山东省“三高共管 六病同防”慢病管理政策执行动力和阻力分析  

An analysis of the driving forces and resistance in the implementation of the"Integrated Control and Prevention of Three Highs and Six Diseases"strategy for chronic disease management in Shandong province

作　　者：王海鹏 范文瑜[1,2] 陈希 杜雪莹 张玉 陈良侠 张高辉[4] 宋君健[5] WANG Haipeng;FAN Wenyu;CHEN Xi;DU Xueying;ZHANG Yu;CHEN Liangxia;ZHANG Gaohui;SONG Junjian(Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine,Shandong University,Shandong University,Jinan 250012,China;Key Laboratory of Health Economics and Policy Research of National Health Commission(Shandong University),Jinan 250012,China;Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250014,China;Shandong Provincial Center for Disease Control and Prevention,Jinan 250014,China;Shandong Provincial Health Publicity and Education Center,Jinan 250002,China)

机构地区：[1]山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心,济南250012 [2]国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学),济南250012 [3]山东第一医科大学附属省立医院,济南250014 [4]山东省疾病预防控制中心健康管理所,济南250014 [5]山东省卫生健康宣教中心,济南250002

出　　处：《中国公共卫生》2025年第2期134-138,共5页Chinese Journal of Public Health

基　　金：国家重点研发计划(2020YFC2006505)。

摘　　要：“三高共管六病同防”慢病管理政策是山东省建立健全慢病管理医防融合服务体系的重要举措。本文利用利益相关者理论,对“三高共管六病同防”慢病管理政策的利益相关者进行界定,探讨卫生服务需求方、供给方、管理方、筹资方等利益相关者的不同利益诉求,并对各利益相关者的损益进行分析。从利益相关者的角度探讨“三高共管六病同防”慢病管理政策实施的动力与阻力,发现卫生行政部门的政治诉求、居民对获得优质价廉卫生服务的需要等是政策实施的主要动力。患者固有就医观念、基层医疗机构医务人员工作量增大、综合医院收益减少等是政策实施的主要阻力。本文针对“三高共管六病同防”慢病管理政策提出利益协调策略,包括通过宣传教育改变居民固有就医观念、增加对基层医疗卫生机构投入并提高其卫生服务水平、完善医务人员激励政策等,以推进和保障“三高共管六病同防”慢病管理政策的实施和发展。The"Integrated Control and Prevention of Three Highs(high blood pressure/glucose/lipids)and Six Diseases(coronary heart disease,stroke,renal lesions,retinal lesions,peripheral neuropathy,and peripheral vascular lesions)"strategy is an important measure to establish and improve the integrated management service system for medical treatment and prevention of chronic diseases in Shandong province.This study uses stakeholder theory to define the stakeholders of the"Integrated Control and Prevention of Three Highs and Six Diseases"strategy,to explore the different stakeholder interests such as health care demand,supply,management and financing,and to analyze the losses and benefits of each stakeholder.From a stakeholder perspective,this study examines the drivers and barriers to implementing the integrated control and prevention of three highs and six diseases strategy.It finds that the political imperatives of health administrations and the needs of the population for quality and affordable health services are the main drivers of strategy implementation.The main obstacles to implementing the strategy are patients'own medical concepts,increased workload for medical staff in primary health care facilities,and reduced revenues for general hospitals.Based on the analysis,we propose some performance coordination measures for the"Integrated Control and Prevention of Three Highs and Six Diseases"strategy,including changing residents'inherent medical concepts through publicity and education,increasing investment in grassroots medical and health institutions and improving their health service levels,and improving incentive policies for medical personnel,in order to promote and ensure the implementation and development of the chronic disease management strategy.

关 键 词：利益相关者理论 “三高共管六病同防” 慢病管理 动力 阻力 

分 类 号：F27[经济管理—企业管理]