基于模糊冲突模型的我国慢性病防控政策执行困境研究

Study on the Dilemma of Policy Implementation of Prevention and Control of Chronic Diseases in China Based on Ambiguity-Conflict Model

目的:分析我国慢性病防控政策执行困境,为进一步提高慢性病防控效果提供依据。方法:检索新医改实施以来,国务院等机构颁布的以慢性病为主题的政策文件,并以“慢性病防控”为主题词,在中国知网数据库、万方数据库检索2016年以来的相关慢性病文献,并以模糊冲突模型为理论基础对目前我国慢性病防控政策执行情况进行分析。结果:我国慢性病防控政策执行过程中模糊性逐渐降低,但冲突性较明显。通过对5份慢性病政策文件以及116篇慢性病相关文献分析发现冲突性主要体现为医疗服务体系与慢性病管理模式存在冲突、基层卫生机构服务能力与居民期望存在差距、居民慢性病防治意识与慢性病防控政策导向存在差异。结论:我国慢性病防控政策的具体实施过程属于政治性执行,其支配性因素为权力。建议从转变医疗卫生体系,加强基层卫生机构的医疗资源投入及绩效考核,完善相关配套措施,加强法律约束与监督等方面确保慢性病政策有效实施。

Objective:To analyze the difficulties in implementing the policy of prevention and control of chronic diseases in China,and to put forward the corresponding measures,so as to provide the basis for improving the prevention and control effect of chronic diseases.Methods:This study searched all the policy documents in China on prevention and control of chronic diseases issued by the State Council and other institutions since the implementation of the new medical reform.with"prevention and control of chronic diseases"as the theme word,and searched relevant chronic disease papers since 2016 in the CNKI and Wan Fang database.Based on ambiguity-conflict model,the implementation of prevention and control of chronic disease policy in China was analyzed.Results:The ambiguity of the implementation of prevention and control of chronic disease policy was gradually reduced,but the conflict was still severe.Through the analysis of 5 chronic disease policy documents and 116 chronic disease related documents,it's found that the conflict mainly manifested in three dimensions:the conflict between the medical service system and the chronic disease management model,the gap between the service capacity of grassroots health institutions and the residents'expectation,and the difference between the residents'concept of disease prevention and control and the chronic disease policy guidance.Conclusion:The specific implementation process of prevention and control of chronic disease policy in China belongs to political implementation,and its dominant factor is government power.It is suggested that the effective implementation of prevention and control of chronic disease policy should be ensured from the following aspects:transforming the medical and health system,strengthening the investment of medical resources and performance evaluation in grassroots health care institutions,perfecting relevant supporting measures,and strengthening the legal restriction and supervision.