政策工具视角下我国家庭医生政策量化分析
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摘要
背景家庭医生制度的良序发展离不开政府政策的引导与支持。政策工具是政府治理经济社会的有效方法和重要途径,选择有效且适宜的政策工具并最大化应用,才能使政策结果与政策目标相一致。目的对我国中央政府层面出台的22篇家庭医生相关政策文件中的政策工具进行分析,探讨我国家庭医生相关政策体系的侧重点与不足点,从而为我国家庭医生政策制定与优化提供参考。方法于2018-12-21访问我国国务院相关部委及其直属机构官方网站,以"家庭医生、签约服务"为关键词在上述官方网站上进行检索,以获取与家庭医生相关的政策文件(n=22)。检索时间为2015-01-01至2018-12-10。基于政策工具视角,运用文献调研法与内容分析法,从基本政策工具和家庭医生政策实施发展过程2个维度对我国颁布的家庭医生相关政策文件进行分析。结果 142个政策文本编号中,供给型、环境型、需求型政策工具分别占43.66%(62/142)、47.89%(68/142)、8.45%(12/142)。供给型政策工具中,科技信息支持被使用最多,占20.42%(29/142),资金投入和公共服务被使用较少,均占2.82%(4/142)。环境型政策工具中,法规管制被使用最多,占16.20%(23/142),税收优惠被使用较少,占0.70%(1/142)。需求型政策工具中,医保支付被使用最多,占4.93%(7/142),政府采购和示范项目被使用较少,均占0.70%(1/142)。政策规划、政策实施、政策监督、政策评价工具分别占44.37%(63/142)、36.62%(52/142)、18.31%(26/142)、0.70%(1/142)。政策规划工具中,目标规划被使用最多,占12.68%(18/142),公共服务、政府采购及示范项目被使用较少,均占0.70%(1/142)。政策实施工具中,科技信息支持被使用最多,占13.38%(19/142),人才支持、资金投入、目标规划、税收优惠及价格补贴被使用较少,均占0.70%(1/142)。政策监督工具中,法规管制被使用最多,占9.86%(14/142),教育培训和公共服务被使用较少,均占0.70%(1/142)。政策评价工具中仅法规管制被使用,占0.70%(1/142)。结论从基本政策工具维度来看,使用最多是环境型政策工具,使用最少的是需求型政策工具。从政策实施发展过程维度来看,政策规划、政策实施工具使用较多,政策监督、政策评价工具使用较少。政府需强化需求型政策工具的拉动作用,增加家庭医生政策监督和评价环节的应用。
Background The well-ordered development of family doctor system is inseparable from the guidance and support of government policies.Policy tools are an effective method and an important way for the government to govern the economy and society.Choosing effective and appropriate policy tools and making the best possible use of them can align policy outcomes with policy objectives.Objective To analyze the policy tools in 22 policy texts related to family doctors issued by the central government of China,and to explore the focuses and shortcomings of these policy systems,providing a reference for the formulation and optimization of family doctor policies in China.Methods The retrieval was carried out in 21 December 2018.The data were obtained by visiting the official websites of the relevant ministries and commissions of the State Council and its directly affiliated agencies,using the search terms of "family doctors or contracted services" in Chinese during 2015-01-01 to 2018-12-10(n=22).Using literature review and content analysis method,the above-mentioned policy texts were analyzed from the perspectives of policy tools and utilization status during the implementation of family doctor policies.Results Among the 142 policy text codes,supply-side policy tools,environmental policy tools and demand-side policy tools accounted for 43.66%(62/142),47.89%(68/142) and 8.45%(12/142),respectively.Among the supply-side policy tools,science and technology information support was used the most,accounting for 20.42%(29/142),and capital investment and public services were the least used,each accounted for 2.82%(4/142).Among the environmental policy tools,regulatory controls were the most used,accounting for 16.20%(23/142),and tax incentives were used less,accounting for 0.70%(1/142).Among the demand-side policy tools,medical insurance payments was used the most,accounting for 4.93%(7/142),and government procurement and demonstration projects were used less,each accounted for 0.70%(1/142).Among the 142 policy text codes,policy planning tools,policy implementation tools,policy supervision tools,and policy evaluation tools accounted for 44.37%(63/142),36.62%(52/142),18.31%(26/142),and 0.70%(1/142),respectively.Among the policy planning tools,target planning was used the most,accounting for 12.68%(18/142),and public services,government procurement and demonstration projects were used less,each accounted for 0.70%(1/142).Among the policy implementation tools,science and technology information support was the most used,accounting for 13.38%(19/142).Talent support,capital investment,target planning,tax incentives and price subsidies were used less,each accounted for 0.70%(1/142).Among the policy supervision tools,regulatory controls were used the most,accounting for 9.86%(14/142),and education and training and public services were used less,each accounted for 0.70%(1/142).Only regulatory controls were used as the policy evaluation tools,accounting for 0.70%(1/142).Conclusion From the perspective of the basic policy tools,the most used are environmental policy tools,and the least used are demand-side policy tools.From the perspective of policy implementation and development,policy planning and policy implementation tools are more used,and policy supervision and policy evaluation tools are used less.The government needs to strengthen the incentive role of demand-side policy tools and increase the application of family doctor policy supervision and evaluation policies.
Background The well-ordered development of family doctor system is inseparable from the guidance and support of government policies.Policy tools are an effective method and an important way for the government to govern the economy and society.Choosing effective and appropriate policy tools and making the best possible use of them can align policy outcomes with policy objectives.Objective To analyze the policy tools in 22 policy texts related to family doctors issued by the central government of China,and to explore the focuses and shortcomings of these policy systems,providing a reference for the formulation and optimization of family doctor policies in China.Methods The retrieval was carried out in 21 December 2018.The data were obtained by visiting the official websites of the relevant ministries and commissions of the State Council and its directly affiliated agencies,using the search terms of "family doctors or contracted services" in Chinese during 2015-01-01 to 2018-12-10(n=22).Using literature review and content analysis method,the above-mentioned policy texts were analyzed from the perspectives of policy tools and utilization status during the implementation of family doctor policies.Results Among the 142 policy text codes,supply-side policy tools,environmental policy tools and demand-side policy tools accounted for 43.66%(62/142),47.89%(68/142) and 8.45%(12/142),respectively.Among the supply-side policy tools,science and technology information support was used the most,accounting for 20.42%(29/142),and capital investment and public services were the least used,each accounted for 2.82%(4/142).Among the environmental policy tools,regulatory controls were the most used,accounting for 16.20%(23/142),and tax incentives were used less,accounting for 0.70%(1/142).Among the demand-side policy tools,medical insurance payments was used the most,accounting for 4.93%(7/142),and government procurement and demonstration projects were used less,each accounted for 0.70%(1/142).Among the 142 policy text codes,policy planning tools,policy implementation tools,policy supervision tools,and policy evaluation tools accounted for 44.37%(63/142),36.62%(52/142),18.31%(26/142),and 0.70%(1/142),respectively.Among the policy planning tools,target planning was used the most,accounting for 12.68%(18/142),and public services,government procurement and demonstration projects were used less,each accounted for 0.70%(1/142).Among the policy implementation tools,science and technology information support was the most used,accounting for 13.38%(19/142).Talent support,capital investment,target planning,tax incentives and price subsidies were used less,each accounted for 0.70%(1/142).Among the policy supervision tools,regulatory controls were used the most,accounting for 9.86%(14/142),and education and training and public services were used less,each accounted for 0.70%(1/142).Only regulatory controls were used as the policy evaluation tools,accounting for 0.70%(1/142).Conclusion From the perspective of the basic policy tools,the most used are environmental policy tools,and the least used are demand-side policy tools.From the perspective of policy implementation and development,policy planning and policy implementation tools are more used,and policy supervision and policy evaluation tools are used less.The government needs to strengthen the incentive role of demand-side policy tools and increase the application of family doctor policy supervision and evaluation policies.
引文
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[8]宋之杰,商贝贝,郭燕平,等.“互联网+社区家庭医生”资源整合服务体系构建研究[J].卫生经济研究,2018,35(3):32-35.SONG Z J,SHANG B B,GUO Y P,et al.Study on the construction of resource integration service system of internet plus general practitioners[J].Health Economic Research,2018,35(3):32-35.
[9]王良晨,葛敏,江萍,等.社区居民对家庭医生签约服务的认知与意愿研究[J].中国全科医学,2018,21(4):401-406.DOI:10.3969/j.issn.1007-9572.2018.04.006.WANG L C,GE M,JIANG P,et al.Community residents'awareness and willingness towards contractual services from family doctors[J].Chinese General Practice,2018,21(4):401-406.DOI:10.3969/j.issn.1007-9572.2018.04.006.
[10]邹思梅,张新生,罗达欣,等.深圳市家庭医生式服务项目定价与补偿机制研究[J].中国卫生经济,2017,36(4):54-58.DOI:10.7664/CHE20170414.ZOU S M,ZHANG X S,LUO D X,et al.Research on the pricing and compensation mechanism of family doctor service items in Shenzhen[J].Chinese Health Economics,2017,36(4):54-58.DOI:10.7664/CHE20170414.
[11]国务院办公厅.关于进一步深化基本医疗保险支付方式改革的指导意见[Z].2017.
[12]贺小林,江萍,朱敏杰,等.政府协同与医保助推:“四医联动”保障下的家庭医生服务[J].中国卫生政策研究,2017,10(10):10-15.DOI:10.3969/j.issn.1674-2982.2017.10.003.HE X L,JIANG P,ZHU M J,et al.The government collaboration and medical insurance to boost:"The Four medical linkage"under the protection of family doctor service[J].Chinese Journal of Health Policy,2017,10(10):10-15.DOI:10.3969/j.issn.1674-2982.2017.10.003.
[13]梁鸿,贺小林.中国家庭医生制度探索与改革的长宁模式[J].中国卫生政策研究,2017,10(10):1-2.DOI:10.3969/j.issn.1674-2982.2017.10.001.LIANG H,HE X L.The Changning model in the exploration and reform of Chinese family doctor system[J].Chinese Journal of Health Policy,2017,10(10):1-2.DOI:10.3969/j.issn.1674-2982.2017.10.001.
[14]彭小芹,蒲川.我国家庭医生签约影响因素的文献计量学研究[J].中国全科医学,2018,21(16):1916-1922.DOI:10.3969/j.issn.1007-9572.2018.16.003.PENG X Q,PU C.Associated factors for residents signing a contract with a family doctor in China:a bibliometric study[J].Chinese General Practice,2018,21(16):1916-1922.DOI:10.3969/j.issn.1007-9572.2018.16.003.
[15]江萍,王洁,赵琦,等.基于家庭医生工作室标化工作量的绩效管理应用研究[J].中国卫生政策研究,2017,10(10):16-22.DOI:10.3969/j.issn.1674-2982.2017.10.004.JIANG P,WANG J,ZHAO Q,et al.Research on performance management based on standardized workload of family doctor studio[J].Chinese Journal of Health Policy,2017,10(10):16-22.DOI:10.3969/j.issn.1674-2982.2017.10.004.
[16]刘春平,陈添华,郑敏,等.海南省家庭医生签约服务开展现状及发展建议研究[J].中国全科医学,2017,20(34):4248-4252.DOI:10.3969/j.issn.1007-9572.2017.34.007.LIU C P,CHEN T H,ZHENG M,et al.Current situation and development suggestions of family doctors'contract-signing services in Hainan Province[J].Chinese General Practice,2017,20(34):4248-4252.DOI:10.3969/j.issn.1007-9572.2017.34.007.2018081020181215
[2]殷东,张家睿,王真,等.中国家庭医生签约服务开展现状及研究进展[J].中国全科医学,2018,21(7):753-760.DOI:10.3969/j.issn.1007-9572.2018.07.001.YIN D,ZHANG J R,WANG Z,et al.Delivery status of contractual services from family doctors in China and advances in the related studies[J].Chinese General Practice,2018,21(7):753-760.DOI:10.3969/j.issn.1007-9572.2018.07.001.
[3]李阳,段光锋,田文华,等.构建分级诊疗体系的政策工具选择:基于省级政府政策文本的量化分析[J].中国卫生政策研究,2018,11(1):48-52.DOI:10.3969/j.issn.1674-2982.2018.01.008.LI Y,DUAN G F,TIAN W H,et al.Selection of policy tools for constructing tiered medical care system:a quantitative analysis based on provincial government policy text[J].Chinese Journal of Health Policy,2018,11(1):48-52.DOI:10.3969/j.issn.1674-2982.2018.01.008.
[4]ROTHWELL R,ZEGVELD W.Reindus dalization and technology[M].London:Logman Group Limited,1985:83-104.
[5]俞修言,马颖,吴茂荣,等.基于政策工具的我国医养结合政策内容分析[J].中国卫生政策研究,2017,10(1):41-45.DOI:10.3969/j.issn.1674-2982.2017.01.007.YU X Y,MA Y,WU M R,et al.Analysis on the policy content of pension combined with medical service from the perspective of policy in China[J].Chinese Journal of Health Policy,2017,10(1):41-45.DOI:10.3969/j.issn.1674-2982.2017.01.007.
[6]刘云,黄雨歆,叶选挺.基于政策工具视角的中国国家创新体系国际化政策量化分析[J].科研管理,2017,38(s1):470-478.LIU Y,HUANG Y X,YE X T.A quantitative analysis of China's internationalization policies in its innovation system based on policy tools[J].Science Research Management,2017,38(s1):470-478.
[7]张雷,傅涵,李月娥.沈阳市某区家庭医生人力资源现状与对策研究[J].中国公共卫生,2018,34(2):282-284.DOI:10.11847/zgggws1117448.ZHANG L,FU H,LI Y E.Human resources for family doctor service at district level in Shenyang City:current status and countermeasures[J].Chinese Public Health,2018,34(2):282-284.DOI:10.11847/zgggws1117448.
[8]宋之杰,商贝贝,郭燕平,等.“互联网+社区家庭医生”资源整合服务体系构建研究[J].卫生经济研究,2018,35(3):32-35.SONG Z J,SHANG B B,GUO Y P,et al.Study on the construction of resource integration service system of internet plus general practitioners[J].Health Economic Research,2018,35(3):32-35.
[9]王良晨,葛敏,江萍,等.社区居民对家庭医生签约服务的认知与意愿研究[J].中国全科医学,2018,21(4):401-406.DOI:10.3969/j.issn.1007-9572.2018.04.006.WANG L C,GE M,JIANG P,et al.Community residents'awareness and willingness towards contractual services from family doctors[J].Chinese General Practice,2018,21(4):401-406.DOI:10.3969/j.issn.1007-9572.2018.04.006.
[10]邹思梅,张新生,罗达欣,等.深圳市家庭医生式服务项目定价与补偿机制研究[J].中国卫生经济,2017,36(4):54-58.DOI:10.7664/CHE20170414.ZOU S M,ZHANG X S,LUO D X,et al.Research on the pricing and compensation mechanism of family doctor service items in Shenzhen[J].Chinese Health Economics,2017,36(4):54-58.DOI:10.7664/CHE20170414.
[11]国务院办公厅.关于进一步深化基本医疗保险支付方式改革的指导意见[Z].2017.
[12]贺小林,江萍,朱敏杰,等.政府协同与医保助推:“四医联动”保障下的家庭医生服务[J].中国卫生政策研究,2017,10(10):10-15.DOI:10.3969/j.issn.1674-2982.2017.10.003.HE X L,JIANG P,ZHU M J,et al.The government collaboration and medical insurance to boost:"The Four medical linkage"under the protection of family doctor service[J].Chinese Journal of Health Policy,2017,10(10):10-15.DOI:10.3969/j.issn.1674-2982.2017.10.003.
[13]梁鸿,贺小林.中国家庭医生制度探索与改革的长宁模式[J].中国卫生政策研究,2017,10(10):1-2.DOI:10.3969/j.issn.1674-2982.2017.10.001.LIANG H,HE X L.The Changning model in the exploration and reform of Chinese family doctor system[J].Chinese Journal of Health Policy,2017,10(10):1-2.DOI:10.3969/j.issn.1674-2982.2017.10.001.
[14]彭小芹,蒲川.我国家庭医生签约影响因素的文献计量学研究[J].中国全科医学,2018,21(16):1916-1922.DOI:10.3969/j.issn.1007-9572.2018.16.003.PENG X Q,PU C.Associated factors for residents signing a contract with a family doctor in China:a bibliometric study[J].Chinese General Practice,2018,21(16):1916-1922.DOI:10.3969/j.issn.1007-9572.2018.16.003.
[15]江萍,王洁,赵琦,等.基于家庭医生工作室标化工作量的绩效管理应用研究[J].中国卫生政策研究,2017,10(10):16-22.DOI:10.3969/j.issn.1674-2982.2017.10.004.JIANG P,WANG J,ZHAO Q,et al.Research on performance management based on standardized workload of family doctor studio[J].Chinese Journal of Health Policy,2017,10(10):16-22.DOI:10.3969/j.issn.1674-2982.2017.10.004.
[16]刘春平,陈添华,郑敏,等.海南省家庭医生签约服务开展现状及发展建议研究[J].中国全科医学,2017,20(34):4248-4252.DOI:10.3969/j.issn.1007-9572.2017.34.007.LIU C P,CHEN T H,ZHENG M,et al.Current situation and development suggestions of family doctors'contract-signing services in Hainan Province[J].Chinese General Practice,2017,20(34):4248-4252.DOI:10.3969/j.issn.1007-9572.2017.34.007.2018081020181215