新医改中的政策工具组合结构:阶段性评估与发展前瞻

The Structure of Policy Instruments Combination in the New Health Care Reform:Staged Evaluation and Development Prospect

通过对我国36份医疗卫生政策的文本分析,全面评估2009年至今我国新医改的政策工具组合结构及其与政策目标的契合度。研究发现新医改在政策工具使用上存在结构性失衡和选择上的路径依赖,表现为不同类型政策工具的比例失衡,现有政策工具的长期延续性与新政策工具的匮乏。不同类型的政策工具之间的耦合平衡对于医疗卫生服务中的供需平衡至关重要。面向未来,一方面,需要优化我国医改政策工具组合结构,推动供给型、环境型、需求型政策工具的良性耦合。另一方面,在政策工具的设计中需要考虑到政策工具的生命周期,兼顾政策工具使用的连续性与实效性,在深入剖析政策目标、政策情境、政策工具内在关联性的基础上,通过持续的价值辩论与情境互动推动政策工具创新,不断丰富医改政策"工具箱"。

Based on the text analysis of 36 medical and health policies in China from 2009 to 2019,the combination structure of policy tools and their compatibility with policy objectives of China’s new medical reform are comprehensively evaluated.The results show that there are structural imbalance and path dependence in the use of policy tools in the new health care reform,which is manifested in the imbalance of the proportion of different types of policy tools,the long-term continuity of existing policy tools and the lack of new policy tools.The coupling balance between different types of policy instruments is very important for the balance of supply and demand in medical and health services.Facing the future,on the one hand,it is necessary to optimize the composition structure of China’s medical reform policy tools and promote the benign coupling of supply-oriented,environmental-oriented and demand-oriented policy instruments.On the other hand,in the design of policy tools,we need to consider the life cycle of policy tools and the continuity and effectiveness of the use of policy tools.Based on the in-depth analysis of policy objectives,policy context,and policy tools,we should promote the innovation of policy tools through continuous value debate and context interaction,and constantly enrich the policy"toolbox"of health care reform.