基本公共卫生健康体检政策执行偏差及对策——基于W农村的案例研究  

Deviation and Countermeasures in the Implementation of Basic Public Health Examination Policies Based on A Case Study in Rural Area

作　　者：李佩瑶 许兴龙 杨心悦 Li Peiyao(School of Management,Jiangsu University,Zhenjiang,P.R.China)

机构地区：[1]江苏大学管理学院,江苏镇江212013

出　　处：《中国卫生事业管理》2024年第6期686-689,共4页Chinese Health Service Management

基　　金：国家自然科学基金“基于居民主动利用的基层卫生服务价值实现机制与提升策略研究”(72274081);江苏大学科研立项项目“主动健康视角下基层卫生服务价值实现机制与提升策略研究”(22C181)。

摘　　要：目的:以基本公共卫生健康体检政策为切入点,旨在分析基本公共卫生服务健康体检政策执行偏差的形成机理,探究政策执行偏差矫正之策。方法:采用单案例研究法,通过对W村健康体检政策执行人员、政府相关单位工作人员及其当地居民进行参与式观察和半结构访谈,结合当地相关政策文件和资料对W村健康体检政策执行事前、事中和事后过程进行案例剖析。结果:课题组成员通过走访苏南W农村,发现基本公共卫生健康体检政策执行过程存在机械执行、象征执行、抵制执行等困境。基于理论分析框架和现实访谈资料,发现基本公共卫生健康体检政策执行偏差的形成机理主要包括事前政绩考核压力造成健康体检政策执行方向扭曲、事中资源不足和执行主体出现政策理解偏差导致健康体检执行背离初衷、事后居民错误认知抑制执行主体完善体检后续服务等。结论:基层医疗卫生机构不仅需要向居民提供健康服务,更要重视在这一过程中居民对服务内容的反馈。关注供方与需方之间互动关系不仅仅是服务过程的必然要求,更是推动基层医疗卫生服务机构发展的必由之路。据此提出畅通上下级沟通渠道、完善内外监督机制、加强健康体检政策宣传力度等建议,以期促进基本公共卫生服务高质量发展。Objective To analyze the mechanism of deviation in the implementation of basic public health service health examination policy,and explore the strategies for correcting policy implementation deviation.Methods Using a single case study method,participatory observation and semi-structured interviews were conducted on the health examination policy implementers,government staff,and local residents in W Village.A case analysis was conducted on the pre,during,and post implementation process of the health examination policy in W Village,combined with relevant local policy documents and data.Results There were difficulties in the implementation process of basic public health examination policies,such as mechanical execution,symbolic execution,and resistance to execution.Based on the theoretical analysis framework and practical interview data,it was found that the formation mechanism of deviation in the implementation of basic public health examination policies mainly included the distortion of the direction of health examination policy implementation caused by the pressure of pre performance assessment,the lack of resources during the process,and the hindsight of residents'erroneous cognition inhibiting the improvement of follow-up services of the execution subject.Conclusion Grassroots medical and health institutions need not only to provide health services to residents,but also pay attention to feedback from residents on service content in this process.Paying attention to the interaction between suppliers and demanders is not only a necessary requirement of the service process,but also a necessary path to promote the development of grassroots medical and health service institutions.Based on which,suggestions were made to facilitate communication channels between superiors and subordinates,improve internal and external supervision mechanisms,strengthen the publicity of health examination policies,which can promote the high-quality development of basic public health services.

关 键 词：基本公共卫生 健康体检 政策执行偏差 对策 

分 类 号：R197.62[医药卫生—卫生事业管理]