基于政策执行综合模型的贵州省医联体政策执行效果分析

Analysis on the effect of policy implementation of Medical Cluster in Guizhou Province based on the comprehensive model of policy implementation

目的:分析贵州省医联体政策执行成效、剖析影响因素并提出政策完善建议。方法:基于梅兹曼尼安和萨巴提尔综合模型框架,利用中国卫生健康统计年鉴数据以及对贵州省遵义市某医联体内就诊患者进行结构式访谈的结果,进行政策执行影响因素的二元Logistic回归分析。结果:贵州省城镇人口比重较低,城镇以及收入较高的患者会更多选择到"医院"进行首诊(P<0.05);医联体政策目标明确,但是贵州省人均卫生总费用却低于全国;三级医院占比较低,基层卫生医疗机构医生失衡、床位欠缺,并且居民医疗保健支出较低;样本患者政策知晓度较低、认可度较高,认可情况受到性别、年龄、月收入情况、就业状况等因素影响(P<0.05)。结论:贵州省医联体政策执行面临问题是乡村人口比重高,患者就医行为多样性;要有效地解决此问题需要提高社会卫生支出与个人卫生支出、三级医院的占比,促进医疗资源有效下沉到基层医疗卫生机构,提高患者对基层医疗卫生机构的认知水平,加强县域内紧密型医联体建设,激活基层医疗卫生机构诊疗能力和积极性。

Objective: To analyze the effectiveness of the implementation of the policy of Medical Union in Guizhou Province, analyzes the influencing factors, and puts forward suggestions for policy improvement. Methods: Based on the Mazmanian and Sabatier’s policy implementation composite model framework, using the data of China Health Statistical Yearbook and the results of structured interviews with patients in a medical association in Zunyi City, Guizhou Province, binary logistic regression analysis was carried out on the influencing factors of policy implementation. Results: The proportion of the urban population in Guizhou Province is low, and patients with higher income in cities and towns will choose more ‘hospitals’ for first diagnosis(P < 0.05);Although the policy objective of the medical association is clear, the total per capita health expenditure in Guizhou Province is far lower than that in the whole country;The proportion of the Grade Ⅲ hospitals is relatively low, doctors in grass-roots health and medical institutions are unbalanced, beds are lack, and residents’ medical and health care expenditure is low;The policy awareness and recognition of the sample patients were low, and the recognition was affected by gender, age, monthly income, employment and other factors(P < 0.05).Conclusion: In order to effectively solve this problem, it is necessary to increase the proportion of social health expenditure, personal health expenditure and the Grade Ⅲ hospitals, promote the effective sinking of medical resources to basic medical and health institutions, and improve the cognitive level of patients to grass-roots medical and health institutions;Strengthen the construction of close medical association in the county, and activate the diagnosis and treatment ability and enthusiasm of villages and towns.