| 引用本文：陶磊, 梁海伦.我国分级诊疗政策的推广路径与动因——基于政策扩散理论的分析[J].中国卫生政策研究,2019,12(6):9-14 |
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| 我国分级诊疗政策的推广路径与动因——基于政策扩散理论的分析 |
| 投稿时间：2018-05-23 修订日期：2018-11-28 PDF全文浏览 HTML全文浏览 |
| 陶磊, 梁海伦 |
| 中国人民大学公共管理学院 北京 100872 |
| 摘要:我国分级诊疗政策从局部到全国的试点推广过程是一个典型的政策扩散过程。这一政策经历了三个阶段，第一个阶段是从2006-2009年的政策论证期，第二个阶段是从2009-2015年的局部试点期，第三个阶段则是从2016年至今的全面试点期。从政策扩散的角度看，这一过程有三个基本特点，即时间上的S型分布，城乡间的实施差异，区域上的试点推广错位。本文从政策扩散的微观机制出发，认为中央强制推动使得该政策得以在全国迅速出台与推广，模仿在时间压力下减少了政策制定成本，竞争机制下各地政策趋于多样化的实践。然而从实际执行效果来看，这一政策推广的过程存在象征执行、政策趋同、一刀切等现象，使得分级诊疗喊声大、落实小，而缺乏系统的顶层设计与中央投入不足则严重制约了地方积极性的发挥。 |
| 关键词:分级诊疗 政策扩散 路径 动因 |
| 基金项目:国家自然科学基金（71804183） |
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| Study on the path and impetus of China's hierarchical healthcare system reform: An analysis based on the policy diffusion theory |
| TAO Lei, LIANG Hai-lun |
| School of Public Management and Policy, Renmin University of China, Beijing 100872, China |
| Abstract:The hierarchical healthcare system reform policy development process is a typical policy diffusion process which is conducted from county-level in the policy demonstration and initial piloting phase to national-level promotion for the final stage of development. Generally, the process underwent three phases, namely the policy demonstration period from 2006 to 2009, the partial piloting phase from 2009 to 2015, and the full pilot period from 2016 to present. From the perspective of policy diffusion, the process has got three basic characteristics including the S-type distribution in time, the promotion of differences between urban and rural areas, and the pilots scaling in the region. Starting from the micro-scale of policy diffusion, this paper found that the central compulsory promotion has enabled rapid adoption and promotion of the policy countrywide, imitating the strategy of reduced policy-making costs under time pressure, and practicing the diversification of local policies under the competition mechanism. However, from the perspective of actual implementation effect, this policy's promotion process has been constrained in adapting to local conditions during specific implementation. Some problems occurred during the policy's symbolic implementation, convergence and one-size-fits-all, which made China's hierarchical healthcare system reform loud and small in terms of grading diagnosis and treatment. In addition, the lack of systematic top-level design and insufficient central budgets input has seriously constrained the participation and motivation of local government in the policy diffusion. |
| Key words:Hierarchical healthcare system Policy diffusion Path Impetus |
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