政策工具视角下四川省全科医生政策变迁研究  

Changes in Policies for General Practitioners in Sichuan Province:a Policy Instrument-based Analysis

作　　者：刘力滴 廖晓阳[1] 杜鹏 张鹏 王磊 杨梓钰[1] 陈博旺 陈璐[1] 刘长明 张亚琳[1] 邹川[2] LIU Lidi;LIAO Xiaoyang;DU Peng;ZHANG Peng;WANG Lei;YANG Ziyu;CHEN Bowang;CHEN Lu;LIU Changming;ZHANG Yalin;ZOU Chuan(International Medical Center/General Practice Ward,West China Hospital,Sichuan University,Chengdu 610041,China;Department of General Practice,Chengdu Fifth People's Hospital,Chengdu 611130,China;Department of General Practice,Chengdu Third People's Hospital,Chengdu 610031,China;Department of Personnel and Science and Education,Health Commission of Sichuan Province,Chengdu 610041,China)

机构地区：[1]四川大学华西医院特需医疗中心/全科医学病房,四川省成都市610041 [2]成都市第五人民医院全科医学科,四川省成都市611130 [3]成都市第三人民医院全科医学科,四川省成都市610031 [4]四川省卫生健康委员会人事与科教处,四川省成都市610041

出　　处：《中国全科医学》2021年第4期407-413,420,共8页Chinese General Practice

基　　金：中华医学会医学教育分会和中国高等教育学会医学教育专业委员会2018年医学教育研究立项课题(2018B-N03018);四川省卫生健康科研课题(19PJ244)。

摘　　要：背景目前我国每万人口全科医生配置普遍未达到“2020年政策目标”,且注册率低问题突出,以我国西部最明显。政策工具是政府为实现政策目标所采取的手段总称,只有政策工具适宜,才能使政策结果与政策目标相一致。目的了解四川省政府自新医改实施以来出台的全科医生相关政策中的政策工具的侧重点、不足及变迁。方法于2019年12月-2020年1月,以“全科医生”为关键词在四川省人民政府、四川省卫生健康委员会等官网上检索2009-01-01至2019-12-31发布的全科医生相关政策文件。基于政策工具视角,采用内容分析法和定量分析法,从政策工具和政策发展过程两个维度对政策文本进行分析。结果共纳入48篇政策,268个政策编码中,规范型、激励型、能力建设型、权威型、系统变革型、象征和劝诫型分别占4.9%(13/268)、8.6%(23/268)、22.4%(60/268)、54.5%(146/268)、7.8%(21/268)、1.9%(5/268)。政策工具在2012年和2018年形成两个高峰,前者以权威型工具为主,后者以能力建设型工具为主,权威型工具较前明显减少,激励型较前明显增加。使用最多的政策工具是目标与规划〔32.1%(86/268)〕,使用最少的是舆论宣传〔0.4%(1/268)〕。政策规划、政策实施、政策监督及政策评价占比分别为51.1%(137/268)、44.4%(119/268)、3.4%(9/268)、1.1%(3/268)。结论新医改实施以来四川省全科医生政策工具使用符合实际需要,对全科医生发展有所裨益,未来政策优化应注重象征和劝诫型、激励型工具,并综合考虑各类型政策工具的联系和均衡使用,加强对政策实施过程的监督和评价反馈。Background Currently,the ratio of general practitioners(GPs)to 10000 residents fails to reach the 2020 target set in China's 13th Five-year Plan(2016—2020).Moreover,the rate of registered GPs is low,especially in western China.Policy instruments are a general term for the means adopted by the government to achieve policy objectives.Only when policy instruments are appropriate,can policy implementation results be consistent with the policy objectives.Objective To analyze the highlights and weaknesses as well as changes of the policies for GPs issued by the People's Government of Sichuan Province from 2009〔the year in which deepening the reform of the pharmaceutical and healthcare system(the new round of medical reform)was initiated〕to 2019.Methods From December 2019 to January 2020,using"general practitioners"in Chinese as key words,we searched the official websites of the People's Government of Sichuan Province and Health Commission of Sichuan Province for policy documents for GPs issued from January 1,2009 to December 31,2019,and performed content analysis and quantitative analysis of the texts of the policy documents in terms of types and development changes of policy instruments.Results A total of 48 policy documents were included,involving 268 coded policy instruments,consisting of normative,incentive,capacity-developing,authoritative,systematic reform,symbolic and hortatory instruments,accounting for 4.9%(13/268),8.6%(23/268),22.4%(60/268),54.5%(146/268),7.8%(21/268)and 1.9%(5/268),respectively.The number of policy instruments had a first peak in 2012,with authoritative instruments as the major type.Then authoritative instruments decreased significantly and incentive instruments increased significantly.And the instruments had a second peak in 2018,with capacity-developing instruments as the major type.Goals and planning were used the most〔32.1%(86/268)〕,while consensus propaganda was least frequently used〔0.4%(1/268)〕.Policy planning,policy implementation,policy supervision and policy evaluatio

关 键 词：全科医生 卫生政策 内容分析法 政策分析 

分 类 号：R197[医药卫生—卫生事业管理]