定点零售药店纳入医保门诊统筹政策实施的动力及影响因素分析——基于利益相关者理论

Analysis of Motivation and Influencing Factor of Integrating Retail Pharmacies into Basic Medical Insurance Outpatient Pooling Fund——Based on the Stakeholders Theory

目的:探究将定点零售药店纳入基本医保门诊统筹政策的实施动力及影响因素,并有针对性地提出对策建议。方法:对我国东、中、西部三个省份省会城市的医保部门决策者、医院管理者和一线门诊医生、药店经营者和工作人员以及职工医保参保人进行半结构化访谈,运用利益相关者理论对各方在政策响应过程中的利益关联程度、政策影响力及执行意愿进行分析。通过构建核心变量矩阵识别并分析政策实施过程中的主要动力及影响因素。结果:研究发现,各利益相关者与政策的关联程度普遍较强,医保部门在政策制定和推动方面具有显著的影响力,并表现出积极的实施意愿。医院管理者和零售药店经营者也展现出较强的执行意愿,但一线门诊医生和药店员工的积极性相对较低。参保患者对政策的态度在不同地区存在差异,但随着政策的深入实施,参保人对政策的认同感会普遍增强。结论:为确保政策顺利实施,医保部门可加强技术支持和监管保障,医院管理者和药店经营者应提升管理水平,提高员工的积极性。同时,各方应加强政策宣传教育,尤其需要加大政策实施成效宣传,确保患者能够充分理解政策的好处,进一步提升参保人对门诊共济保障政策的认同感。

Objective:The paper explores the motivations and influencing factors in the implementation of integrating retail pharmacies into basic medical insurance outpatient pooling fund policy,the attitudes of various stakeholders towards the policy,and put forwards targeted suggestions to promote the policy smoothly.Methods:Semi-structured interviews were conducted with the decision-makers of healthcare security departments,managers of medical institution and outpatient doctors,retail pharmacy managers and staff,and employees'basic medical insurance participants in the capital cities of three provinces in eastern,central and western regions of China.The stakeholders theory was used to analyze three core variables:the degree of interest correlation,the influence of policies,and the willingness to implement policies,and the core-variable matrix was further used to identify the motivations and influencing factors during the policy implementation.Results:All stakeholders have a strong interest correlation with the policy,and the healthcare security departments have a strong influence in policy and hopes to actively promote the implementation of the policy.The managers of hospitals and retail pharmacies have a strong willingness to implement the policy,but outpatient doctors and pharmacy staff are less motivated.Patients'attitudes towards the policy vary in different regions,but with the implementation of policies,the willingness of the insured people to implement policies will generally increase.Conclusion:The healthcare security departments need to provide strong technical support and supervision.The managers of medical institutions and retail pharmacies need to improve the management mode to enhance the professional competence and motivations of employees.Meanwhile,the publicity of the policy,especially the effectiveness of the policy should be strengthened to ensure that the insured people can fully understand the benefits of the policy,and implement the outpatient mutual aid policies.