不完全契约理论框架下医疗服务体系纵向整合效应的理论和实证研究

连续性医疗服务需求的增加、国内外医疗服务体系整合的趋势以及政府政策的导向均显现出医疗服务体系纵向整合成为卫生服务体系改革方向的可能性。但是，对于医疗服务体系纵向整合效应的理论和实证研究相对缺乏。本研究将更符合中国医疗服务体系纵向整合实际的不完全契约理论引入医疗服务体系纵向整合效应研究。在“整合治理-管理行为-整合目标实现”的逻辑框架下开展四个方面的研究。第一，通过规范研究在不完全契约理论框架下，结合医疗服务体系的特殊性，构建医疗服务体系纵向整合的效应分析模型。第二，借助Z-tree平台设计并开展经济实验研究，检验医疗服务体系纵向整合对管理者行为影响的规律。第三，通过从患者和社区居民两个层面开展的观察性实证研究，检验医疗服务体系纵向整合对区域居民医疗服务连续性的影响，使用倾向值匹配方法解决选择性偏倚。最后，探讨影响医疗服务体系纵向整合的治理因素，为完善区域医疗服务体系提供政策建议。

The improving demand of continuous medical services, the trend of integrating, and the policy guide are showing the possibility of vertically integration of delivery system to be one reform direction. However, the theoretical and empirical research is deficient in China. Incomplete contract theory is introduced into this study. Under the framework “integration governance - management behavior- integration objectives achieved”, we carry out four contents. First, we use normative research to build an impact model combing with the special nature of medical delivery. Second, we design and conduct an experimental research with the Z-tree platform to test the managers’ behavior patterns by the influence of vertical integration. Third, we use empirical observational studies from patients and community residents respectively to test the impact of vertical integration on continuous medical delivery, using propensity matching method to solve the selection bias. Finally, we explore the factors influencing the effects to provide policy recommendations on the governance of integrated medical delivery.