Abstract：
Medical service fragmentation is a common problem worldwide, and many countries have adopted integration to solve the difficulty. Contrary to developed countries, developing countries such as China must consider how to implement integration under a relatively weak medical foundation. This study aims to evaluate the effect of the \"Compact Union of County and Township Health Sectors\" policy on the medical service capacity of a typical integration model represented by Shanxi Province in China and determine the path the policy followed. By using Shanxi\'s county-level medical integration as a quasi-natural experiment, this study establishes a difference-in-differences model to investigate the effect of the policy using official data. A series of tests are conducted to verify the robustness of the result. Finally, the policy pathway is tested. The results show that the third-level surgeries and outpatient service utilization of leading hospitals and township institutions increased. Still, inpatient service utilization and fourth-level surgeries did not show a significant change in either type of institution. Moreover, the enhancement of leading hospitals\' service capacity comes mainly through improving asset efficiency and personal income, while the improvement of township institutions\' capacity comes primarily through increased personal income. Compact integration of county-level medical institutions can stimulate and improve service capacity by improving asset efficiency and personal income, even with a weak medical foundation. However, to achieve continuous service capacity improvement, the professional level of county-level institutions must be strengthened with a superior hospital\'s assistance, and personnel\'s enthusiasm for active innovation must be cultivated.
摘要：
医疗服务碎片化是世界范围内普遍存在的问题,许多国家已经采取一体化来解决这一困难。与发达国家相反，中国等发展中国家必须考虑如何在相对薄弱的医疗基础下实施一体化。本研究旨在评估“县乡卫生部门契约联盟”政策对中国以山西省为代表的典型整合模式的医疗服务能力的影响，并确定政策遵循的路径。通过将山西县级医疗整合作为准自然实验，这项研究建立了一个差异模型，以使用官方数据调查该政策的效果。进行了一系列测试以验证结果的鲁棒性。最后,政策路径受到考验。结果表明，主要医院和乡镇机构的三级手术和门诊服务利用率增加。尽管如此，两种类型的机构均未出现住院服务利用率和四级手术的显著变化.此外，主要通过提高资产效率和个人收入来提高领先医院的服务能力，而乡镇机构能力的提高主要来自个人收入的增加。县级医疗机构的紧密整合可以通过提高资产效率和个人收入来刺激和提高服务能力,即使医疗基础薄弱。然而,为了实现服务能力的持续提高，县级机构的专业水平必须在上级医院的协助下得到加强，必须培养员工积极创新的热情。
