration of principal-agent theory and stewardship theory.Results:Through the integration of principal-agent theory and stewardship theory,it is found that there is a two-level entrustment relationship among the government,the merged county medical community and medical staff.Among these three,the housekeeping behavior decreases and the agency behavior increases.Conclusion:In order to realize the public welfare of medical services,the first-level entrustment relationship should actively promote the establishment of the entrustment-housekeeper relationship.On the basis of restricting the agency behavior of the merged county medical community through strict control methods,the merged county medical community should be given sufficient trust and power to stimulate the housekeeping behavior and subjective initiative;in the second-level entrustment relationship,the medical staff’s public welfare goal motivation is the weakest,and strict supervision and restraint methods can better solve the agency problem due to target heterogeneity and information asymmetry.