我国医防融合政策分析:政策演化与政策工具运用

Analysis of medication and prevention integration policy in China: Policy evolution and policy tool application

目的:梳理我国医防融合政策的演变历程与变化趋势,探讨医防融合政策的结构特征,为健全医防融合政策体系提供参考。方法:通过词频分析法统计医防融合政策的重点内容;基于政策工具视角,构建“政策工具—服务提供主体”二维框架,分析医防融合政策特征。结果:医防融合一词由“防治结合”和“医防协同”演化而来,在此过程中政策呈现出内容丰富化、范围扩大化、体系完备化和医防关系紧密化的变化趋势。X维度环境型、供给型、需求型政策工具使用比例分别为57.78%、30.37%、11.85%;Y维度基层医疗卫生机构、医疗联合体、医院、专业公共卫生机构占比分别为50.00%、30.23%、10.47%、9.30%。结论:医防融合缺乏顶层设计;政策工具结构失衡,重环境轻需求;服务提供主体层面重基层但政策工具运用不充分。

Objective: To review the evolution path and trend of the medication and prevention integration policy in China and explore its structural features, so as to provide references for improving the medication and prevention integration policy system. Methods: Word frequency analysis was used to summarize the key contents of medication and prevention integration policy;based on the perspective of policy tools, a two-dimensional framework of “policy tools—service providers” was constructed to analyze the characteristics of the medication and prevention integration policy. Results: The term “medicine and prevention integration” evolved from “combination of prevention and treatment” and “coordination of medicine and prevention”. In the process of evolution, the policies manifested a trend of enrichment in content, expansion in scope, completeness in system, and closer relationship between medical care and prevention. In the X dimension, environmental-, supply-and demand-type policy tools respectively accounted for 57.78%, 30.37% and 11.85% of the total number of policy tools;in the Y dimension, primary health care institutions, medical consortia, hospitals, and professional public health institutions respectively accounted for 50.00%, 30.23%, 10.47%, and 9.30% of health facilities. Conclusions: The medication and prevention integration policy lacks top-level design;the policy tools have an unbalanced structure, which emphasize the environment over demand;at the level of service providers, attention is being paid to primary health care, but the use of policy tools is not sufficient.