我国三医联动水平量化评价及驱动路径探究  

Quantitative evaluation and driving path exploration on the level of the tripartite system reform in China

作　　者：郭凌云 傅柳婕 管泳怡 周亮茹 郑秋莹[1] 李瑞锋[1] GUO Ling-yun;FU Liu-jie;GUAN Yong-yi;ZHOU Liang-ru;ZHENG Qiu-ying;LI Rui-feng(School of Management,Beijing University of Chinese Medicine,Beijing 102401,China)

机构地区：[1]北京中医药大学管理学院,北京102401

出　　处：《中国卫生政策研究》2025年第3期9-17,共9页Chinese Journal of Health Policy

基　　金：国家中医药管理局公立中医医院运行机制研究项目(BUCM-2024-KJ-GL-014)。

摘　　要：目的:定量评价2009—2022年我国三医联动水平,探讨我国三医联动的影响因素及驱动路径,为促进三医联动发展提供新视角。方法:测算我国31个省份(不含港澳台地区)的三医系统及其内部不同二元系统间的耦合协调度,并利用模糊集定性比较分析法探究多要素驱动三医联动的条件组态。结果:各省份三医系统间的耦合协调度总体呈现逐年递增的趋势;二元系统中,医疗和医保系统间的整体协调发展状况最好且区域发展最为均衡;三医和内部二元系统间的耦合协调度省份差距均逐渐扩大,多极化趋势加剧;促进高水平三医联动的路径可归纳为内外均衡发展型(H1)、政府主导型(H2、H3)两类,其中人均GDP和卫生健康支出作为核心条件的H1路径分布最普遍。结论:建议强化体制和技术创新,利用跨部门协同机制与数字化技术整合资源;结合地区禀赋选择适配的高水平优化路径,缩小区域发展差距;同时在政策的高位推动下不断完善保障和监督制度,促进三医联动的协同治理。Objective:To quantitatively evaluate the level of the three medical linkage in China from 2009 to 2022,explore the influencing factors and driving paths of the three medical linkage in China,and provide a new perspective for promoting the development of the three medical linkage.Methods:An optimized coupling coordination degree model was used to calculate the coupling coordination degree between the trinity healthcare systems and different binary systems within the systems in 31 provinces of China(excluding Hong Kong,Macao and Taiwan),and the Fuzzy-set Qualitative Comparative Analysis method was used to explore the condition configurations of multi-factor-driven three medical linkage.Results:From 2009 to 2022,the coupling coordination degree between the trinity healthcare systems in each province of China generally showed an increasing trend year by year.Among the binary systems,the overall coordinated development situation between the medical and medical insurance systems was the best and the regional development was the most balanced.The coupling coordination degree gap between the trinity healthcare system and the internal binary systems among provinces gradually widened,and the multi-polarization trend intensified.The paths to promote high-level three medical linkage can be summarized into two types:internal and external balanced development type(H1)and government-led type(H2,H3),among which the H1 path with per capita GDP and health expenditure as core conditions was the most common.Conclusion:It is suggested to enhance institutional and technological innovation,and integrate resources through a cross-departmental collaboration mechanism and digital technology.Provinces should select high-level optimization paths by leveraging regional endowments to narrow the regional development gap.Meanwhile,under the impetus of high-level policies,the protection and supervision system continues to improve,thereby promoting the three medical linkage.

关 键 词：三医联动 耦合协调发展 模糊集定性比较分析(fsQCA) 

分 类 号：R197[医药卫生—卫生事业管理]