摘要
DRG是优化医疗资源配置的重要杠杆,对于提高医疗服务质量和效率具有重要作用。为了探究我国DRG政策的演变过程和扩散机制,文章基于政策扩散理论,从政策时间、政策工具、政策力度三个维度构建了政策扩散的分析框架,对我国2009—2022年发布的574份DRG政策进行量化文本分析。研究发现:我国DRG政策演变包括地方自主探索、地方政策试点、中央全面推广三个阶段,呈现“慢—快—慢”的扩散特点;环境型政策工具运用较多,而供给型政策工具和需求型政策工具运用相对较少;中央政策与地方政策的政策力度具有明显差异,政策力度的平衡性较差;模仿机制、行政指令推行机制和学习机制在我国DRG政策扩散过程中发挥显著作用。建议通过加强中央政策的顶层设计、优化地方政策工具的使用结构、构建DRG政策的交流共享平台,推动我国各城市DRG政策的制定和完善。
As a critical lever for optimizing the allocation of medical resources,Diagnosis-Related Groups(DRG)play an important role in enhancing the quality and efficiency of medical services.In order to explore the evolution process and diffusion mechanism of China's DRG policies,based on the theory of policy diffusion,this paper constructs an analytical framework of policy diffusion from three dimensions including policy time,policy tools and policy intensity,and carries out quantitative text analysis on 574 DRG policies released in China from 2009 to 2022.The results show that the evolution of DRG policy includes three stages:local independent exploration,local policy pilot,and central comprehensive promotion,exhibiting a"slow-fast-slow"diffusion pattern.Environment-type policy tools predominate in China's DRG policy landscape,while supply-type and demand-type policy tools are relatively scarce.Notable disparities in policy intensity exist in central and local policies,suggesting poor balance of policy intensity.Mimicry mechanism,administrative instruction implementation mechanism and learning mechanism have played a significant role in the process of DRG policy diffusion.It is suggested to strengthen the top-level design of central policies,optimize the utilization structure of local policy tools,and establish a communication and sharing platform for DRG policies to promote the formulation and improvement of DRG policies in China.
出处
《社会保障研究》
北大核心
2023年第2期62-74,共13页
Social Security Studies
基金
国家自然科学基金项目“标尺竞争机制、DRG/DIP支付方式改革与医疗服务定价”(72204251)的阶段性成果。
