整合型医疗卫生服务体系交易费用:解构、测度与应对  

Transaction costs of integrated delivery systems: deconstruction, measurement, and strategic responses

作　　者：苗豫东 朱东方 李寅飞 申战垒[1] MIAO Yudong;ZHU Dongfang;LI Yinfei;SHEN Zhanlei(College of Public Health,Zhengzhou University,Zhengzhou 450001,Henan,China;Henan Provincial People’s Hospital,Zhengzhou 450003,Henan,China)

机构地区：[1]郑州大学公共卫生学院,河南郑州450001 [2]河南省人民医院,河南郑州450003

出　　处：《健康发展与政策研究》2024年第6期500-504,536,共6页Health Development and Policy Research

基　　金：国家社会科学基金一般项目(21BGL222)。

摘　　要：整合型医疗卫生服务体系(Integrated Delivery Systems,IDS)的建立是医疗卫生服务供给制度的重大革新,构建IDS是全球医药卫生体制改革的重要趋势,也是实现健康中国战略的重要框架。降低交易费用是确保新制度成功实施的关键,本文以威廉姆森-张五常交易费用分析范式为指导,将IDS交易费用分解为计划决策成本、业务协作成本、专项投入成本、监督管理成本,构建IDS交易费用微观测度模型,并基于行动者网络理论,从提高交易费用认知、建立节约制度供给、健全补偿激励机制、构建集体行动路径等4个方面提出应对策略,以期降低IDS交易费用,有助于IDS韧性可持续运行。The establishment of an integrated delivery system(IDS)marks a significant reform in healthcare service provision,representing a critical trend in global healthcare reforms,and serving as a crucial framework for achieving the Healthy China initiative.Reducing transaction costs is key to the successful implementation of this new system.Guided by the Williamson-Steven Cheung transaction cost analysis paradigm,this study decomposes transaction costs into planning and decision-making costs,operational collaboration costs,specific investment costs,and supervision costs,thereby constructing a micro-measurement model for IDS transaction costs.Leveraging actor-network theory,the study proposes strategies to enhance awareness of transaction costs,establish cost-saving institutional provisions,refine compensation and incentive mechanisms,and create pathways for collective action among stakeholders.These strategies aim to reduce IDS transaction costs and facilitate the resilient and sustainable operation the system.

关 键 词：整合型医疗卫生服务体系 交易费用 解构 测度模型 应对策略 

分 类 号：R19[医药卫生—卫生事业管理]