政策工具视角下我国门诊慢性病医疗保障政策文本量化研究

Quantitative Study on the Chronic Diseases Outpatient Reimbursement Policy in Chinese Medical Insurance Schemes from the Perspective of Policy Tools

目的:分析门诊慢性病医疗保障政策现状与不足,为优化门诊慢性病保障提出政策建议。方法:基于政策工具视角,结合政策演进、利益相关者维度构建三维分析框架,采用内容分析法对政策文本进行三维量化分析。结果:筛选后共纳入27份政策文件。政策工具利用总体呈现不平衡现象,环境型政策工具利用占比达50%以上,需求型政策工具使用最少,仅为20.9%。子工具中分级诊疗(1.7%)、家庭医生服务(0.8%)、政策宣传(1.7%)使用较少。利益相关者分布不均衡,作用对象主要是政府和供给方,占比分别为41.7%、38.3%。随着政策演进,政策工具的使用数量与种类均呈现迅速上升的态势,但仍以环境型政策工具为主,而且支付方与需求方两个利益相关者涉及较少。结论:政策工具利用差异化显著,需求型政策工具应用不足,未来应充分考虑门诊慢性病医疗保障特点及群众需求,持续优化政策工具,增加供给型与需求型政策工具的使用,增强支付方与需求方两个利益相关者的参与。

Objective To analyze the status and problems of medical security policy of outpatient chronic diseases in China,and put forward optimization policy suggestions.Methods Based on policy tools,a three-dimensional analysis framework was constructed combining policy evolution and stakeholders.Three-dimensional quantitative analysis of policy texts was conducted using content analysis method.Results A total of 27 policy papers were included for analysis.The overall use of policy tools was unbalanced,in which the environment-oriented policy tools accounted for more than 50%,while the demand-oriented policy tools only accounting for 20.9%.Among the sub-tools,the use rate of hierarchical diagnosis and treatment,family physicians and policy advocacy was 1.7%,0.8%and 1.7%,respectively.The distribution of stakeholders was not balanced,most of which was the government and the supplier.In the policy evolution progress,the number and types of policy tools were increasing rapidly.However,they were still concentrated in environmental policy tools,and the payers and demanders were rarely involved.Conclusion The utilization of policy tools was significantly different,while the utilization of demand-type policy tools was insufficient.It is suggested to fully consider the characteristics of outpatient chronic disease medical security and the people’s needs,continuously optimize the policy tools,increase the use of supply-oriented and demand-oriented policy tools,and improve the participation of stakeholders of the payer and demanders.