家庭医生政策执行偏差的产生与治理路径——基于史密斯模型的分析  

The Generation of Family Doctor Policy Implementation Deviation and Its Governance Paths:Analysis Based on the Smith’s Model

作　　者：蒲新微[1,2] 李欣悦 PU Xinwei;LI Xinyue(School of Philosophy and Sociology,Jilin University,Changchun,Jilin 130015;National Research Institute of Intelligent Social Governance at Jilin University,Changchun,Jilin 130015)

机构地区：[1]吉林大学哲学社会学院,吉林长春130015 [2]国家智能社会治理吉林大学研究院,吉林长春130015

出　　处：《长白学刊》2025年第2期102-119,F0002,共19页Changbai Journal

基　　金：国家社科基金重点项目“脱贫人口‘急难愁盼问题’的识别与破解研究”(23ASH015);吉林大学研究生创新研究计划项目“城市社区家庭医生签约服务政策执行偏差与优化路径研究——以C市N社区为例”(2023CX259)。

摘　　要：家庭医生政策执行偏差是制约当前家庭医生签约服务健康发展的现实梗阻。对执行偏差进行有效矫正和治理是破解家庭医生发展困境、保障人民健康的关键突破口。基于史密斯政策执行过程模型,构建家庭医生政策产生执行偏差的分析框架。政策内容模糊极易诱发基层执行者的本位主义行为,而不完善的激励约束机制为家庭医生变通执行创造了机会空间。就医观念固化和政策对话缺失使得医患双方之间的有机互动难以维系。面对资源禀赋不足,政策环境发展滞后的现实情境,基层执行者不得不寻求变通执行的策略来达成政策目标。政策执行走样最终导致家庭医生政策功能被弱化。未来应从提升政策质量、完善激励约束、增进政策认同、优化资源配置等维度对家庭医生政策执行偏差进行有效纠正和综合治理。The implementation deviation of family doctor policy is a real obstacle that restricts the healthy development of family doctor contracting service.It is a key breakthrough to crack the development dilemma of family doctors and protect people’s health that correcting and managing the policy implementation deviation effectively.Based on the Smith’s Policy Implementation Process Model,the article constructs a generation mechanism framework for the implementation deviation of family doctor policy.The ambiguity of policy content can easily induce the selfish departmentalism behavior of grassroots executives,while the imperfect incentive and constraint mechanism creates the opportunity space for family doctors to implement the policy in a flexible way.The solidified concept of medical care and the lack of policy dialogue make it difficult to maintain the organic interaction between doctors and patients.In the face of insufficient resource endowment and lagging development of policy environment,grassroots practitioners have to seek alternative implementation strategies to achieve policy goals.The deviation in policy implementation ultimately leads to the weakening of the function of family doctor policy.In the future,the implementation deviation of family doctor policy should be effectively corrected and comprehensively managed from the dimensions of improving the quality of policy,perfecting incentives and constraints,enhancing policy recognition and optimizing the allocation of resources.

关 键 词：家庭医生政策 政策执行偏差 家庭医生签约服务 史密斯政策执行过程模型 政策执行 

分 类 号：D669.7[政治法律—政治学] C913.7[政治法律—中外政治制度]