协同治理理论视角下医联体绩效管理的优化策略探讨

The optimization strategies for performance management of medical alliances from the perspective of collaborative governance theory

目的分析我国现有医联体绩效管理的现状并探讨其优化策略,以期推动医联体的高质量发展。方法从《医疗联合体综合绩效考核工作方案》入手,采用协同治理理论的分析框架,运用理论分析法并结合医联体的运行和发展现状,从合作机制、动力机制、运行机制和保障机制四个维度对现有指标体系进行分析。结果医联体绩效评价指标体系对实现医疗资源的均衡配置、促进不同层级医疗机构分工合作发挥着重要作用。在合作机制上,指标较为笼统且未涉及到医联体与其他利益相关方(如医保机构)的合作机制方面的考核;在运行机制上,缺乏对问题情境下及时反馈和协商机制的考核;在动力机制上,缺乏对利益共享机制的明确的评价指标;在保障机制上,缺少对各成员责任履行与利益分配的监督评价指标。结论现有指标体系在规范我国医联体绩效管理方面发挥着重要作用,在协同治理理论视角下仍有一定的提升空间,应强化对医联体动态反应机制、激励机制、内外部联动等方面的考核,以促进我国医联体的高质量发展。

Objective To analyze the current situation of the performance management of medical alliances in China and to discuss its optimization strategies,in order to promote the high-quality development of medical alliances.Methods Starting from“Comprehensive performance appraisal work plan of medical alliances”,we adopted the analytical framework of collaborative governance theory and analyzed the existing index system from four dimensions:cooperation mechanism,dynamic mechanism,operation mechanism and guarantee mechanism with theoretical analysis method in combination with the operation and development status of medical alliances.Results The application of the performance evaluation index system of medical alliances had important guiding significance for realizing the balanced allocation of medical resources and promoting the cooperation of health institutions at different levels.In terms of the cooperation mechanism,the indicators were relatively general and the assessment of the cooperation mechanism between medical alliances and other stakeholders(such as medical insurance institutions)was not involved.In terms of operation mechanisms,there was no evaluation indicator for timely feedback and negotiation mechanism in problematic situations.In terms of dynamic mechanism,there was a lack of clear evaluation indicators for the benefit-sharing mechanism,and in terms of guarantee mechanism,there was still a lack of supervision and evaluation indicators for the performance of members'responsibilities and the distribution of benefits.Conclusions Current index system plays an important role in standardizing the performance management of medical alliances in China,and there is still some room for improvement from the perspective of collaborative governance theory.It is necessary to enhance the assessment of the dynamic response mechanism,incentive mechanism,and internal and external linkage of medical alliances,so as to promote the high-quality development of medical alliances in China.