我国医联体集团建设与国际医疗资源整合利用方式的比较分析

Comparative analysis of China's Medical Cluster group construction and international medical resources integration and utilization methods

为了解决医疗卫生资源的优化配置和合理分布问题,许多国家都采取了集团化发展的医联体模式,在全球视野下比较研究各种医联体的社会效应可以更好地促进国内医联体良性发展。近年来由于国家鼓励医联体的发展,全国各地发展出多种形式的医联体,形成了中国特色的医联体,但是在多地建立与发展的医联体模式不同、效果不同,对医疗卫生资源配置的效应有较大差异。笔者运用比较方法,分析国内外不同医联体整合医疗卫生资源的效果,通过奥尔森集体行动困境理论研究医联体集团化合作存在的问题与困境,结果发现国内医联体存在政策措施不到位、集团内部目标不一致、集团管理约束力不强、存在“搭便车”效应、利益分配不均衡、缺乏有效的激励机制等问题。建议从集团治理理论出发,政府采用选择性激励方法引导医联体优化医疗卫生资源分布和配置,奖励医联体资源向基层倾斜、提升服务质量。

In order to solve the problem of optimal allocation and rational distribution of medical and health resources,many countries have adopted the mode of collectivized development of Medical Clusters.Comparing and studying the social effects of various Medical Cluster from a global perspective can better promote the benign development of Medical Cluster in China.In recent years,due to the state's encouragement of the development of a Medical Cluster,various forms of Medical Cluster have been developed all over the country,forming a Medical Cluster with Chinese characteristics.However,the modes and effects of establishing and developing Medical Clusters in many places are different,and the effects on the allocation of medical and health resources are quite different.We use comparative methods to analyze the effects of different Medical Cluster at home and abroad on the integration of medical and health resources.Through Olson's collective action dilemma theory,we study the problems and difficulties existing in the collectivization cooperation of the Medical Cluster.The results show that there are some problems in China's Medical Cluster,such as inadequate policies and measures,inconsistent internal objectives of the group,weak binding force of group management,free riding effect,unbalanced distribution of interests,lack of effective incentive mechanism,and so on.It is suggested that based on the group governance theory,the government should adopt the selective incentive method to guide the Medical Cluster to optimize the distribution and allocation of medical and health resources,reward the medical consortium to tilt its resources to the grassroots level and improve the service quality.