基层卫生推进乡村卫生组织一体化的障碍——基于行动者中心的制度主义分析

推进乡村卫生一体化管理是深化医药卫生体制改革中的一项重要举措。然而，全国各地在实施过程中障碍重重，进程并不顺利。对此，本文以乡村卫生组织一体化模式为例，运用行动者中心的制度主义这一理论工具，结合广东省13县（市）关键行动者的现场访谈，从政策制定者、实施者与政策目标对象的互动出发，分析相关行动者的特征、行动者格局和相互间的互动模式，剖析推进的障碍因素，揭示一体化政策实施过程的复杂性。最后，提出从政策资源、财政资金资源和组织资源投入的角度，建立乡村卫生组织一体化推进策略。

Barriers of promoting rural health care organizational integration: Analysis based on actor-centered institutionalism

Facilitating the integration between township and village level health services is one of the important strategies in health system reform in China. However, the implementation of the policy is not as smooth as expected. Based on the information derived from interviews with key actors from 13 counties and cities, this study employed the theory of actor centered institutionalism to analyze the interaction between policy makers, policy implementers and policy targets in relation to the organizational integration. The study also identified the barriers of promoting rural health care organizational integration, which revealed the complexity of this issue. Finally, to facilitate the integration, we suggest that the government should focus on inputting more policy resources, financial resources and organizational resources.