基于胡德政策工具的试点地区DIP政策文本量化分析

A Quantitative Studies of DIP Policies in the Pilot Regions of China Based on Hood's Policy Instrument

目的基于胡德政策工具视角对我国按病种分值付费(Diagnosis Intervention Packet,DIP)政策进行文本挖掘,对政策内容进行词频分析和聚类分析,探索各试点地区政策实际,进一步剖析原因,为后续政策调整与施行提供科学参考依据。方法纳入政策文本来自地方医疗保障局、地方卫生健康委员会、地方人民政府门户网站以及北大法宝等平台,从中选取了与DIP相关程度较高的政策文件。采用NVivo 20.0软件进行文本编码、词频分析,基于胡德政策工具与地区分布维度,进一步探讨DIP政策具体情况。结果共纳入27份政策文本,涵盖了所有试点省份,政策编码共1707条。权威型、财政型、信息型、组织型政策工具分别占54.9%,20.3%,16.9%和7.9%。东、中、西、东北部地区的编码参考点占比分别为23.0%、20.2%、44.5%、8.7%。结论各试点地区DIP政策工具使用中,侧重权威型工具而对组织型工具的使用较少。在权威型政策工具中,以机制建设类子工具使用居多,标准规范类子工具使用偏少。各试点地区政策工具侧重不同,政策工具使用应因地制宜。

Objective Based on the Hood Policy Tool perspective on China's DIP policy text mining,word frequency analysis and clustering analysis of the policy content,to explore the actual policy in each pilot region,to further analyze the reasons,to provide a scientific and reference for the subsequent policy adjustment and implementation.Methods Policies were included in this study from platforms such as local healthcare protection bureaus,local healthcare commissions,local people's government portals,and NVivo,from which policy documents with a high degree of relevance to DIP were selected.NVivo 20.0 software was used for text coding,word frequency analysis,and analysis based on Hood's policy tool dimensions and regional distribution dimensions to further explore DIP policy specifics.Results A total of 27 policies were included,covering all pilot provinces,with a total of 1,707 policy codes.Authoritative,fiscal,informational,and organizational policy instruments accounted for 54.9%,20.3%,16.9%,and 7.9%,respectively.The percentage of coded reference points in the East,Central,West,and Northeast regions were 23.0%,20.2%,44.5%,and 8.7%,respectively.Conclusion The use of DIP policy tools in the pilot regions focused on authoritative tools and less on organization tools.Among the authoritative policy tools,the subtools of mechanism building were mostly used,while the sub-tools of standards and norms were less used.The focus of the policy tools varies among the pilot regions,and the use of policy tools should be tailored to the local context.