| 引用本文：王悦,顼禹同,满晓玮,等.政策工具视角下我国基层医疗卫生机构“一类保障、二类管理”政策文本分析[J].中国卫生政策研究,2026,19(5):40-48 |
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| 政策工具视角下我国基层医疗卫生机构“一类保障、二类管理”政策文本分析 |
| 投稿时间：2026-03-24 修订日期：2026-05-08 PDF全文浏览 HTML全文浏览 |
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王悦，顼禹同，满晓玮，赵丽颖，蒋艳
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| 北京中医药大学管理学院 北京 100029 |
| 摘要:目的 分析基层医疗卫生机构“一类保障、二类管理”政策在工具组合、目标匹配与不同区域的差异。方法 基于“政策工具-政策目标-经济区域”的框架”对74份政策文本量化分析。结果 政策工具中，需求型最多（41.33%），供给型次之（36.66%），环境型最少（22.02%）；政策目标有提高基层岗位吸引力（26.13%）、均衡资源配置（19.93%）、促进可持续发展（19.65%）、激发机构运行活力（16.89%）、保障基本运行（12.95%）、明确各方主体责任（4.45%）；中、西部地区需求型工具多用于提升基层岗位吸引力（41.52%、43.11%），东北地区供给型工具多用于保障基本运行（30.38%）。结论 政策工具中需求型最多、环境型较少；政策目标分布不均且工具匹配单一；四大经济区域在政策目标、工具运用及两者匹配上存在差异。应聚焦治理需求，调整工具配置；兼顾目标均衡，强化运行保障并明确主体责任；立足区域短板，精准施策。 |
| 关键词:基层医疗卫生机构 财政保障 绩效管理 政策工具 |
| 基金项目:北京市卫生健康委员会委托课题“北京市基层医疗机构运行补偿机制研究”资助项目（BUCM-2024-KJ-GL-011） |
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| Analysis of the policy texts on "First-class Guarantee and Second-class Management" for primary medical and health institutions in China from the perspective of policy tools |
| WANG Yue, XU Yu-tong, MAN Xiao-wei, ZHAO Li-ying, JIANG Yan |
| School of Management， Beijing University of Chinese Medicine， Beijing 100029， China |
| Abstract:Objective To analyze the differences in tool combinations， goal matching， and regional variations of policies on "public welfare first-class guarantee and public welfare second-class management" for primary medical and health institutions.Methods A quantitative analysis of 74 policy texts was conducted based on the analytical framework of "policy tools-policy goals-economic regions".Results Among policy tools， demand-side policy tools ccounted for the largest proportion at 41.33%， followed by supply-side policy tools at 36.66%， while environmental policy tools occupied the smallest share of 22.02%. The proportions of policy goals were as follows： improving the attractiveness of grassroots positions （26.13%）， balancing resource allocation （19.93%）， promoting sustainable development （19.65%）， stimulating the operational vitality of institutions （16.89%）， ensuring basic operation （12.95%）， and clarifying the responsibilities of various subjects （4.45%）. In the central and western regions， demand-side policy tools are mainly applied to improving the attractiveness of primary healthcare positions， accounting for 41.52% and 43.11% respectively. In the northeastern region， supply-side policy tools are largely oriented toward ensuring basic operational needs， with a proportion of 30.38%.Conclusions Among policy tools， demand-side tools are the most prevalent， while environmental-side tools are the least used. The distribution of policy objectives is uneven， and the matching relationship between policy tools and objectives remains simplistic. There are differences among the four major regions in terms of policy objectives， tool application， and the matching degree between the two. Efforts should be focused on governance demands to adjust the configuration of policy tools； attention should be paid to balancing policy objectives， strengthening the guarantee for basic operations， and clarifying the responsibilities of all relevant subjects； and measures should be precisely based on regional shortcomings. |
| Key words:Primary medical and health institution Fiscal guarantee Performance management Policy tools |
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