| 引用本文：崔月颖, 周驰, 施利杰, 杨磊.我国县域医共体建设利益相关政策工具的应用和演变——基于胡德分类[J].中国卫生政策研究,2022,15(3):37-44 |
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| 我国县域医共体建设利益相关政策工具的应用和演变——基于胡德分类 |
| 投稿时间：2022-01-25 修订日期：2022-03-10 PDF全文浏览 HTML全文浏览 |
| 崔月颖1, 周驰1, 施利杰3, 杨磊1 |
1. 杭州师范大学公共卫生学院 浙江杭州 310036;
2. 中国医学科学院医学信息研究所 北京 100020;
3. 浙江省德清县疾病预防控制中心 浙江湖州 313200 |
| 摘要:目的：通过分析2011—2021年国家在促进县域医疗服务供给体系建设过程中政策工具，尤其是财力型政策工具的使用情况，探索利益机制在县域医共体建设和发展中的作用。方法：采用C.Hood (胡德)政策工具分类，结合县域医共体的构建和发展要求，在词频分析的基础上，归纳文件各级标题内容的主题，再利用Nvivo软件对政策工具进行节点归类和分析，统计各类政策工具的使用情况。结果：90%的文件都应用了财力型政策工具，工具出现的参考点占比为16%，可利用的正式组织工具、权威型工具分别占31%和34%，信息型工具占19%。与利益相关的“服务价格”“薪酬制度”“医保功能”“政府投入”“绩效考核”等工具合计占20%。考核对象从“机构”逐步过渡到“医联体”，考核角度和考核内容逐步拓展，并趋向于以健康结果为导向。结论：基于利益机制的财力型政策工具占比在增加；以健康结果为导向的绩效考核是必然的趋势。各地要结合自己的发展实际，遵循原则、体现差异，细化本地县域医共体的改革方案，重视不同政策工具间的协同作用，将康复护理服务作为短板弱项予以加强，逐步明确“健康结果”指标，推动县域卫生服务高质量发展。 |
| 关键词:县域医共体 政策工具 利益 内容分析 绩效考核 |
| 基金项目:浙江省哲学社会科学规划课题(22NDJC135YB) |
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| Application and evolution of interest-related policy instruments for county health alliance: Based on Hood categorization |
| CUI Yue-ying1, ZHOU Chi1, SHI Li-jie3, YANG Lei1 |
1. School of Public Health Hangzhou Normal University, Hangzhou Zhejiang 310036, China;
2. Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China;
3. Deqing Center for Disease Control and Prevention, Huzhou Zhejiang 313200, China |
| Abstract:Objective: To explore the effect of the interest mechanism in the construction and development of the county health alliance by analyzing the application of policy tools, especially treasure policy tools, in the process of promoting the supply system in county health alliance from 2011 to 2021. Methods: The themes of titles at all levels of documents are summarized based on the classification of C. Hood policy tools combined with the construction and development requirements of county health alliance according to the word frequency analysis, and then Nvivo software is used to classify and analyze policy tools to count the use of various policy tools. Results: The proportion of the policy documents used “Treasure” tools is 90%. The reference points of tools accounted for 16%. “Organization” and “Authority” tools accounted for 31% and 34% respectively. “Information” tools covered 19%. Interest-related tools such as “service price”, “remuneration pattern”, “medical insurance function”, “government investment”, and “performance assessment” accounted for 20% in total. The assessment object has gradually transitioned from “institutions” to “health alliance”, and the assessment content tends to be oriented by health outcomes. Conclusion: The proportion of treasure policy tools based on interest mechanism is going up. Health outcome-oriented performance appraisal is an inevitable trend. All localities should combine their actual development, follow principles, reflect differences, refine the reform plan of local county health alliance, attach importance to the synergy between different policy tools, strengthen rehabilitation nursing services as shortcomings and gradually identify the indicators of “health outcomes”, so as to promote the high-quality development of county health services. |
| Key words:County health alliance Policy Instruments Interest Content analysis Performance assessment |
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