政策工具维度下的家庭医生签约服务政策文本分析

Text analysis of China′s family physicians contracted service policy based on policy tools

目的对家庭医生签约服务相关政策文本进行分析,探讨我国家庭医生签约服务推进过程中政策的侧重点与存在的问题,为制度的优化与完善提供借鉴和参考.方法选取2011 年至2019年中央出台的54份相关政策文本,建立以政策工具、利益相关方为基础的二维分析框架,通过政策文本量化分析和文献调研法,对相关政策文本进行描述性分析.结果 54份文件中,出现命令与规制工具使用的占52.8%(124/235),出现能力建设工具使用的占27.2%(64/235),出现信息与劝诫工具使用的占13.2%(31/235),出现激励工具和系统变革工具使用的分别占5.1%(12/235)和1.7%(4/235);政策工具涉及政府和医生主体的较多(分别占34.3%和32.7%),涉及患者和医疗机构主体的相对较少(分别占17.6%和15.4%).讨论建议优化政策工具组合,增加激励工具对医生的使用力度,探索变革工具新形式;政策制定过程中,要提高对基层医疗机构资源配置和患者认知度、满意度的重视.

Objective To analyze the policy texts related to the contracted service of family physicians, and probe into the key points and existing problems of the policy in the process of promoting the contracted service of family physicians in China, for the purpose of providing references for the optimization and perfection of the system. Methods A total of 54 relevant policy texts issued by the Central Government from 2011 to 2019 were selected, for establishing a two-dimensional analysis framework based on policy tools and stakeholders.By means of quantitative analysis of policy text and literature research method, we analyzed the relevant policy texts. Results Study of the 54 texts found 52.8%(124/235)mentioned commands and regulatory tool use, 27.2%(64/235)mentioned capacity building tool use, 13.2%(31/235)mentioned information and exhortation tool use, 5.1%(12/235)only mentioned incentive tool use, and 1.7%(4/235)only mentioned system change tool use;while most of them(34.3% and 32.7%)mentioned government and physicians, and only a few(17.6% and 15.4%)mentioned patients and medical entities. Conclusions It is suggested to optimize the policy tools mixture, and increase the use of incentive tools to physicians, and explore new forms of system change tools.It is also proposed to pay more attention to resource allocation of primary medical institutions, and to patient awareness and satisfaction.