中国家庭医生制度的政策变迁与启示——基于倡议联盟框架的分析  

Policy Change and Enlightenment of Family Doctor System in China:Based on the Advocacy Coalition Framework

作　　者：高鹏 杨翠迎[1] Gao Peng;Yang Cuiying

机构地区：[1]上海财经大学公共经济与管理学院,上海200433

出　　处：《复印报刊资料（社会保障制度）》2022年第10期24-32,共9页SOCIAL SECURITY SYSTEM

基　　金：国家社会科学基金重大资助项目(20&ZD114);上海财经大学研究生科研创新资助项目(CXJJ-2020-324);上海财经大学“千村调查”博士生研究资助项目(QCDC-2020-04)。

摘　　要：借助倡议联盟框架理论对家庭医生制度从形成初期至今的政策文本进行了梳理,并结合政策子系统内的联盟构成、信念体系、政策学习及政策论坛等进行深入研究。研究发现:家庭医生制度在建立和发展中涉及多个主体,而政策的变迁引发了不同的信仰体系与倡议联盟的对立,阻碍家庭医生作用的发挥,而随着政策的进一步变迁,矛盾的逐步加剧诱发了“签而不约”的现象。家庭医生制度应当建立家庭医生与患者的“契约式”信任关系,明确家庭医生与患者的利益诉求,协同各部门实现良性互动并完善制度性衔接,重视政策学习与政策论坛的作用,从而实现家庭医生制度设计与目标实现的动态结合,切实提高家庭医生制度的效果,推动医疗卫生体制改革的进一步发展。The policy texts of the family doctor system are analyzed from the initial stage to the present with the help of the advocacy coalition framework,and an indepth study is made on the coalition composition,belief system,policy learning and policy forum in the policy subsystem.It is found that the establishment and development of the family doctor system involves multiple subjects,and the policy change leads to the opposition between different belief systems and advocacy coalition,which hinders the development of the role of family doctors.With the further policy change,the gradual intensification of contradictions leads to the phenomenon of“signing but not agreeing”.Thus,it is suggested that the family doctor system should establish a“contractual”trust relationship between family doctors and patients,clarify the interests of family doctors and patients,cooperate with various departments to achieve positive interaction and improve institutional convergence,and emphasize the role of policy learning and policy forum so as to make the dynamic combination of family doctor system design and objectives,effectively improve the quality of the family doctor system,and promote the further development of medical and health system reforms.

关 键 词：家庭医生 政策变迁 签约服务 医养结合 

分 类 号：R197.1[医药卫生—卫生事业管理]