混合政策工具视角下县域医共体改革效应评估

Evaluation of the Effects of County-level Medical Alliance Reform from the Perspective of Mixed Policy Tools

目的:基于混合政策工具视角评估县域医共体改革措施及实施效果。方法:以广东省阳西县为例,结合定性和定量数据分析其实施医共体改革前后(2017—2019年)的医疗服务能力、医疗资源利用及就医流向等情况。结果:混合政策工具在县域医共体改革中产生了积极效应。权威性和激励性政策工具的行使优化了县域医共体内部资源配置,并在医疗费用控制、双向转诊制度、医疗服务格局优化等方面发挥了一定作用。而能力性政策工具则提升了县域医共体在组织、管理、资源、服务等诸多方面的综合能力,为改革中达成多元目标奠定了基础。同时,多种政策工具同时使用会形成一定的张力和冲突,在地方政府主导的县域医共体改革中,对权威性工具的过度依赖会制约激励性工具的成效。结论:县域医共体改革应使得权威性和激励性政策工具相得益彰,在合理地去行政化前提下,充分发挥医保支付政策中市场激励作用,并发挥学习性政策工具优势,加强政府对县域医共体的监管和绩效考核。

Objective:To analyze the reform measures and outcomes of the county-level medical alliance from the perspective of mixed policy tools.Methods:Taking Yangxi County in Guangdong Province as the object to carry out a case study,qualitative and quantitative data was applied to analyze the medical service capacity,medical resource utilization and patient flow before and after the reform of the medical alliance from 2017 to 2019.Results:Mixed policy tools have produced positive effects in the reform of county-level medical alliance.The authority and incentive tools optimized the internal resource allocation of the county medical alliance,and played a role in the control of medical expenses,the dual referral system,and the optimization of the medical service pattern.The capacity tools enhanced the comprehensive capabilities of the county medical alliance in terms of organization,management,resources,and services,which laid the foundation for the achievement of multiple goals.Meanwhile,the simultaneous use of multiple policy tools will inevitably lead to certain conflicts and tensions.In the county-level medical alliance reform led by local governments,excessive reliance on authoritative tools will restrict the effectiveness of incentive tools.Conclusion:Further reform of county-level medical alliance should make authority and incentive tools complement each other.Under the premise of rational de-administration,the government should give full play to the market incentives of medical insurance payment policies and develop learning policy tools,and strengthen the supervision and performance appraisal of the county-level medical alliance.