Bogue R J, Antia M, Harmata R, Hall C H
J Health Polit Policy Law. 1997 Aug;22(4):1051-76. doi: 10.1215/03616878-22-4-1051.
In the United States, health system change occurs as the interaction of politics and policies is played out and pushed forward by individuals and organizations taking action in their local communities and markets. This article provides context and descriptive information about a model of local health care reform that is being tested in twenty-five communities around the nation. We introduce a value-based model of community-responsive health system change, the Community Care Network (CCN) Vision. We briefly describe a national demonstration program that is testing this model between January 1996 and the end of 1998. We offer several ways of looking at the local and regional multisectoral partnerships that are attempting to demonstrate the CCN vision. We look at their composition, the kinds of actions in which they are engaged, several example challenges and responses to them, and we give several examples of schools becoming part of the health system of last resort. Finally, we present some early ideas on how the local actions described here may influence (and be influenced by) the political and policy contexts in which they occur.
在美国，卫生系统的变革是在政治与政策的相互作用中发生的，这种相互作用由在当地社区和市场采取行动的个人和组织推动向前。本文提供了关于一种地方医疗改革模式的背景和描述性信息，该模式正在全国25个社区进行测试。我们介绍了一种基于价值的社区响应型卫生系统变革模式，即社区护理网络（CCN）愿景。我们简要描述了一个全国示范项目，该项目在1996年1月至1998年底期间对这一模式进行测试。我们提供了几种看待地方和区域多部门伙伴关系的方式，这些伙伴关系正试图展示CCN愿景。我们审视了它们的构成、所从事的行动类型、几个典型挑战及应对措施，并给出了一些学校成为最后求助卫生系统一部分的例子。最后，我们提出了一些初步想法，即这里所描述的地方行动可能如何影响（以及受到何种影响）它们所处的政治和政策环境。
