School of Public Administration, Central South University, Changsha 410083, China.
School of Public Health, University of Toronto, Toronto, ON M2J 4A6, Canada.
Int J Environ Res Public Health. 2019 Aug 19;16(16):2975. doi: 10.3390/ijerph16162975.
Integrated healthcare has received considerable attention and has developed into the highly important health policy known as Integrated Healthcare in County (IHC) against the background of the Grading Diagnosis and Treatment System (GDTS) in rural China. However, the causal conditions under which different integrated health-care modes might be selected are poorly understood, particularly in the context of China's authoritarian regime. This study aims to identify these causal conditions, and how they shape the mode selection mechanism for Integrated Healthcare in County (IHC). A theoretical framework consisting of resource heterogeneity, governance structure, and institutional normalization was proposed, and a sample of fifteen IHCs was selected, with data for each IHC being collected from news reports, work reports, government documents and field research for Fuzzy-sets Qualitative Comparative Analysis (fsQCA). This study firstly pointed out that strong governmental control and centralization are necessary conditions for the administration-oriented organization mode (MOA). Additionally, this research found three critical configured paths in the selection of organizational modes. Specifically, we found that the combination of low resource heterogeneity, weak governmental control, centralization, and normalization was sufficient to explain the selection path of the insurance-driven organization mode (MOI); the combination of low resource heterogeneity, strong governmental control, centralization, and normalization was sufficient for selecting MOA; and the combination of weak governmental control, weak centralization, and weak normalization was sufficient for selecting the contractual organization mode (MOC). Our study highlighted the necessity and feasibility of constructing different IHC modes separately and promoting their development gradually, as a result of the complex relationships among the causal conditions described above, thus helping to optimize the distribution of health resources and integrate the healthcare system.
在中国农村分级诊疗制度的背景下，整合医疗受到了广泛关注，并发展成为高度重要的卫生政策，即县域整合医疗（IHC）。然而，对于不同整合医疗模式可能被选择的因果条件，人们了解甚少，尤其是在中国的威权政体背景下。本研究旨在确定这些因果条件，以及它们如何塑造县域整合医疗（IHC）的模式选择机制。本研究提出了一个由资源异质性、治理结构和制度规范化组成的理论框架，并选择了 15 个 IHC 作为样本，对每个 IHC 的数据进行了收集，包括新闻报道、工作报告、政府文件和实地研究，用于模糊集定性比较分析（fsQCA）。本研究首先指出，强政府控制和集中化是行政导向组织模式（MOA）的必要条件。此外，本研究还发现了组织模式选择中的三条关键配置路径。具体来说，我们发现资源异质性低、政府控制弱、集中化和规范化是解释保险驱动型组织模式（MOI）选择路径的充分条件；资源异质性低、政府控制强、集中化和规范化是选择 MOA 的充分条件；政府控制弱、集中化弱和规范化弱是选择契约组织模式（MOC）的充分条件。我们的研究强调了分别构建不同的 IHC 模式并逐步推进其发展的必要性和可行性，这是由于上述因果条件之间的复杂关系，从而有助于优化卫生资源配置和整合医疗体系。
Zotero 插件