中文摘要：

目的 构建我国区域医疗联合体发展困境的多级递阶结构模型,阐释各阶层间的内在逻辑,旨在为推进我国整合型服务体系的建设提供策略性建议。方法 采用文献法,总结并归纳当前我国医联体发展进程中的制约因素。采用解释结构模型方法,辅助卫生政策与管理专家判别与核检,揭示各因素间的层级关系及传导环路。结果 我国医联体发展进程的19类制约因素存在一个“四阶梯结构”与“一条传导环路”。外显因素为“医生积极性不足”及“患者参与度低”,内核要素是“政策—立法宏观调控”,并通过“顶层没规则—内部缺机制—运行无规范—个体欠协同”逐级递阶,共同阻滞着我国医联体健康发展。结论 推进与完善医联体顶层设计并辅以配套机制,驱动医联体稳定、可持续运行,激活参与主体间协同及联动,推进我国医联体全面健康发展。

英文摘要：

Objective To build a multi-level hierarchical structure model of obstacles for Regional Integrated Care Alliance（RICA）,and to identify the role relationship among all obstacles and transmission pathways.Additionally,some coping strategies will be provided for development of Chinese integrated care.Methods Using the literature research,limited factors of regional care alliance in China were summarized.Ultimately,the hierarchy relationship among various obstructive factors and effect loops were found by using Interpretative Structural Modeling.Results Direct obstacles of RICA are ＂insufficient motivation of doctor＂ and ＂low participation of patient ＂,and an internal core driver is ＂ macro policy-law regulation ＂.They potentially have an influence on the implementation of RICA mainly through a pathway of the ＂ top-level design-internal mechanisms-operation specification-individual collaboration＂.Conclusion The top-level policy and supporting mechanism of RICA must be considered in future for driving the stable and sustainable operation,and achieving collaboration and linkage among participations,so as to promote the comprehensive and healthy development of RICA.