To explore the impact mechanism of the construction of county medical communities (hereinafter referred to as medical communities) on the hierarchical diagnosis and treatment system.

Based on social network theory, an analytical framework for the impact of medical community construction on the hierarchical diagnosis and treatment system was constructed from three aspects: the network location of participating entities in medical communities, the internal social structure of medical communities, and the overall characteristics of medical communities. From June 2018 to February 2023, a field survey was conducted in S county, Yunnan province. By reviewing the experience of medical community construction in the county, the impact mechanism of medical community construction on the hierarchical diagnosis and treatment system was analyzed.

The analysis of the construction of the medical community in S county showed that the leading hospital of the medical community located at the center of the social network could promote interaction between other medical institutions in identifying and utilizing resources, while the township health centers located at the hub connected unrelated entities through special network positions; By constraining county medical institutions to " siphon" grassroots resources, guiding county medical institutions to sink high-quality medical resources, and encouraging grassroots medical and health institutions to participate in the construction of a hierarchical diagnosis and treatment system, the connection between participating entities could be strengthened, information sharing could be strengthened, group cooperation could be promoted, organizational efficiency could be improved, and hierarchical diagnosis and treatment could be promoted; The construction of the medical community has increased network density and the central position of the leading unit, thereby improving the overall governance capacity of the hierarchical diagnosis and treatment system, and comprehensively promoting the construction of the hierarchical diagnosis and treatment system through institutional constraints, resource integration, and benefit redistribution.

The construction of the medical community in S county has changed the original social network structure. Through the construction of a " constraint-guidance-incentive" mechanism and the active promotion of the leading hospital, the supply and demand sides work together to guide social network entities to allocate resources reasonably and patients to make reasonable use of resources, helping to achieve the goal of hierarchical diagnosis and treatment.

Health care coalitions; County medical community; Hierarchical diagnosis and treatment; Social network theory; Benefit distribution; Resource integration