紧密型治理影响县域医共体绩效的组态路径研究

The Paths of Merged Governance Affecting the Performance of County Medical Consortia

目的:探索县域医共体紧密型治理影响医共体绩效的路径,为医共体高质量发展阶段精准施策提供依据。方法:分析广东省县域医共体紧密型治理情况,基于组态理论、利用模糊集定性比较分析法探究紧密型治理影响医共体绩效的路径及核心条件。结果:实现高县域医共体绩效的有效路径有3条,核心条件为医共体有效考核、财务统一管理和药品统一管理落实到位。在实现以上核心条件的情况下,即使信息互联互通未落实也可能实现高县域医共体绩效;导致非高县域医共体绩效的有效路径有11条,核心条件为医共体决策权限、财务统一管理和收入统一管理均落实不力。结论:为提高县域医共体绩效,应重点保障医共体决策权限,全面落实县域医共体考核机制以及财务统一管理、药品统一管理和收入统一管理。

Objective:To explore the paths between construction strategies and performance of county medical consortia and in-forming policy making for further high-quality development of county medical consortia.Methods:It analyzes current development status of county medical consortia in Guangdong Province,and explored the core conditions and configuration paths between construc-tion strategies and performance of county medical consortia using fuzzy-set Qualitative Comparative Analysis(fsQCA).Results:There are three effective paths for achieving high performance of county medical consortia.The core conditions are the effective evaluation of county medical consortia,unified management of finance and drug.Though information sharing is not implemented well,high perfor-mance can be achieved with the above core conditions implemented effectively.There are 11 effective paths for non-high performance of county medical consortia.The core conditions for non-high performance include the ineffective implementation of decision-making autonomy,unified management of finance and income.Conclusion:The key to improving the performance of county medical consortia is effective implement of decision-making autonomy,evaluation,and the unified management of finance,drugs and income in county medical consortia.