西安交通大学学报（社会科学版）2025，Vol.45Issue(4)：82-91,10.DOI:10.15896/j.xjtuskxb.202504007
政策过程视域下县域医共体政策的价值取向、实践逻辑与优化路径
Policy Value Orientation,Practice Logic and Optimization Path of County Medical Community from the Perspective of Policy Process
摘要
Abstract
For a long time,China has faced issues of uneven distribution of healthcare resources and weak primary-level service capacity.Both longstanding and emerging problems such as"difficulty in accessing medical care and high costs"have become increasingly prominent.Strengthening primary healthcare has been recognized as the fundamental solution to these issues.The Fifth Plenary Session of the 19th Central Committee clarified one of the main directions for strengthening primary healthcare:building an integrated medical and health service system that provides continuous,full-cycle health services.County-level medical consortia represent one of China's practical achievements in implementing the"ensuring basic healthcare,strengthening grassroots services,and establishing mechanisms"strategy while exploring integrated healthcare service systems. Existing literature has confirmed that building county-level medical consortia can promote comprehensive improvement of county-level medical service capabilities,summarized construction experiences,while also pointing out numerous issues in China's county-level medical consortium development process,such as the lack of holistic perspective in policy design,and the need to improve departmental coordination mechanisms,resource allocation mechanisms,and internal management mechanisms.However,existing research lacks panoramic analysis of the policy evolution process and goal orientation of China's county-level medical consortia from a historical dimension,neglects the guiding role of consortium policies in construction practices,and shows an imbalance between excessive focus on experience summarization and insufficient theoretical exploration,with inadequate summarization of practical logic and innovative mechanisms based on actual consortium development cases. To address these issues,this study constructs a theoretical analysis framework based on policy process stage theory.Taking central policies on county-level medical consortia as the research object,it divides policy evolution stages,clarifies policy value orientations,and conducts grounded theory analysis on the"Typical Cases of Compact County-level Medical Consortium Construction"compiled by the Primary Health Department of the National Health Commission.Through real cases,it outlines the practical logic of consortium construction,finally analyzes potential deviations between value orientations and practical logic,and proposes policy optimization suggestions accordingly,aiming to provide new theoretical analysis perspectives for high-quality development of county-level medical consortia. Research findings reveal:(1)County-level medical consortium policies can be divided into policy exploration,piloting,and promotion stages,forming a value orientation of"adopting multiple policy tools to enhance medical service capabilities and promote public health"during evolution.(2)In practice,central policy-driven external forces first promote the establishment of a trinity operational mechanism integrating"organization,resources,and administration"within counties,generating internal momentum that facilitates optimization of primary service processes,ultimately achieving system and health outcome improvements.(3)While overall alignment exists between policy objectives and practical logic in consortium construction,deviations still occur in specificaspects including policy goal discrepancies,implementation subject deviations,and policy tool mismatches.These issues require optimizing coordination between policy and practice through improving construction processes,reshaping mechanisms,and exploring new pathways.By conducting comparative analysis between static policy value orientations and dynamic practical logic,this study breaks through the fragmented perspective separating policy and practice in existing county-level medical consortium research.关键词
县域医共体政策/卫生资源配置/医疗卫生服务体系/政策过程/健康系统宏观模型/模糊—冲突模型Key words
county-level medical community policy/health resource allocation/healthcare service system/policy process/macro model of health systems/fuzzy-conflict model分类
社会科学引用本文复制引用
毛瑛,李浩然,张静雅,谢涛..政策过程视域下县域医共体政策的价值取向、实践逻辑与优化路径[J].西安交通大学学报（社会科学版）,2025,45(4):82-91,10.基金项目
国家社会科学基金重大项目(17ZDA079) （17ZDA079）
国家自然科学基金专项项目(72342016). （72342016）
