中国国家医疗联盟的演变及部门间互动机制:基于复杂系统理论的分析

The evolution and inter-sectoral interaction mechanism of China's national medical alliance: An analysis based on complex systems theory.

作者信息

Feng Chong, Zhu Jianping, Chen Yusheng

机构信息

Management School, Xiamen University, Xiamen, China.

Data Mining Research Center, Xiamen University, Xiamen, China.

出版信息

Int J Health Plann Manage. 2022 May;37(3):1454-1476. doi: 10.1002/hpm.3413. Epub 2022 Jan 4.

Abstract

This work investigates the performance and inter-sectoral interaction mechanism of China's largest vertically integrated care network, the national medical alliance (NMA). The data collected derive from the China Health Statistics Bulletin and the China Health Statistical Yearbook for the period 2009-2018. The data include 64 observation indicators for five medical sectors in the NMA, namely, tertiary hospitals (THS), secondary hospitals (SHS), community health centres (CHCS), township hospitals (TsHS) and professional public health institutions (PPHIS). This research combines complex systems theory with a multilevel structural dynamic factor model, and yields two main results. First, although the trend for the NMA's global factor is increasing, the evolutionary paths for sectoral factors differ substantially. Among the sectoral factors, the sectoral factor of THS continued to decline, and neither the sectoral factor of CHCS nor the sectoral factor of TsHS has significantly improved. Then, the interaction mechanism between the various NMA sectors is investigated. While a close relationship has been formed between THS and CHCS and between SHS and CHCS, there remains no close two-way relationship between either THS and TsHS or THS and SHS. Thus, going forward, to reach the policy expectations, China's NMA implementation must consider the interaction between different constituent sectors.

摘要

本研究探讨了中国最大的垂直整合医疗网络——国家医疗联合体(NMA)的绩效及部门间互动机制。所收集的数据源自《中国卫生统计年鉴》和《中国卫生健康统计年鉴》2009 - 2018年期间的数据。这些数据包括NMA五个医疗部门的64个观测指标,即三级医院(THS)、二级医院(SHS)、社区卫生服务中心(CHCS)、乡镇卫生院(TsHS)和专业公共卫生机构(PPHIS)。本研究将复杂系统理论与多层次结构动态因素模型相结合,得出两个主要结果。第一,虽然NMA的全局因素呈上升趋势,但各部门因素的演变路径差异很大。在各部门因素中,THS的部门因素持续下降,CHCS和TsHS的部门因素均未得到显著改善。其次,研究了NMA各部门之间的互动机制。虽然THS与CHCS之间以及SHS与CHCS之间已形成紧密关系,但THS与TsHS之间或THS与SHS之间仍不存在紧密的双向关系。因此,展望未来,为实现政策预期,中国NMA的实施必须考虑不同组成部门之间的相互作用。

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