基于生态理论视角下区域医疗联合体生态系统健康评价建模与实证研究

The medical care system and health services are fragmented, which has become a serious impediment to improve the whole performance of health-system in our country, integration of existing health care system has become a strategic choice to bridge the fragmented. The emergence of a variety of regional medical association in the country, there is a tendency to be widely implemented under the new health care reform. However, there has been much controversy in its stability and sustainability (i.e. healthy development issues), more than that it is more a lack of theoretical guidance and evaluation system. The project has been inspired by the research paradigm of social bionics, in the case of ecological theory is introduced and evolved into the enterprise ecosystem. The project draws on the theory and mechanism of ecological and proposes the two concepts of "regional medical association ecosystem and regional medical association ecosystem health", the subjects and environmental system among regional medical association and their mechanism of interaction is regarded as object of study. This research aims to build content, features, functions, elements, and so the theoretical system of regional medical association ecosystem, to analysis consensus environment, diagnose problems and identify instability factors of restricting the healthy operation among regional medical association, to build a comprehensive evaluation model of regional medical association ecosystem health, which contains six dimensional, such as "organizational structure, resilience, operation mechanism, vitality, and service functions and external environment" , and to undertake empirical research. The project will make some eco-management strategies and policy recommendations, to shape our regional medical association ecosystem and promote the healthy development of regional medical association ecosystem. Finally the research will provide the scientific basis for quantitative decision of regional medical association.

割裂的医疗服务体系和碎片化服务已严重阻碍我国卫生系统整体绩效，整合现有的医疗服务体系成为弥合割裂的战略选择，全国各地涌现出多种多样的医联体，新医改背景下大有广泛推行的趋势，但对医联体系统稳定性和可持续性（即长期健康发展问题）存在争议，更缺乏理论指导和评价体系。项目受生态理论被引入并演化成企业生态系统理论这一社会仿生学研究范式启发，借鉴了生态理论及机理，提出“医联体生态系统及其健康”两个概念，将医联体内的主体与环境系统之间的相互作用及其机理作为研究对象，旨在构建医联体生态系统的内涵、特征、功能要素等理论体系，对医联体进行系统问题诊断、分析共生环境与识别制约其健康运行的失稳因素，最终构建“组织结构、恢复力、运作机制、活力、外部环境和服务功能”六维的医联体生态系统健康综合评价模型并进行实证研究，提出医联体生态系统塑造策略及其健康发展的生态化管理的政策建议，为医联体的量化决策提供科学依据与参考。

我国卫生服务体系的割裂断层化与服务碎片化已严重制约当前卫生体制改革进程，构建整合型卫生服务体系成为弥合裂痕的战略选择。在此背景下，全国涌现出多种形式的医联体模式。然而，学术与实务界对医联体缺乏理论共识，更存在诸多争议。在生态系统理论被广泛衍化至企业、产业和组织生态系统的社会仿生研究范式启示下，本研究借鉴生态理论及机理，以此解构医联体实践，试图探究它的本质属性及内在规律。.研究首次提出并界定了医联体生态系统的概念、特征、功能要素等，诊断并识别了系统外部环境及失稳因素。基于解释结构模型构建了医联体发展困境的多级递阶结构，提出了医联体联盟稳定性评价指标体系框架，构建了以“组织结构、运作机制、稳定性、活力、外部环境和服务效能”六维医联体生态系统健康运行评价框架，并在全国范围内选择69个医联体进行实证评价。结果发现，当前，我国医联体生态系统普遍存在组织的网络结构相对松散，自身抵抗力存在脆弱性风险，自身弹性和恢复力不佳，组织活力尚未全面释放，外部环境支持不足，使得服务效能未能充分显现等六大核心问题。最后，基于上述理论构建和实证研究，本研究提出了医联体生态系统健康发展的生态化治理策略及政策建议。.本研究以医联体生态系统的理论构建、评价指标体系开发、实证评价为核心内容，并从生态化视角对医联体予以解析，旨在增进各方对医联体实践发展的准确把握与深刻理解，进一步推动我国整合型卫生服务体系的构筑进程。.本项目共正式发表12篇学术论文，并有4篇文章正在组织投稿。.本项目部分成果在国内相关学术研讨会发言并传播相关研究成果。.本项目将医联体作为整合型卫生服务体系一个特例进行生态视角下的审视和解读，提出了开创性政策建议，具有一定理论创新和学术价值。同时，医联体的联盟稳定性、活力、服务效能等全新概念均为首次被提出，这些对实践的创新性刻画有助于实践管理者从新的视角审视医联体建设和发展，具有一定的社会影响和应用价值。