| 引用本文：肖丹妮,任文博,胡琳琳.职工医保普通门诊统筹政策扩散模式与影响机制研究基于全国228个地级市的事件史分析[J].中国卫生政策研究,2025,18(8):53-62 |
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| 职工医保普通门诊统筹政策扩散模式与影响机制研究基于全国228个地级市的事件史分析 |
| 投稿时间：2025-07-01 修订日期：2025-08-05 PDF全文浏览 HTML全文浏览 |
| 肖丹妮，任文博，胡琳琳 |
| 中国医学科学院/北京协和医学院 卫生健康管理政策学院 北京 100730 |
| 摘要:推行门诊共济改革是完善我国医疗保障体系的关键举措。本研究基于政策扩散理论，以全国228个地级市为对象，运用事件史方法分析职工医保普通门诊统筹政策的扩散模式和影响因素，并将其分为权益置换型、福利增量型Ⅰ类、Ⅱ类三种分别分析。研究发现，普通门诊统筹政策扩散在时间上呈“S”型曲线，空间扩散具有邻近效应和区域示范效应。权益置换型政策横向扩散；福利增量型Ⅰ类以横向为主、纵向为辅；福利增量型Ⅱ类不受上级压力影响，以横向扩散为主。扩散影响因素上，政策扩散总体受政策问题、合法性、政府能力多重因素影响。权益置换型政策扩散不受上级政府压力影响，但受政策问题和政府能力影响，福利增量型Ⅰ类政策扩散受政策问题影响最大，Ⅱ类政策受政府能力影响最大。 |
| 关键词:门诊统筹 门诊共济 政策扩散 事件史分析 影响因素 |
| 基金项目:中国医学科学院医学与健康科技创新工程（2021-I2M-1-046） |
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| Research on the diffusion mode and influence mechanism of the outpatient coordination policy of employees' basic medical insurance： Event history analysis based on 228 prefecture-level cities in China |
| XIAO Dan-ni, REN Wen-bo, HU Lin-lin |
| School of Health Policy and Management， Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100730， China |
| Abstract:Implementing the reform of outpatient mutual-aid is a crucial measure to improve China's medical security system. Based on the policy diffusion theory， we took 228 prefecture-level cities across the country as the research objects and used the event history method to analyze the diffusion mode and influencing factors of the general outpatient pooling policy for employees' basic medical insurance， and divided into three types： the type of reducing the stock of Medical Savings Accounts （MSA）， the welfare increment type I and type II for separate analysis. We found that the diffusion of the general outpatient pooling policy presented an "S"-shaped curve over time， and was mainly horizontally diffused in space， with a neighboring effect and a regional demonstration effect. The type of reducing the stock of MSA policy diffuses horizontally； the welfare increment type I is mainly horizontal diffusion， supplemented by vertical diffusion； the welfare increment type II is not affected by the pressure from higher-level governments， and mainly adopts the horizontal diffusion mode. In terms of the influencing factors of policy diffusion， the diffusion of the general outpatient pooling policy was affected by multiple factors such as policy issues， legitimacy， and government capacity. The diffusion of the type of reducing the stock of MSA policy was not affected by the pressure from higher-level governments， but was influenced by policy issues and government capacity. The diffusion of the welfare increment type I policy was most affected by policy issues， and the welfare increment type II was most affected by government capacity. |
| Key words:Outpatient pooling Outpatient mutual-aid Policy diffusion Event history analysis Influencing factors |
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