政策扩散视域下全科医生政策推广路径探析

Analysis on the Promotion Path of General Practitioner Policy in the Perspective of Policy Diffusion

全科医生是居民的健康守门人,完善全科医生制度是“强基层”战略的重点,是健全基层卫生服务体系、提升服务能力的重要基础。文章基于政策扩散的视角与间断均衡理论,构建了时间—空间维度分析框架,并运用政策文本计量法对全科医生政策创新与扩散路径进行剖析。研究发现:全科医生政策扩散的路径在时间上呈现出“间断—均衡—间断”的特征,在空间上则呈现出“创新—模仿—模仿延续”的过程;影响全科医生政策扩散的因素主要包括政策所存在的时滞、合力尚未形成、缺乏差异化制度设计、投入不足等,并据此提出完善顶层设计、明晰权责范围、构建机制支撑等政策建议。

General practitioners are the"health gatekeepers"of residents.Improving the"general practitioners"system is the focus of the"strong foundation"strategy,which is an important foundation for improving the primary health service system and enhancing service capacity.Based on the perspective of policy diffusion and intermittent equilibrium theory,this paper constructs a"time-space dimension"analysis framework and analyzes the policy innovation and diffusion paths of general practitioners by using the policy text measurement method.The study finds that the path of general practitioner policy diffusion is characterized by"intermittent-equilibrium-intermittent"in time,and"innovation-imitation-intermittent"in space."The factors affecting the proliferation of general practitioner policies include the time lag of policies,the lack of synergy,the insufficiency of differentiated institutional design,and the inadequate central investment etc.And according to the factors,we put forward policy suggestions such as improving top-level design,clarifying the scope of authority and responsibility,and constructing mechanism support.