Zhao Linyan, Du Jie, Liu Wenhao, Xu Qun, Zhang Yuhui
School of Public Health, Shandong Second Medical University, Weifang, China.
Second People's Hospital of Weifang, Weifang, China.
Front Public Health. 2025 May 14;13:1578712. doi: 10.3389/fpubh.2025.1578712. eCollection 2025.
The Vertical Integration of High-Quality Medical Resources (VI-HQMR) is a strategy of medical resource reallocation. It is the key to strengthen primary health care (PHC) and build an integrated delivery system (IDS). It contributes to the Sustainable Development Goals (SDGs) of universal health coverage (UHC) set out by the World Health Organization (WHO). In order to VI-HQMR, countries around the world have carried out many beneficial explorations. However, our understanding of the importance of clarifying the internal logical from policy perspective in the VI-HQMR is limited. This study aims to develop a theoretical model from the symbiotic perspective to improve the strategy of VI-HQMR.
Policies related to the VI-HQMR were retrieved for exploratory research. The texts and entries were coded according to the four elements of symbiosis theory, the first-level categories and their variables were mined, and the occurrence frequency was used as the main indicator for thematic clustering.
A total of 609 policies were retrieved, among which 1,072 entries mentioned VI-HQMR. Results showed that the VI-HQMR included 482 symbiotic units, 549 symbiotic models, 383 symbiotic environments and 96 symbiotic interfaces. Secondary and above public hospitals and PHC institutions are the most important symbiotic units. Medical alliances are the most important symbiotic model. The symbiotic environment includes policy, technology and economics. The vertical integration of human resources is the main symbiotic interface.
The VI-HQMR is still in the initial exploration stage. The symbiotic model is changing from parasitism to the commensalism. To achieve the optimal mutualism model, we need to work hard from the symbiotic environment. Health administrative department should coordinate with other relevant departments to introduce special policies to support the VI-HQMR. Through opening the way for promotion, financial incentive, and informationization assistance, improve the enthusiasm of urban hospitals.
优质医疗资源纵向整合（VI-HQMR）是一种医疗资源重新配置的策略。它是加强初级卫生保健（PHC）和构建整合型服务体系（IDS）的关键。它有助于实现世界卫生组织（WHO）提出的全民健康覆盖（UHC）这一可持续发展目标（SDGs）。为了推进VI-HQMR，世界各国开展了许多有益探索。然而，我们从政策角度对厘清VI-HQMR内部逻辑重要性的认识有限。本研究旨在从共生视角构建一个理论模型，以完善VI-HQMR策略。
检索与VI-HQMR相关的政策进行探索性研究。依据共生理论的四个要素对文本和条目进行编码，挖掘一级类别及其变量，并以出现频次作为主题聚类的主要指标。
共检索到609项政策，其中1072个条目提及VI-HQMR。结果显示，VI-HQMR包含482个共生单元、549个共生模式、383个共生环境和96个共生界面。二级及以上公立医院和基层医疗卫生机构是最重要的共生单元。医疗联盟是最重要的共生模式。共生环境包括政策、技术和经济。人力资源的纵向整合是主要的共生界面。
VI-HQMR仍处于初步探索阶段。共生模式正从寄生向偏利共生转变。要实现最优的互利共生模式，需要从共生环境方面着力。卫生行政部门应与其他相关部门协同，出台支持VI-HQMR的专项政策。通过开辟晋升通道、给予财政激励和信息化帮扶等方式，提高城市医院的积极性。
