Page 213 - 《社会》2025年第5期

社会·2025·5

into a “medical consortium” system and receiving technical support from a higher鄄
level hospital. The study conceptualizes the knowledge practice dilemma triggered
by institutional integration as “knowledge misalignment”， wherein the relationships
between hospitals， physicians， and medical technologies are reconstructed during
consolidation， leading to inefficient knowledge operations in circulation，
application， and interaction. This misalignment result in unintended consequences
such as upward migration and concentration of patients and functional overlap，
thereby deviating from the policy objectives of the “tiered healthcare delivery
system”. Specifically， in terms of knowledge flow， physicians are constrained by
organizational boundaries and career development incentives， leading to the short鄄
term and inefficient nature of cross鄄institutional practice; in knowledge application，
the mismatch between advanced technologies and primary healthcare settings
increases medical risks； and in knowledge interaction， the unequal relationship
between senior and junior doctors reinforces the dominance of specialized expertise，
further marginalizing primary care. These mechanisms reveal the deep鄄seated
challenges in healthcare resource integration. This study expands the sociological
perspective on cross鄄level healthcare integration and critically reflects on the
institutional tensions in China’s pursuit of healthcare equity: professional knowledge
systems are not merely passive objects controlled by administrative power， but
rather closely intertwined with organizational conditions， constituting an integral
element within the hierarchical structure of healthcare.
Keywords：knowledge misalignment， medical consortium， organizational integration，
knowledge transfer， tiered healthcare delivery system

一、 问题的提出

医疗资源分配不均反映了中国社会经济发展的不平等状况（朱恒鹏、

林绮晴，2015；姚泽麟，2016）。 为了应对这一问题，国家积极推动医疗资
源的合理布局，力图改善基层医疗服务能力，着力构建“大病向上转移，
小病留在基层”的分级诊疗秩序。近年来，“区域性医疗联合体”（下文简
1
称“医联体”） 成为促进医疗资源整合的重要手段。 政府通过在不同层
1. 当前医联体有多种模式。 根据《卫生健康委、中医药局关于印发医疗联合体管理办法
（试行）的通知》（国卫医发〔 2020〕13 号），医联体是一个包含多种组织形式的宽泛概念，
“医联体包括但不限于城市医疗集团、县域医疗共同体、专科联盟和远程医疗 （转下页）

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