通讯作者: 王虎峰, wanghufeng616@ruc.edu.cn

DOI：10.12201/bmr.202501.00035

The Spillover Effects of County Medical community: Behavior, Time, and Situation - An Analysis of 8 Rural Counties in 6 Cities of A Province

• 摘要：同一政策下，不同地区“医疗共同体”的利益何以集成？不同地区医共体建设效果为何参差不齐？本文从溢出视角切入，构建“行为、时间、情境”的溢出分析框架，基于A省6市8个县乡村的医共体建设案例，探究中国情景下医共体建设得以推进或遭遇阻滞的原因。研究发现，医共体政策目标的实现深受利益溢出影响，医共体政策得以发挥效能优势的关键在于医共体如何应对不同层级医院间的正负溢出现象。基本行为溢出能够有效实现多级医院态度与行为的双向调适；跨时间与跨情境溢出能够解释同一行为如何在不同时空下对患者就医、医院发展提供正向溢出；负向溢出可能带来道德风险。研究认为，破解医共体建设阻滞问题需要运用分层分类治理思维，本文基于中国场景下的案例分析，对话溢出效应理论，为医共体建设与基层医疗服务能力提升提供理论参考与选择依据。

  关键词： 县域医共体; 溢出效应; 政策选择; 案例分析

   

  Abstract: Under the same policy, how can the interests of different regional medical communities be integrated? Why are the effects of country medical community construction uneven in different regions? Previous studies mostly evaluated policy effects based on outcome indicators, and rarely discussed the internal mechanism of policies based on Chinas practical scenarios. This paper, starting from the perspective of policy spillover, built a spillover framework of behavior, time and situation based on the cases of country medical community in 6 cities and 8 rural counties in A province, and explored the reasons for the promotion or block of medical community construction in China. It is found that the realization of the policy objectives of the medical community is deeply affected by the spillover of benefits. The key to the realization of the efficiency advantage of the medical community policy lies in how to deal with the positive and negative spillovers between hospitals at different levels. The basic behavior overflow can effectively realize the bidirectional adjustment of multilevel hospital attitude and behavior. Cross-time and cross-context spillover can explain how the same behavior provides positive spillover to patients medical treatment and hospital development in different time and space. Negative spillovers may bring moral hazard. According to the research, it is necessary to use hierarchical and classified governance thinking to solve the problem of blocking the construction of the medical community. Based on the case analysis under the Chinese scenario and the dialogue spillover effect theory, this paper provides theoretical reference and selection basis for the construction of the country medical community and the improvement of primary medical service ability.

  Key words: County Medical community、Spillover effect、Policy options、Case study; ; ; 

  提交时间：2025-01-14

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2024-09-22	bmr.202501.00035V1	下载

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