新医改背景下基层卫生政策对乡镇卫生院的影响机制分析——基于乡镇卫生院院长访谈的实证研究  

Empirical analysis of influence mechanism of primary healthcare policies on township hospitals under the background of new medical reform:Evidence based on interviews with directors of township hospitals

作　　者：赵世超 朱凤霞 刘倩 张森 孟庆跃 ZHAO Shi-chao;ZHU feng-xia;LIU Qian;ZHANG Sen;MENG Qing-yue(School of Public Administration, Shandong Normal University, Jinan Shandong 250014, China;PKU China Center for Health Development Studies, Peking University, Beijing 100191, China)

机构地区：[1]山东师范大学公共管理学院,山东济南250014 [2]北京大学中国卫生发展研究中心,北京100191

出　　处：《中国卫生政策研究》2020年第5期54-59,共6页Chinese Journal of Health Policy

基　　金：第五次国家卫生服务调查专题调查:农村基层卫生组织建设评估(2012);山东省社会科学规划年度项目(19DSHJ05)。

摘　　要：目的:探究新医改背景下基层卫生政策的实施对乡镇卫生院运行状况的影响与协同作用机制,为完善基层卫生政策和促进乡镇卫生院发展提供科学依据。方法:采用多阶段分层抽样,对44位乡镇卫生院院长进行半结构化个人深度访谈,使用主题框架法对访谈内容进行编码和分析。结果:院长在访谈中主要谈到了基本药物制度、绩效工资制度和补偿机制三项与基层卫生机构密切相关的新医改政策,对乡镇卫生院本身及其与患者和卫生人员的关系均产生了直接或间接的积极与消极影响。结论:基层卫生政策主要影响了乡镇卫生院的经济效益和医患行为,不同政策的作用效果存在一定程度的正负相抵,政策协同性有待加强。Objective:To analyze the implementation of primary healthcare policies and carry out an empirical exploration of its influence and synergistic mechanism on the internal and external operation in township hospitals under the background of the new medical reform,so as to provide scientific basis for improving primary healthcare policies and promoting the development of township hospitals.Methods:Using a multistage stratified sampling method,in depth interviews were conducted among 45 directors of township hospitals by help of semi-structural interview syllabus.With the help of thematic framework analysis,the interview content was coded and analyzed.Results:In the interview,the interviewees mainly talked about the three new medical reform policies including the essential medicine system,the pay for performance system and the compensation mechanism,which all had positive and negative,direct or indirect impacts on township hospitals and its stakeholders in different levels.Conclusions:The primary healthcare policies have complicated effects on the economic results and the behavior of health workers and patients in township hospitals.Different policies have opposite effects which lead to poor cooperativeness,so the policy coordination needs to be further strengthened.

关 键 词：乡镇卫生院 基层卫生政策 新医改 影响机制 

分 类 号：R197[医药卫生—卫生事业管理]