基层医疗卫生服务绩效的影响因素组态与路径研究  

Study on the Configuration and Action Paths of Factors Affecting the Performance of Primary Healthcare Service

作　　者：申贤磊 何荣鑫 梁万年 SHEN Xianlei;HE Rongxin;LIANG Wannian(Vanke School of Public Health,Tsinghua University,Beijing 100084,China;Institute for Health China,Tsinghua University,Beijing 100084,China)

机构地区：[1]清华大学万科公共卫生与健康学院,北京市100084 [2]清华大学健康中国研究院,北京市100084

出　　处：《中国全科医学》2025年第16期1973-1979,共7页Chinese General Practice

基　　金：清华大学万科公共卫生与健康学院科研项目(2022BH005)。

摘　　要：背景当前发展不平衡、不充分的基层医疗卫生服务难以满足新时期人民群众日益增长的卫生健康服务需求。明晰基层医疗卫生服务绩效的影响因素与作用路径,一直是学术界共同关注的热点问题。目的明确影响我国基层医疗卫生服务绩效的多重因素组合与发展路径,为进一步提升基层医疗卫生服务提供决策依据。方法于2022年11月—2023年8月开展研究,数据来源于《2021中国卫生健康统计年鉴》《2021中国统计年鉴》等。以31个省(自治区、直辖市)基层医疗卫生服务绩效为结果变量,以大数据应用、医疗技术、政府关注、体系整合、医疗资源、健康需求6个变量为条件变量,开展模糊集定性比较分析(fsQCA)研究。结果高水平基层医疗卫生服务绩效是多种因素共同作用的结果,组态分析结果显示,共有4种组态提升基层医疗卫生服务绩效,可归纳为“技术-环境型”“组织-环境型”“技术-组织-环境型”3种模式。组态1:大数据应用*~医疗技术*~政府关注*~体系整合*医疗资源。组态2:~大数据应用*~医疗技术*体系整合*医疗资源*~健康需求。组态3:大数据应用*医疗技术*体系整合*医疗资源*健康需求。组态4:大数据应用*~政府关注*体系整合*医疗资源*健康需求。(*表示“且”,~表示“非”)。4种组态解的一致性为0.926,解的覆盖度为0.612,原始覆盖度为0.314~0.396,唯一覆盖度为0.017~0.083。我国东、中、西部地区提升基层医疗卫生服务绩效的组态有所不同。结论加大对基层的医疗资源投入,目前仍是提高我国基层医疗卫生服务绩效的普适措施,但也要注意技术条件、组织条件、环境条件各种因素的有效结合。东、中、西部地区间的驱动路径存在着明显差异,各地区应结合自身发展禀赋及条件因素,选择不同的驱动路径,合理配置有限的医疗资源,有针对性地改善条件,提升医疗卫生服�Background At present,the unbalanced and inadequate development of primary healthcare services does not meet people's growing demand for them in the new era.Identifying the influencing factors and their action paths on the performance of primary healthcare services has always been an issue of common concern in the academic circles.Objective To clarify the combination of multiple factors and their action paths that affect the performance of primary healthcare services in China,and to provide decision-making basis for further improvement of primary healthcare services.Methods The study was conducted from November 2022 to August 2023,and the data were obtained from the 2021 China Health Statistics Yearbook and the 2021 China Statistical Yearbook.A fuzzy set qualitative comparative analysis(fsQCA)was conducted with the performance of primary healthcare services in 31 provinces(autonomous regions and municipalities)as the outcome variables,and application of big data,medical technology,government attention,system integration,medical resources and health demand as the conditional variables.Results The quality of performance of primary healthcare services is the result of a combination of various factors.The results of configuration analysis show that there are 4 configurations to improve the performance of primary healthcare services,which can be classified into 3 patterns:"technology-environment""organization-environment"and"technology-organization-environment".Configuration 1:Application of Big Data*-Medical Technology*-Government Attention*-System Integration*Medical Resources.Configuration 2:-Application of Big Data*-Medical Technology*System Integration*Medical Resources*-Health Demand.Configuration 3:Application of Big Data*Medical Technology*System Integration*Medical Resources*Health Demand.Configuration 4:Application of Big data*-Government Attention*System Integration*Medical Resources*Health Demand.(*means"and",-means"non").The consistency of the four configuration solutions was 0.926,the coverage of the sol

关 键 词：基层医疗卫生服务 服务绩效 定性比较分析 整合型医疗卫生服务体系 

分 类 号：R197.1[医药卫生—卫生事业管理]