中医药联合体建设的政策目标与工具:基于政策文本的定量研究

Q3 Medicine
北京大学学报(医学版) Pub Date : 2025-06-18
B Li, Y Bao, X Feng
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引用次数: 0

摘要

目的:对国家层面出台的医疗联合体相关政策文件进行文本分析,识别中国医疗联合体政策工具的结构特征和使用情况,评价其与政策目标的契合度,揭示政策设计中的结构性矛盾,为优化医疗联合体制度提供依据。方法:以“Medical Consortium”为关键词,系统检索北京大学法律数据库、中国知网政府文献数据库中国家级医疗联合体政策文件。基于政策工具理论,构建“政策工具-政策目标”二维分析框架,定量分析政策工具与目标的频率、分布特征及互动关系。结果:共纳入2009 - 2024年国家级医联体政策文件50份,其中单个科室单独发布的占56%。政策文本分析结果表明,政府可以使用多种政策工具来实现目标,但存在结构性失衡,环境政策工具占比最高(46.48%),主要侧重于制度保障(27.27%)和组织治理(22.73%),对公众意识引导的关注最少(6.82%)。供给侧政策工具过度依赖IT基础设施建设(24.77%)和医疗资源合理配置(24.77%),对劳动力能力建设(9.17%)和财政投入(4.59%)重视不足(38.38%)。需求侧政策工具仅占15.14%,以医疗保险支付(37.21%)和试点推广(32.56%)为主,服务外包等市场化工具(9.30%)使用较少。相互作用分析表明,政策工具主要侧重于提高初级保健服务能力,但对优化医疗资源配置的支持不足,表明政策工具与政策目标不一致。结论:中华医学会政策表现出部门间协调不力和结构性失衡,主要表现为过度依赖环境侧和供给侧工具,需求侧工具使用不足,以及工具类别内部错位。政策工具和目标没有很好地匹配。为了解决这些问题,未来的政策制定应加强跨部门合作,多样化政策工具,优化内部结构,提高工具与目标的一致性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Policy objectives and tools for the construction of Chinese Medical Consortium: A quantitative study based on policy texts].

Objective: This study conducts a text analysis of the policy documents related to Medical Consortium issued at the national level, identify the structural characteristics and utilization of Chinese Medical Consortium policy instruments, evaluate their alignment with policy objectives, uncover the structural contradictions in policy design, and provide a basis for optimizing the Medical Consortium system.

Methods: This study systematically searched national-level Medical Consortium policy documents from the PKU Law Database, CNKI Government Document Database using keyword like Medical Consortium. A two-dimensional "policy instrument-policy objective" analytical framework was constructed based on policy instrument theory to quantitatively analyze the frequency, distribution characteristics, and interactive relationships between policy instruments and objectives.

Results: A total of 50 national-level Me-dical Consortium policy documents from 2009 to 2024 were included, with 56% issued solely by single departments. The policy text analysis results showed that the government could use diverse policy instruments to achieve objectives, but the structural imbalances existed, environmental policy instruments accounted for the highest proportion (46.48%), mainly focusing on institutional safeguards (27.27%) and organizational governance (22.73%), with minimal focus on public awareness guidance (6.82%). Supply-side policy instruments (38.38%) overly relied on IT infrastructure development (24.77%) and rational allocation of medical resources (24.77%), with insufficient attention to workforce capacity building (9.17%) and financial input (4.59%). Demand-side policy instruments constituted only 15.14%, dominated by health insurance payment (37.21%) and pilot program promotion (32.56%), while market-oriented instruments such as service outsourcing (9.30%) were rarely used. Interaction analysis revealed that policy instruments were concentrated on enhancing primary care service capacity but provided inadequate support for optimizing allocation of medical resources, which indicated a misalignment between policy instruments and policy objective.

Conclusion: Chinese Medical Consortium policies exhibit weak interdepartmental coordination and structural imbalances, characterized by excessive reliance on environmental and supply-side instruments, underuse of demand-side tools, and internal misalignment within instrument categories. And policy instruments and objectives are not well matched. To address these issues, future policy formulation should strengthen cross-departmental collaboration, diversify policy instruments, optimize their internal structures, and improve the alignment between instruments and objectives.

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来源期刊
北京大学学报(医学版)
北京大学学报(医学版) Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
9815
期刊介绍: Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.
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