摘要目的:基于福建省县域紧密型医共体"八统一"制度执行现状，对执行过程中的关键问题进行分析，为完善"八统一"制度提供借鉴。方法:2019年10—12月，选取福建省16个县区的紧密型医共体开展调研，通过访谈、问卷、现场考察等方法收集调研地区相关资料。在此基础上，运用米特-霍恩模型对"八统一"制度的执行现状进行系统分析和评价。采用完成率描述"八统一"制度的执行情况。结果:调研地区16家医共体"八统一"制度建设的完成率为60.15%，山区县为65.90%，沿海地区为47.50%。在八项制度中，机构名称(16家，100.00%)、医疗质量(13家，81.25%)、宣传(12家，75.00%)、人员调配(11家，68.75%)和财务管理(10家，62.50%)的完成率较高，而药品供应(7家，43.75%)、劳务绩效(6家，37.50%)和信息化建设(3家，18.75%)的完成情况较差。部分调研地区能出台本土化的具体实施办法逐步推动"八统一"制度执行。政策目标模糊、政策资源不足、执行手段单一、执行主体价值取向的偏颇以及复杂的社会经济环境等因素影响"八统一"制度的有效执行。结论:福建省紧密型医共体"八统一"制度在执行过程中尚未取得预期效果，应通过明确政策目标、拓宽政策资源、丰富执行手段、加强经验交流和优化政策环境等保障制度的有序推进和长效实施。

abstractsObjective:To analyze key issues in the implementation process of the " Eight-integrations system" for close-type countywide medical alliances in Fujian province, and provide references for improving such a mechanism.Methods:Sixteen counties in the province were selected from October to December 2019 and materials were collected by means of interview, questionnaires and field survey. On such basis, the Meter-horn model was used to systematically analyze and evaluate the implementation status, and completion rate was used to describe the implementation of the " Eight-integration system" .Results:The average completion rate of the regions surveyed was 60.15%, of which the mountainous counties being 65.90%, and coastal counties being 47.50%. Of the eight regulations to be integrated, the aspects of better completion include institutions′ names(16 institutions, 100.00%), quality of care(13 institutions, 81.25%), promotions(12 institutions, 75.00%)、staff deployment(11 institutions, 68.75%) and financial management(10 institutions, 62.50%). Those of poor completion rates were drug supply(7 institutions, 43.75%), labor performance(6 institutions, 37.50%)and informationization development(3 institutions, 18.75%). Some of the counties staged localized measures to promote the " Eight-integration system" . Such factors as vague policy objectives, inadequate policy resources, lack of means, biased value orientations of the implementation entities, and complex socio-economic environments influence negatively effective implementation of the system.Conclusions:This system has not yet achieved the expected effects in the implementation process. We should improve the system implementation and its sustained operation by such means as clarifying policy objectives, broadening policy resources, enriching implementation means, enhancing experience exchange and optimizing policy environments.