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我国分级诊疗的政策叙事、历史呈现与实现进路——基于历史制度主义的分析 被引量:9

Policy Narrative, Historical Presentation and Future Approaches of Hierarchical Diagnosis and Treatment in China——The Analysis from the Perspective of Historical Institutionalism
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摘要 历史制度主义强调通过中间层次的制度来联结宏观层面的社会经济背景和微观层面的社会事实。分级诊疗政策叙事包含愿景与行动两重意蕴,二者的统合承接了社会转型的宏大背景、影响着分级诊疗格局的现实样态。通过梳理既有文献以及分析统计数据,研究发现,有序分级诊疗格局曾短暂形成于计划经济时期,而后却又在时间的推移中逐渐失序,尽管其在当下重新得到重视,但分级诊疗美好愿景的实现仍难一蹴而就。我国的分级诊疗实践缘何产生上述的变化?从历史制度主义的视角来看,政府以体系建设与政策约束为代表的关联性制度安排的转向导致了医疗机构与社会成员之间从衔接走向失配,这是分级诊疗格局失序的制度性原因。有鉴于此,未来我国分级诊疗美好愿景及政策目标的实现进路在于:始终坚守基本医疗卫生事业的公益属性、积极履行医疗服务体系建设中的政府主体责任和有效发挥政策工具的协调引导作用。 Historical institutionalism emphasizes the linking of socioeconomic contexts at the macro level and social facts at the micro level through intermediate levels of institutions. The policy narrative of hierarchical diagnosis and treatment contains the implication of vision and action. The convergence of the two takes place in the context of social transformation and influences the reality of the hierarchical diagnosis and treatment pattern.By combing the existing literature and analyzing statistical data, the study found that the orderly hierarchical diagnosis and treatment pattern was formed during the planned economy period, but then gradually out of order over time. Despite the renewed attention it is now receiving, the realization of the beautiful vision of hierarchical diagnosis and treatment is still difficult to achieve overnight. Why has the practice of hierarchical diagnosis and treatment in China changed in the way it has? From the perspective of historical institutionalism, the shift of the government’s related institutional arrangements represented by system construction and policy constraints has led to the transition from articulation to mismatch between medical institutions and social members, which is the institutional reasons for the disorganization of the hierarchical diagnosis and treatment pattern. Based on this, the way forward for the future vision of hierarchical diagnosis and treatment lies in upholding the public interest attribute of basic medical and health care, actively fulfilling the main responsibility of the government in the construction of the medical service system, and effectively playing the role of coordination and guidance of policy tools.
作者 党秀云 李霖 DANG Xiuyun;LI Lin(School of Management,Minzu University of China,Beijing,100081)
出处 《行政论坛》 CSSCI 北大核心 2023年第1期108-117,共10页 Administrative Tribune
关键词 分级诊疗 政策叙事 历史呈现 制度创新 hierarchical diagnosis and treatment policy narrative historical presentation institutional innovation
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