TOE框架下医疗、医保、医药协同发展和治理的组合路径研究:基于32省市的模糊集定性比较分析OA

Objective To identify the multi-dimensional driving configurations for the coordinated governance of medical care,medical insurance and pharmaceuticals(three-medical coordination),extract differentiated development paths,and pro-vide empirical evidence for local governments to formulate targeted governance policies matching regional resource endowments.Methods Based on the TOE analytical framework,fsQCA was adopted to explore the multiple concurrent factors and complex causal mechanisms of the coordinated development and governance of medical care,medical insurance,and pharmaceuticals.Results Necessary condition test verifies digital technology serves as a necessary condition for high-level three-medical coordination,while organizational governance capacity and institutional environment satisfy the criteria of sufficient conditions.Five original con-ditional configurations are simplified and consolidated into four coordination modes,namely survival-adaptive type,demand-driven type,dual-driving type and resource-advantage agglomeration type.Digital technology exists indispensably across all paths,and organizational governance capacity can be substituted by other contextual factors.Conclusion Three-medical coordina-tion results from the combined effects of technological,organizational and environmental factors.The four categorized paths fit re-gions with disparate resource endowments,thereby requiring differentiated governance strategies tailored to local realities.Since organizational governance has not yet evolved into a core driving factor at the current stage,prioritized construction of digital infra-structure and institutional systems can effectively improve the overall efficiency of three-medical coordination.