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| 文章编号：1672-3104(2025)03-0169-16 |
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聚合与耦合：乡村健康韧性治理的双重逻辑——基于乡镇卫生院的双案例扎根分析 |
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许源源1, 2，杨凯伊1 |
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（1. 中南大学公共管理学院，湖南长沙，410075；
2. 中南大学乡村振兴研究中心，湖南长沙，410075） |
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| 摘 要： 采用双案例扎根分析提炼出影响不同整合模式下乡镇卫生院发展的五大共性因素：环境基础、制度保障、资源禀赋、动态能力和服务质量，并从制度、资源、组织、社会维度概括出乡村健康韧性治理的四大运行机制：基于权力让渡和领导注意力的利益协调保障机制、基于政策企业家和魅力型领导的资源整合动员机制、基于价值共识的动态能力提升机制，以及基于信任资本的服务声誉重构机制。由此提炼出乡村健康韧性治理的双重逻辑——自上而下的聚合逻辑和自下而上的耦合逻辑，创新性地提出应将兼具结构韧性和演化韧性双重维度的“韧性程度”而非单一维度的“整合程度”作为评判乡村健康治理成效的标准，拓展和丰富了乡村健康治理的理论空间和实践内涵。 |
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| 关键词： 乡镇卫生院；乡村健康治理；扎根理论；韧性 |
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Aggregation and coupling: The dual logics of rural health resilience governance—A grounded analysis of dual-case based on rural health centers |
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XU Yuanyuan1, 2, YANG Kaiyi1 |
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（1. School of Public Administration, Central South University, Changsha 410075, China;
2. Research Centre for Rural Revitalization, Central South University, Changsha 410075, China） |
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| Abstract: By employing a dual-case grounded analysis, the paper extracts five common factors which influence the development of rural health centers under different integration models, namely, environmental foundation, institutional guarantees, resource endowment, dynamic capabilities, and service quality. Besides, the paper also identifies four key operational mechanisms of resilient governance in rural health from institutional, resource, organizational, and social perspectives, which are interest coordination and guarantee mechanism based on power delegation and leadership attention, resource integration and mobilization mechanism driven by policy entrepreneurs and charismatic leadership, dynamic capability enhancement mechanism rooted in value consensus, and service reputation reconstruction mechanism built on trust capital. Consequently, this study extracts the dual logic of rural health resilience governance (a top-down aggregation logic and a bottom-up coupling logic), and innovatively proposes that the effectiveness of rural health governance should be evaluated based on the degree of resilience, which encompasses both structural and evolutionary resilience, rather than a single-dimensional degree of integration. This approach expands and enriches both the theoretical framework and practical implications of rural health governance. |
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Key words: township health clinics; rural health governance; grounded theory; resilience |
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