政策工具视角下的我国全科医生政策研究

Study of the General Practitioners' Policies in China from the Perspective of Policy Tools

目的对我国中央政府层面出台的31份全科医生相关政策文本中的政策工具进行分析,探讨我国全科医生相关政策体系的侧重点与不足点,从而为未来调整和优化全科医生政策提供参考。方法选取我国2009—2018年中央政府层面发布的31篇全科医生相关政策文件为研究对象。访问我国国务院、国家发展改革委、国家卫生计生委等国务院相关部委和机构网站,以"全科医生"为题名或关键词在上述官方网站上进行检索,以获取与全科医生相关的政策文件。检索时间为2009—2018年。基于政策工具视角对纳入分析的全科医生政策文件进行编码和摘录,采用内容分析法和定量分析法对纳入的全科医生相关政策所采用的政策工具进行统计分析。结果 174个政策编号中,需求型、供给型、环境型政策工具分别占5.2%(9/174)、29.9%(52/174)、64.9%(113/174)。需求型政策工具中,仅示范项目被使用,占5.2%(9/174);供给型政策工具中,人才培养使用最多,占16.2%(28/174),信息支持和师资投入使用最少,均占1.1%(2/174);环境型政策工具中,策略性措施使用最多,占32.2%(56/174),金融支持使用最少,占4.6%(8/174)。174个政策编号中,内部子模指标占71.3%(124/174),外部子模指标占28.7%(50/174)。在内部子模中,人力系统被使用最多,占39.1%(68/174),筹资系统使用最少,占2.3%(4/174);在外部子模中,政治系统使用最多,占13.3%(23/174),技术系统使用最少,占1.7%(3/174)。结论在政策工具维度上,环境型政策工具比例过高,需求型政策工具关注度偏低,各政策工具内部结构不合理,部分政策工具被忽视;在系统维度上,系统内外部分布不平衡。探索需求型政策的制定、优化各政策工具内部结构、全面考虑各方面政策工具、提高对系统外部的关注度将是我国全科医生相关政策优化与调整的方向。

Objective To analyze the policy tools in 31 policy texts related to general practitioners(GPs)issued by the Chinese central government,and probe the emphases and limitations of the policy system of GPs,providing a reference for the modifying and improvement of such policies.Methods We searched the websites of the State Council of the People's Republic of China and its subordinated agencies such as National Development and Reform Commission,National Health and Family Planning Commission and so on for policy documents related to GPs issued during 2009 to 2018 with"general practitioners"in Chinese as the searching title or key words.The included 31 policy documents were numbered and extracted based on the perspective of policy tools.And the extracted policy tools were counted and studied with quantitative content analysis.Results In the 174 policy codes,demand-side policy tools,supply-side policy tools,and environmental policy tools accounted for 5.2%(9/174),29.9%(52/174),64.9%(113/174),respectively.Of the demand-side policy tools,only demonstration projects were used,accounting for 5.2%(9/174).Among supply-side policy tools,talent development was used most,accounting for 16.2%(28/174),while information support and teachers were used least,each of them accounted for 1.1%(2/174).Of the environmental policy tools,strategic measures were used most,accounting for 32.2%(56/174),financial support was used least,accounting for 4.6%(8/174).Among 174 policy codes,internal submodule index and external submodule index accounted for 71.3%(124/174),28.7%(50/174),respectively.Among the internal submodules,the human system was used most,accounting for 39.1%(68/174),while the financing system was used least,accounting for 2.3%(4/174).Among the external submodules,the political system was used most,accounting for 13.3%(23/174),whereas the technical system was used least,accounting for 1.7%(3/174).Conclusion In respect of dimension of policy tools,the proportion of environmental policy tools is too high,the attention to demand-side policy tools is low,the internal structure of each policy tool is unreasonable,some policy tools are ignored.In terms of the system dimension,the internal and external distribution of the system is imbalanced.Therefore,exploring the formulation of demand-side policies,optimizing the internal structure of each policy tool,considering all kinds of policy tools in an all-round way,and increasing the attention to the outside of the system are the direction of modifying and optimization of GPs'policies in China.