DRG支付方式改革背景下公立医院高质量发展机制——基于双重嵌入性视角的单案例研究  

High-Quality Development Mechanism of Public Hospitals under the Background of DRG Payment Reform——A Case Study Based on the Perspective of Dual Embeddedness

作　　者：孟翠湖[1] 辛至明 孟雪晖 Meng Cuihu;Zhi ming;Meng Xuehui(School of Accounting,Nanjing University of Finance and Economics,Nanjing,210023,China;School of Humanities and Management,Zhejiang Chinese Medical University,Hangzhou,311403,China)

机构地区：[1]南京财经大学会计学院,南京210023 [2]浙江中医药大学人文与管理学院,杭州311403

出　　处：《公共管理学报》2024年第1期134-145,174,共13页Journal of Public Management

基　　金：江苏省研究生科研与实践创新计划项目(SJCX23_0624)。

摘　　要：目前,中国DRG(Diagnosis-Related Group)支付方式改革已初显成效,公立医院如何在这一制度背景下迈向高质量发展道路备受关注。本文采用诠释主义案例研究范式,深描在DRG支付制度背景下公立医院“谋生行义”的过程,归纳出公立医院“义生耦合”的高质量发展机制:正式制度嵌入设计激励约束机制,而政治嵌入若发挥纠正作用将促使组织激励结构趋同;医院通过非正式制度嵌入传导激励约束机制,实现组织生存和制度落地;制度嵌入性与政治嵌入性嵌合形成公立医院高质量发展助力,有利于实现利益主体间激励相容。DRG支付制度背景下公立医院变革及公共治理的实践已十分丰富,本文界定了制度嵌入性和政治嵌入性的概念,为上述情境提供了新的理论解释框架,并通过质性案例研究进行学理归纳;另外,文章拓展了新经济社会学理论在中国行政事业单位的应用。At present,China's DRG(Diagnosis-Related Group)payment reform has begun to show results,but the institution still needs to be further improved to suit China's situation.This article is based on the dual embeddedness perspective and aims to explore the high-quality development mechanism of public hospitals under the background of the DRG payment system.This article adopts the interpretivist case study paradigm to deeply describe the process of"making a living and doing righteousness"in public hospitals under the background of the DRG payment system,and summarizes the high-quality development mechanism of"coupling of righteousness and livelihood"in public hospitals.The mechanism constructed in this article is as follows:Formal system embedding designs incentive and constraint mechanisms,and if political embedding plays a corrective role,it will promote the convergence of organizational incentive structures;Hospitals transmit incentive and constraint mechanisms through informal system embedding to achieve organizational survival and system implementation;The integration of institutional embeddedness and political embeddedness forms a driving force for the high-quality development of public hospitals,which is conducive to achieving incentive compatibility among stakeholders.However,the single case study used in the article itself has limitations in external validity.In addition,although the article excluded strong economic and political factors when selecting the case hospital,it also objectively ignored the important role of"big hospitals"in the field.Moreover the article defines the concepts of institutional embeddedness and political embeddedness,provides a new theoretical explanation framework for the above situation,and conducts academic induction through the qualitative case study.In addition,the article expands the application of new economic sociology theory in the field of Chinese administrative institutions.

关 键 词：DRG(Diagnosis-Related Group)支付 制度嵌入性 政治嵌入性 高质量发展 公立医院 

分 类 号：R197[医药卫生—卫生事业管理]