地方政府分级诊疗政策创新扩散研究——基于全国地级市数据的事件史分析

Innovation and diffusion of local government's hierarchical medical policy:An event history analysis based on prefecture-level data in China

地方政府卫生政策改革创新对于深化我国医药卫生体制改革具有重要意义。本研究以我国分级诊疗政策为例,收集并构建了全国170个地级城市2014—2018年五年时间内的数据库,采用事件史方法分析了地方分级诊疗政策出台的影响因素。研究发现,地方政府卫生政策改革创新呈现自下而上政策推广和横向竞先模式;卫生部门、医保部门和大型公立医院在我国地方政府分级诊疗政策制定中存在着显著性影响,而基层医疗卫生机构作用不显著。基于此,本文提出以下政策建议:(1)加强中央政府推进分级诊疗改革协调力度;(2)构建以紧密型医联体为基础的多方主体利益激励共融机制;(3)突出以基层医疗卫生机构为导向的“开源”性改革。

The local government's health policy reform initiative is of great significance for the improvement of China's healthcare system reform.Taking China's grading diagnosis and treatment policy as a good example of policy innovation,this study collected and constructed a database of 170 prefecture level cities in China during the period from 2014 to 2018.Factors influencing the local governments'introduction of hierarchical medical policy were examined using the event history analysis based on data mined from the database.The results showed that the patterns followed by the local government during healthcare reform present a bottom-up and horizontal competition model;health,medical insurance departments,and large public hospitals had significant influence in the formulation of the local government's hierarchical medical policy,while the role of primary healthcare institutions was not significant.This study is helpful to the expansion of applicability of the policy diffusion theory in health policy,and also has great practical significance for deepening the reform of China's healthcare system.This paper presents the following policy recommendations:(1)strengthen the coordination role of the central government in promoting hierarchical medical policy;(2)construct seamlessly integrated healthcare systems as incentive mechanisms for stakeholders;(3)highlight the great importance to open up the source of primary cares.