区域人口健康水平差异及其影响因素——基于经济合作与发展组织28国的模糊集定性比较分析

Disparities in regional population health levels and their influencing factors:a fuzzy set qualitative comparative analysis of the data from 28 OECD countries

目的 探究区域人口健康水平的影响因素及其组态效应,以期为我国有关部门制定人口健康政策提供借鉴。方法 基于TOE框架,以经济合作与发展组织(organization for economic co-operation and development, OECD,简称经合组织)28国人口健康情况为案例,运用模糊集定性比较分析(fsQCA)方法进行条件组态分析,探讨技术、组织、环境条件影响OECD28国人口健康水平的驱动路径。结果 (1)技术、组织、环境条件均无法单独构成区域人口高健康水平的必要条件。(2)区域人口高健康水平6种组态模式。这6种组态模式体现了不同国家人口健康水平的多重实现方式:以高卫生支出为核心的支出-组织驱动型,强调公共卫生资源合理配置、加强环境保护的环境-组织驱动型,以发挥高医疗技术水平、高卫生支出的核心作用的技术-组织驱动型。(3)相对其他条件而言,强化组织管理能力,即加强公共卫生资源合理配置、加大卫生支出的作用至关重要。结论 各地区可结合自身条件因素选择不同的人口健康实现路径。研究结论可为提高我国健康水平提供一定的参考。

Objective To identify the factors influencing regional population health levels and their configurational effects to provide insight for relevant departments of China to make population health policy.Methods Using the TOE framework,this paper examined the population health status of OECD 28 countries as a case study.Fuzzy-set Qualitative Comparative Analysis(fsQCA)was used to conduct conditional configuration analysis,exploring the driving path of technical,organizational and environmental conditions affecting the population health level.Results①No single condition,whether it be technical,organizational,or environmental,could independently constitute the prerequisites for a high regional health level.②Six configuration modes were identified for achieving high health level of regional population in different countries:an expenditure-organization-driven model centered on high health expenditure,an environment-organization-driven model emphasizing rational allocation of public health resources strengthening environmental protection,and a technology-organization-driven model highlighting the advanced medical technology and significant health expenditure.③Among the various conditions,strengthening the organizational and managementcapabilities by way of rationally allocating public health resources and fortifying the role of health expenditure,proved to be crucial.Conclusion Each local administration can choose different pathways for population health improvement on its own conditions.The research findings can provide some reference for elevating health levels in China.