中文摘要：

目的 系统分析新医改形势下乡镇卫生院的行为模式,为完善乡镇卫生院服务职能提供建议.方法 利用委托-代理理论,对新医改形势下乡镇卫生院的经营策略与职能分化进行理论研究,并利用定量和定性资料分析验证理论模式.结果 县政府与乡镇卫生院之间存在以权威体制为基础的多任务委托-代理关系.根据参与约束原则和等报酬原则,乡镇卫生院基于自身利益最大化,会采取“退守”策略进而导致职能的分化,形成4种行为模式,即“以医疗为中心兼顾公共卫生”型、“以医疗为中心公共卫生准退出”型、“以公共卫生为中心医疗退出”型、双向“维持”型.调查的20所乡镇卫生院定量与定性资料分析结果验证了上述理论假设.结论 新医改背景下,乡镇卫生院出现职能“分化”趋势,这与新医改对“强基层”的政策导向不相契合,将形成新的健康不公平.建议加强乡镇卫生院医疗服务能力建设,建立卫生院之间分工协同发展机制;根据经济发展水平调整公共卫生服务的财政配套责任分担比例;加大政策宣传,引入水平监督,激励居民参与.

英文摘要：

Objective Analyze systematicaly the behavioral patterns of township health centers in the ongoing health reform and recommend on improving the role of such centers.Methods Principal-agent theory was called into play,to theoretically study the business strategy and functional differentiation of these centers during the reform.Then make quantitative and qualitative analysis to validate the theoretical models so found.Results Principal-agent relationship is found to exist between the county government and such centers,which is based on the authoritarian political system.According to the participation constraint principle and compensation principle,these centers are supposed to take the defensive retreat strategy to maximize their interests,which results in differentiation of their functions.Four behavioral patterns come into being as follows：Centering on medical service with an eye on public health; Centering on medical service with para-retreat from public health; Centering on public health with retreat from medical service,and maintenance of both.The above theoretical hypothesis was validated in a quantitative and qualitative study on 20 centers.Conclusion These centers tend to have differentiated functions in the health reform,which goes against the policy of ＂reinforcing primary care＂ and will lead to new health inequity.The authors recommend that these centers to enhance the capacity building of medical services and build a job responsibility and synergy development mechanism among themselves; to align the supportive fiscal responsibility for public health service with local economic development; to step up policy promotion,introduce a supervisory mechanism,and attract residents＇ participation.