基于霍恩--米特模型的家庭医生签约服务政策执行障碍因素分析

Analyzing The Difficulties to Implement Family Doctor Contract Service Policy Based on Horn-Meter Model

目的:分析评价家庭医生签约服务在政策执行过程中的障碍因素,为推进我国家庭医生签约服务政策的有效运行提供理论依据与决策参考。方法:运用文献分析、卫生统计年鉴、个人深入访谈等方式收集资料,基于霍恩-米特模型分析框架,探讨家庭医生签约服务政策执行中的障碍因素。结果:政策执行障碍因素包括政策标准制定较宽泛、目标可行性较低、政策资源不足(人才资源缺口大、财政资源投入与信息化技术应用不足、权威资源配套机制不健全)、执行方式单一、执行者之间、执行者与目标群体之间缺乏沟通与协调、执行机构间权责分工不明、执行人员的价值取向特性及系统环境复杂多变等问题,一定程度上偏离政策预期效果,使家庭医生签约服务的开展陷入困境。结论:家庭医生签约政策执行中涉及到的霍恩-米特模型的六个变量交互影响,各部门主体应在执行过程中处理好变量间的关系,及时修正、完善存在的问题,保证签约服务政策的长效实施与有序推进。

Objective To analyze and evaluate the obstacles in the process of implementing family doctor contract service policy, and provide theoretical basis and decision reference for improving the effective operation of family doctor contract service policy in China. Methods Data was obtained by literature review, health statistical yearbook, and personal in-depth interview, and analyzed based on the analysis framework of Horn-Meter model. Results Obstacles to policy implementation include inaccurate policy standard, lower feasible target, insufficient policy resources, single execution mode, lack of communication and coordination, unclear division of responsibilities, value orientation of executives, and the complex system environment. Conclusion The six variables of Horn-Meter model involved in the implementation of family doctor contract service policy interact with each other. Each department should deal with the relationship among different variables in the implementation process, timely correct and perfect the existing problems, and ensure the long-term implementation and orderly progress of the contracting service policy.