组态视角下多层次医疗保障体系驱动机制研究  

Research on the driving mechanism of a multi-level medical security system from the perspective of configuration

作　　者：刘晖[1] 何欣悦 寇丽圆 夏小川 LIU Hui;HE Xinyue;KOU Liyuan;XIA Xiaochuan(School of Health Management,Gansu University of Traditional Chinese Medicine,Lanzhou,Gansu730000,China;不详)

机构地区：[1]甘肃中医药大学卫生管理学院,甘肃兰州730000 [2]甘肃中医药大学公共卫生学院

出　　处：《中国预防医学杂志》2024年第9期1166-1171,共6页Chinese Preventive Medicine

基　　金：甘肃省科技厅2023年度第三批省级科技计划(基础研究计划——软科学专项)项目(23JRZA462)。

摘　　要：目的 识别多层次医疗保障体系成功推进的关键要素和路径组合,在基本医疗保障基础上,为满足医疗保障多样化、个性化需求,形成覆盖全面、层次分明、互为补充的医疗保障体系提供理论指导。方法 本研究运用清晰集定性比较分析(crisp sets qualitative comparative analysis,csQCA)与个案分析相结合的研究方法,探究多层次医疗保障体系推进的结构要素及实现路径。结果 通过对所在区域、推动主体、多元合作、特殊人群、覆盖范围、数据共享、特殊疾病7个结构要素进行必要性检验,发现单个前因条件不构成多层次医疗保障体系成功推进的必要条件,存在12个使其成功推进的组态,整合可归纳为“精准定制型”“全面覆盖+精准保障型”“区域协同型”三种推进模式。结论 多层次医疗保障体系成功推进路径具有异质性,多要素之间的联动和条件制约会形成不同路径,呈现出发展模式并发和多样化的特征,建议对多层次医疗保障体系成功推进实行精准的政策和路径引导,避免单一路径依赖。Objective To identify the key elements and pathway combinations essential for the successful promotion of a multi-level medical security system and provide theoretical guidance for meeting the diversified and personalized needs of medical security based on basic medical security and forming a comprehensive,hierarchical and complementary medical security system. Methods A combination of crisp sets qualitative comparative analysis(csQCA) and case analysis was used to explore the structural elements and implementation pathways of the multi-level medical security system. Results Through the necessity test of the seven structural elements of the region, the driving body, multi-stakeholder collaboration, the special population, the coverage area, the data sharing, and the particular disease, it is found that a single antecedent condition does not constitute the necessary condition for the successful promotion of the multi-level medical security system. There are 12 configurations that make it successful. The integration can be summarized into three promotion modes: "precision customization", "comprehensive coverage + precision guarantee", and "regional coordination".Conclusions The successful promotion path of a multi-level medical security system exhibits heterogeneity,with interlinkages and conditional constraints among multiple factors resulting in diverse developmental patterns.It is suggested that precise policies and pathway guidance be implemented to avoid reliance on a single pathway in advancing the multi-level medical security system.

关 键 词：多层次医疗保障体系 定性比较分析 案例研究 结构要素 组合路径 

分 类 号：R197[医药卫生—卫生事业管理]