医患关系的内卷、科层化及其限制OACHSSCD

With the embedded market and bureaucratic logics,the doctor-patient relationship in Southwest ethnic re-gions is undergoing transformation.This study reveals that market competition in medical services and the dysfunctional operation of the hierarchical diagnosis and treatment system have led to an imbalance between medical supply and de-mand.In response to institutional failure,hospitals adopt"involution"as a coping mechanism,resulting in numerous expe-dient organizational behaviors.They were driven to expand for efficiency enhancement,which consequently fosters a para-doxical dynamic of both scrambling for and shunting patients.Healthcare providers are forced to balance service quantity and quality,whereas patients,driven by a consumerist consciousness,raise higher demands for service quality and thera-peutic outcomes.This creates a structural contradiction between medical services provided and patient needs.Meanwhile,bureaucratic logic fragments the integrity of diagnosis and treatment,prompting various departments to prioritize local op-tima over global optima,thereby undermining trust in the doctor-patient relationship.In severe cases,these bureaucratic departments even struggle to coordinate clinical workflows in an organized manner,subsequently generating systemic risks.To improve the doctor-patient relationship in such regions,corresponding adjustments must be made,starting with curbing the extent of market-driven"involution"and strengthening the linkages among the micro-levels of the bureaucrat-ic structure.