健康需求与协同治理:分级诊疗制度建设实践逻辑——基于公共价值视角的扎根理论研究  

Health Demand and Collaborative Governance:The Practical Logic of Hierarchical Diagnosis and Treatment System Construction——The Grounded Theoretical Analysis from the Perspective of Public Value

作　　者：傅利平[1,2] 王奕辉 徐小凤 董永庆[1] Fu Liping;Wang Yihui;Xu Xiaofeng;Dong Yongqing(College of Management and Economics,Tianjin University,Tianjin,300072,China;School of Politics and Public Administration,Qinghai Minzu University,Xining,810073,China;School of Business Administration,Jiangxi University of Finance and Economics,Nanchang.330013,China)

机构地区：[1]天津大学管理与经济学部,天津300072 [2]青海民族大学政治与公共管理学院,西宁810073 [3]江西财经大学工商管理学院,南昌330013

出　　处：《公共管理学报》2024年第3期111-123,173,174,共15页Journal of Public Management

基　　金：国家社会科学基金重点项目(20AGL034)。

摘　　要：建立健全分级诊疗制度是我国不断增进民生福祉,持续推进基本医疗服务均等可及的重要举措。本文以田野调查与典型案例等相关数据为对象,采用扎根理论研究方法,尝试构建分级诊疗制度建设实践逻辑的解释框架。研究发现:我国的分级诊疗制度建设基于“健康需求”,实现“协同治理”,实践逻辑包括健康需求逻辑和协同治理逻辑两条逻辑线。具体而言,公共管理者采取一系列目标管理措施,确立“保障人民健康”公共价值目标;通过改善支持环境、增强主体感知、理顺执行要素、优化机制设计,提供整合型医疗卫生服务体系协同治理的公共秩序产品,即分级诊疗制度。这个过程本质上是公共管理者创造公共价值的过程。本文从公共价值视角出发,既重构了分级诊疗制度建设实践逻辑,也做出了重要的理论贡献和有效的实践贡献,对于推进国家治理体系与治理能力现代化具有重要意义。Establishing and improving the hierarchical diagnosis and treatment system in China is an important measure to continuously improve people's livelihood and promote the equality and accessibility of basic medical services.Based on field investigation and typical case data,this paper attempts to construct an explanatory framework for the practical logic of the hierarchical diagnosis and treatment system construction by using the grounded theory research method.It is found that the construction of hierarchical diagnosis and treatment sys-tem in China is based on"Health Demand"to achieve"Collaborative Governance",and the practical logic includes two logic lines:Health Demand Logic and Collaborative Governance Logic.Specifically,the public administrators adopt a series of target management measures to establish the public value target of"safeguarding people's health";By improving the supporting environment,enhance the perception of the subject,rationalize the implementation factors,optimize the mechanism design,and provide the public order products that enable the integrated medical and health service system to achieve collaborative governance,that is,the hierarchical diagnosis and treatment system.This is essentially a process in which public managers create public value.From the perspective of public value,this paper not only reconstructs the practical logic of the hierarchical diagnosis and treatment system construction,but also makes important theoretical and effective practical contributions,which is of great significance for promoting the modernization of the national governance system and governance capacity.

关 键 词：分级诊疗 公共价值 健康需求 协同治理 

分 类 号：C913[经济管理]