基于三维分析框架的我国家庭医生签约服务政策量化研究  

Quantitative Analysis of China's Contracted Family Doctor Service Policies Based on a Three-dimensional Analysis Framework

作　　者：孙嘉颖 罗金萍 张倩雯 王康 尹文强 陈钟鸣 马东平 SUN Jiaying;LUO Jinping;ZHANG Qianwen;WANG Kang;YIN Wenqiang;CHEN Zhongming;MA Dongping(School of Management,Shandong Second Medical University,Weifang 261053,China;"Health Shandong"Severe Social Risk Prevention and Management Synergy Innovation Center,Weifang 261053,China;Collaborative Innovation Center of Social Risks Governance in Health,Shanghai 200032,China;Finance Department of Weifang People's Hospital,Weifang 261000,China)

机构地区：[1]山东第二医科大学管理学院,山东省潍坊市261053 [2]“健康山东”重大社会风险预测与治理协同创新中心,山东省潍坊市261053 [3]上海市健康相关重大社会风险预警协同创新中心,200032 [4]山东省潍坊市人民医院财务部,261000

出　　处：《中国全科医学》2024年第25期3100-3107,共8页Chinese General Practice

基　　金：国家自然科学基金青年基金资助项目(72004164)。

摘　　要：背景我国家庭医生签约服务工作全面推进不足7年,仍面临着一系列发展问题,保障机制不健全是阻碍家庭医生签约服务发展的关键问题,亟须科学且合理的家庭医生签约服务政策来保障工作的有效开展。目的对我国家庭医生签约服务政策的文本内容进行量化分析,探究现有政策的侧重点及不足,为后续家庭医生签约服务政策的发展和优化提供依据与参考。方法于2023-01-10,检索中国政府、国家卫生健康委员会等官方网站,获取与家庭医生签约服务相关的政策文件15份,检索时限为2015—2022年。构建政策工具-利益相关者-政策力度三维分析框架,对政策文件进行分类、编码及分析。结果政策工具维度中供给型、需求型、环境型工具分别占30.5%(69/226)、19.0%(43/226)、50.5%(114/226),利益相关者维度中家庭医生、签约者、未签约者、基层医疗卫生机构、医院(二级及以上)、政府分别占29.2%(123/422)、14.7%(62/422)、9.2%(39/422)、21.3%(90/422)、13.3%(56/422)、12.3%(52/422),我国家庭医生签约服务政策的平均力度值为2.2分。政策工具-利益相关者交叉维度中,利益相关者在供给型、环境型工具中的分布情况欠佳,子工具存在缺位现象;政策工具-政策力度交叉维度中,环境型工具随着政策力度的加大受到更多使用;利益相关者-政策力度交叉维度中,各利益相关者的政策力度匹配分数具有较大差异,家庭医生主体分数最高(311分),未签约者主体分数最低(90分)。结论政策工具角度,应合理配置政策工具,不断调整使用比重,优化内部结构,并提升利益相关者间政策工具分布的合理性;利益相关者角度,应统筹兼顾所有利益相关者,明确各自定位,着重关注未签约者需求;政策力度角度,应强化政策监督管理能力,持续提高家庭医生签约服务政策的执行力度。Background After being completely promoted for less than seven years,China's contracted family doctor service work still faces a number of development problems.The primary obstacle impeding the work of contracted family doctor service is an inadequate guarantee mechanism.There is an urgent need for scientific and reasonable policies on contracted family doctor service to guarantee the effective development of the work.Objective To quantitatively analyze the textual content of China's contracted family doctor service policies,to explore the focus and shortcomings of the existing policies,and to provide the basis and reference for the development and optimization of the subsequent contracted family doctor service policies.Methods Policy texts were collected by visiting the official websites of the China government and the National Health Commission of the People's Republic of China on 2023-01-10,and 15 policy texts on contracted family doctor service from 2015—2022 were selected to construct a three-dimensional analytical framework of policy tools-stakeholders-policy strength,to categorize,code,and analyze the policy documents.Results Supply-based,demand-based,and environment-based tools accounted for 30.5%(69/226),19.0%(43/226),and 50.5%(114/226) of the policy tool dimension.Family doctors,contractors,noncontractors,primary medical and health care institutions,hospitals(secondary and above),and the government accounted for 29.2%(123/422),14.7%(62/422),9.2%(39/422),21.3%(90/422),13.3%(56/422),and 12.3%(52/422) of the stakeholder dimension.The average strength of China's contracted family doctor service policies was 2.2 points.In the cross-dimension of policy tools-stakeholders,the distribution of stakeholders in supply-based and environment-based tools was relatively poor.There were some sub-tools that were absent from the policy tools.In the cross-dimension of policy tools-policy strength,environment-oriented policy instruments were used more often as policy strength increased.In the cross-dimension of stakehold

关 键 词：家庭医生签约服务 政策工具 利益相关者 政策力度 政策分析 

分 类 号：R197[医药卫生—卫生事业管理]