基于史密斯模型的基本药物制度执行中的问题研究

Problems about performance of the essential medicine system based on the Smith-Model

对我国基本药物制度执行过程中存在的问题进行分析。主要运用政策执行的史密斯模型，对基本药物制度执行过程中理想化政策、政策执行机构、目标群体和政策环境四要素存在的问题以及四要素间的关系进行系统梳理与分析。基本药物制度方案本身的理想化程度较高，但政策目标设置不当，且由于政策四要素中存在多种问题，以及政策四要素间的“紧张”与“冲突”，导致基本药物制度在运行中出现了较多的问题。虽然目前基本药物制度在执行中出现了许多问题，但由于其正处于政策运行的初期阶段，不应轻易对政策进行过大变动，以免引起政策的不稳定。政府部门应综合分析基本药物政策四要素及其相互关系，采取有效措施对出现的问题及各要素间的“紧张”与“冲突”进行处理，才能保障基本药物制度的有效执行。

To study performance problems found in China＇s essential medicine system. The Smith- Model of system implementation was called into play in a systematic collation and analysis for the ideal policies, system implementation agencies, target groups and policy environment in its performance, along with relationships among the four factors. The system is found with a number of loopholes as the system itself is highly idealized, its system objectives set inappropriately, problems found with the four factors, and ＂tension＂ and ＂conflicts＂ among these factors. Given these problems found in its performance, it is inappropriate to make drastic changes to avoid instability of the system at its early stage. Government departments in question are advised to comprehensively analyze the four factors and their relationships then taking effective measures to deal with them and the ＂tension＂, ＂conflict＂ among thercL This can ensure effectively implementation of the essential medicine system.