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协同治理视角下紧密型县域医共体医防融合创新机制研究——以德阳市罗江区为例

Innovative Mechanisms of Medical Care and Prevention Integration in Compact County-Level Medical Alliances From the Perspective of Collaborative Governance—A Case Study of Luojiang District, Deyang City, China

  • 摘要:
    目的 以四川省德阳市罗江区县域医共体为例,分析县域医共体医防融合创新机制及实施路径,以期为医防融合建设提供理论和经验支持。
    方法 以协同治理理论的SFIC模型为主要分析框架,从起始条件、催化领导、制度设计及协同过程四个维度,系统解析罗江区县域医共体医防融合的创新实践及机制,并评价其运行成效。
    结果 罗江区县域医共体通过顶层设计、制度重构、数智技术赋能信息平台和激励多元主体参与协同过程,实现医防融合成效提升。罗江区2024年两慢病(高血压、糖尿病)重症率和四类慢性病(心脑血管疾病、癌症、慢性呼吸系统疾病和糖尿病)过早死亡率分别较2023年下降4.4%和5.53%;2024年全区医保基金支出较2023年下降9.13%。
    结论 基于SFIC模型的分析,未来医防融合应从个人、社区、机构、体系四个层面进行协同创新,深化“以人民健康为中心”的服务模式转型。

     

    Abstract:
    Objective Taking the county-level medical alliance in Luojiang District, Deyang City, Sichuan Province as an example, we analyzed the innovative mechanisms and implementation pathways of medical care and prevention integration of the county-level medical alliance, aiming to provide theoretical and empirical support for promoting the integration of treatment and prevention.
    Methods Using the SFIC model of the collaborative governance theory as the main analytical framework, we systematically analyzed the innovative practices and mechanisms of medical and preventive integration within the county-level medical alliance in Luojiang District from 4 dimensions, including starting conditions (S), facilitative leadership (F), institutional design (I), and collaborative process (C), and evaluated their operational effectiveness.
    Results The county-level medical alliance of Luojiang District has achieved enhanced effectiveness in medical care and prevention integration through top-level design, institutional restructuring, the empowerment of information platforms with digital intelligence technology, and the incentivization of multiple stakeholders to participate in the collaborative process. In 2024, the severe case rates of 2 chronic diseases (hypertension and diabetes mellitus) and the premature mortality rates of 4 chronic diseases (cardiovascular and cerebrovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus) in Luojiang District decreased by 4.4% and 5.53%, respectively, compared to those in 2023. The total medical insurance fund expenditure in the district in 2024 decreased by 9.13% compared to that in 2023.
    Conclusion According to the analysis based on the SFIC model, future efforts in medical care and prevention integration should focus on collaborative innovation at four levels—individual, community, institutional, and system—to further advance the transition toward a service model centered on population health.

     

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