地方政府农村医疗卫生政策的注意力分配差异及优化研究——以1998~2023年政策文本为例  

Study on the Differences in Attention Allocation and Optimization of Local Governmental Rural Healthcare Policies Sampled with Policy Texts from 1998 to 2023

作　　者：李文军 胡思琦 邓宏林 Li Wenjun(Guilin Medical University,Guilin,P.R.China)

机构地区：[1]桂林医学院人文与管理学院,广西桂林541199 [2]广西师范大学政治与公共管理学院

出　　处：《中国卫生事业管理》2024年第9期961-965,共5页Chinese Health Service Management

基　　金：国家社科基金项目“数字技术赋能基层减负增效的实现路径研究”(23CZZ039);广西哲学社会科学规划研究课题“广西农村地区基本公共服务可及性问题及其提升对策研究”(22FGL043);广西八桂学者“社会医学与卫生事业管理”经费资助项目。

摘　　要：目的:一直以来我国政府都非常重视农村医疗卫生工作,文章对地方政府农村医疗卫生政策的注意力分配进行量化评估,探究注意力分配差异和演变,以期为后续农村医疗卫生体系改革提供思路启发。方法:以1998~2023年地方政府发布的172份与农村医疗主题相关的有效政策文本为研究对象,运用Nvivo12、ROST Content Mining 6.0软件探究农村医疗政策变迁的注意力分配变迁状况。结果:农村医疗卫生的管理、医疗救助、医疗资金历来是地方政府制定农村医疗政策时考虑的关键内容,“救助”在我国农村医疗卫生事业发展中,起到了重要的“托底”作用,“健康”“补助”等关键词在地方政府农村医疗改革与管理中发挥了“核心作用”。结论:在萌芽发展阶段,地方政府的关注点是“牧区”“农村”“医疗”“卫生”等领域;在极速升温阶段,地方政府以“医疗救助”为关注焦点,关心医疗基金的筹集与支出,并逐渐将注意力转移至“财政”“资金”等方面;在改革深化阶段,地方政府注意力逐渐向“卫生院”“基层”“乡镇”“卫生室”等方面转移,目的是强化农村基层卫生机构的服务能力;在成熟完善阶段,地方政府关注农村医疗卫生体系的顶层设计,注意力逐渐转向“卫生院”“医生”“建设”等主题。地方政府需进一步加大对农村医疗卫生事业的政策扶持力度,不断提升农村基层医疗卫生服务能力;优化城乡医保政策,增进农村居民医疗服务获得感和幸福感;提高农村医疗卫生事业的人才质量,加强乡村医生队伍建设;筑牢农村医疗救助兜底保障,夯实底线公平。Objective To quantitatively evaluate the attention allocation of local governmental rural medical and health policies,explore the differences and evolution of attention allocation,and provide ideas and inspiration for further rural medical and health system reform.Methods A total of 172 effective policy texts related to rural medical themes released by local governments from 1998 to 2023 were used as research subjects,and Nvivo 12 and ROST Content Mining 6.0 software were used to explore the changes in attention allocation in rural medical policy changes.Results The management of rural healthcare,medical assistance,and medical funds have always been the key considerations for local governments when formulating rural healthcare policies.In which"Assistance"plays an important"bottom line"role in the development of rural healthcare in China,while keywords such as"health"and"subsidies"play a"core role"in local government rural healthcare reform and management.Conclusion In the early stages of development,local governments focused on areas such as pastoral areas,rural areas,healthcare,and hygiene.In the rapid warming stage,local governments focused on"medical assistance",cared about the fundraising and expenditure of medical funds,and gradually shift their attention to"finance","funding"and other aspects.In the stage of deepening reform,local governments were gradually shifting to areas such as"health centers","grassroots","townships"and"health clinics",with the aim of strengthening the service capacity of rural grassroots health institutions.In the mature and perfect stage,local governments paid attention to the top-level design of the rural medical and health system,gradually shifting their attention to"health centers","doctors","construction",and so on.It is necessary for the local governments to increase policy support and enhance the capacity of rural grassroots medical and health services,optimize urban and rural medical insurance policies to enhance the sense of access to medical services for rural residents,im

关 键 词：农村医疗政策 地方政府 政策文本 注意力 

分 类 号：R197.1[医药卫生—卫生事业管理]