研究目的：长期以来，党和国家高度重视基层卫生健康工作，强调医疗联合体建设，致力于推动分级诊疗，优化就医秩序。自2017年国务院办公厅印发《关于推进医疗联合体建设和发展的指导意见》以来，我国的县域医共体建设已经度过五个年头。根据公共政策周期理论，一项合理有效的公共政策，需要在一定周期内的实践和评估中不断完善进步。因此，总结典型地区紧密型县域医共体建设经验，探讨其建设路径与建设效果，能够在实践与理论层面助力医共体的进一步发展，增强县域医疗卫生服务供给，最终实现人民健康水平的提升与政策的优化。研究方法：以福建沙县、山西阳曲县、云南云县为案例，比较分析典型紧密型县域医共体建设路径与模式，同时应用数据包络分析法，从静态和动态两个角度出发，定量分析医共体建设后的县域医疗卫生服务成效。研究结果：（1）对比我国东中西部三个典型紧密型县域医共体建设案例，综合考虑责任共同体、管理共同体、服务共同体、利益共同体四大维度，发现福建三明沙县的综合得分相较其他两个地区更高；（2）由三明各县的紧密型县域医共体建设静态效率分析可知，从2017年到2022年，三明区划内整体县域医疗卫生服务综合效率得到了提升，在技术效率、规模效率方面的提升显著；（3）而由三明各县的紧密型县域医共体建设动态效率分析可知，经过五年的建设探索，投入的床位、人力、设备资源在一定程度上均有效转化为县域内住院人次和就诊人次的提升，体现了整体医疗卫生服务效率水平的进步。讨论与建议：福建三明的紧密型县域医共体建设模式在实践中成效显著，能够较好地提升县域医疗卫生服务效率，值得各地推广学习。未来各地应当因地制宜，立足政府责任，强化配套措施。要做好牵头医院建设，提升医疗质量。同时，应当重视基层医疗机构的转型，重视健康管理。此外，在具体举措层面，建议首先关注法人问题，强调紧密型联系；建议重视人才发展，建立有效的薪酬激励机制；建议发挥医保“指挥棒”功能，不断激励发展；建议加强信息化建设，引导优质医疗资源下沉；建议关注医防融合，强调以健康为中心；建议重视中医中药发展，传承本土医学文化。
Objectives: For a long time, the Party and the state have attached great importance to primary health care, hierarchical medical treatment, and orderly medical service. Since the General Office of the State Council issued the Guiding Opinions on Promoting the Construction and Development of Medical Treatment Combination in 2017, the policy of county medical and health communities in China has been in place for 5 years. According to the public policy cycle theory, a reasonable public policy needs to be evaluated over a period of 3-5 years to facilitate their continuous improvement. Therefore, summarizing the experience of typical areas and discussing their construction paths and effects can help the further development of the county medical community, improve the level of medical and health services in the county, and ultimately realize the improvement of people‘s health level and policy optimization. Methods: Taking Sha County in Fujian, Yunxian in Yunnan, and Yangqu County in Shanxi as cases, to compare and analyze the construction path and mode of typical compact county medical community. At the same time, combined with dynamic analysis and static analysis, quantitatively analyze the effectiveness of county medical and health services after the policy of medical community.Result: (1) Comparing the cases of three typical compact medical communities in the eastern, central and western parts of China, and comprehensively considering the four dimensions of responsibility community, management community, service community and interest community, it is found that the comprehensive score of sha County in Fujian is higher than that of the other two regions. (2) From the static efficiency analysis of the compact county medical community in Sanming counties, it can be seen that from 2017 to 2022, the overall efficiency of county medical and health services has been improved, and the technical efficiency and scale efficiency also have been significantly improved. (3) From the dynamic efficiency analysis of the compact county medical community in Sanming counties, it can be seen that after five years of exploration, the number of beds, manpower and equipment resources invested have been effectively converted into the increase of hospital visits and outpatient and emergency visits, reflecting the progress of the overall medical and health service efficiency.Discussion: Fujian Sanming‘s compact county medical community model has achieved remarkable results in practice, which can better improve the county medical and health service, and is worth promoting and learning from other places. In the future, other regions should emphasize government responsibilities and improve supporting measures in accordance with local conditions. It is necessary to focus on the leading hospitals and improve the quality of medical care. At the same time, attention should be paid to the transformation of primary medical institutions and health management. In addition, at the level of specific initiatives, it is recommended that attention be paid first to the issue of legal persons, emphasizing close contact; Attach importance to talent development and establish an effective salary incentive system; Give full play to the role of medical insurance "baton" to help hierarchic diagnosis and stimulate development; Strengthen the construction of informatization and guide the sinking of high-quality medical resources; Pay attention to the medical and prevention integration, emphasizing health-centered; Promote the development of Chinese medicine and inherit local medical culture.
