基于反脆弱发展理念的基层医疗卫生服务供给侧改革及干预策略研究

“全民健康覆盖”目标实现离不开充满动力、活力、韧力的基层医疗卫生服务体系。然而，受制于政策、制度、资源、竞争环境等复杂社会网络的影响，特别是大医院对基层医疗卫生机构虹吸效应的强化，加剧了基层的多重脆弱性，亟待探索有效的破解之道。.本项目以社会生态理论为基础，构建基层医疗卫生服务体系脆弱性分析与评价理论框架；系统梳理基层医疗卫生服务“供给-需求”的多重错位问题，从复杂生态系统结构功能耦合困境解析视角，探讨阻碍基层医疗卫生服务供给目标的相关制约因素并开展多维脆弱性评价；基于“脆弱-强韧-反脆弱”三元结构理论，解析我国在“强基层”进程中面临诸多困境的系统成因。在反脆弱理念指引和实践分析的基础上，通过对多元改革要素组合及可替代方案的分析比较，提出切实可行的“强基层”优先实施策略，并对基层医疗卫生服务供给侧改革试点效果进行系统评价，产出的创新改革实践理论为我国制定深化医改政策提供精准佐证。

The goal of "Universal Health Coverage" cannot be achieved without a grassroots health care service system full of motivation, vitality and resilience. However, subject to the influence of complex social networks such as policies, institutions, resources and competitive environment. and in particular, due to the the siphon effect of tertiary hospitals on grassroots health care institutions, which has exacerbated their vulnerabilities in multiple aspects, it is urgent to explore effective solutions.. The project establishes a framework of vulnerability analysis and evaluation of the grassroots health care service system based on the social ecological theory. Systematically sort out the multiple misalignment problems of the "supply-demand" of primary health care services, and analyze the related constraints that hinder the supply target of services and carry out multidimensional vulnerability assessment from the perspective of the complex ecosystem structure and function coupling dilemma. Analyze the systematic causes of many difficulties that our country faces in the process of "strengthening grassroots" based on the three-dimentional structure theory of "fragile-strong-antifragile". Analyze and compare the combination of various reform elements and alternatives, propose a practical priority-based "strengthening grassroots" implementation strategy on the basis of antifragility theoretical guidance and practical analysis, and systematically evaluate the effects of pilot supply-side reforms of primary health care services. The output of innovative reform theory will provide accurate evidence for China's formulation of policies to deepen health care reform.