Quantitative research of China's contracted family doctor service policy based on a three dimensional analysis framework of "Tool-Element-Strength"
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摘要:
目的 家庭医生签约服务制度是我国医疗卫生体系改革的重要内容和实现全民健康的重要途径, 尽管近年来相关政策不断出台和调整，但对家庭医生政策文本系统性的量化研究仍然较为稀缺。本文对我国家庭医生政策的文本内容进行量化分析，通过归纳分析现有政策的特征与不足，为我国家庭医生制度的进一步完善提供意见与参考。 方法 于2024年7月1日在国务院等部门官方网站及北大法宝数据库检索收集2011年1月—2024年6月中央层面家庭医生签约服务政策文件，构建“工具-要素-力度”的三维分析框架，采用内容分析法，运用NVivo软件对纳入的政策文本内容编码，从政策工具、政策要素、政策力度3个维度对政策文本进行挖掘分析。 结果 对纳入的23份家庭医生签约服务政策文本进行编码后，共得到133条编码，统计分析后发现家庭医生政策工具运用失衡，激励型(11.28%，15条)、信息劝诫型(9.77%, 13条)与系统变革型(6.02%，8条)工具使用不充分；政策要素配置不均，服务对象(11.28%，15条)、服务内容(10.53%，14条)和服务方式(9.02%，12条)关注度有待提升；政策力度整体偏低，平均分为2.13分；政策工具、力度与要素间缺乏协同匹配。 结论 提高政策工具运用均衡性，优化家庭医生政策工具内部结构；注重不同要素的政策供给，丰富和完善家庭医生政策内容；重视维度间政策协同性，健全家庭医生签约服务政策体系。 Abstract:Objective As a pivotal element of healthcare system reform, China ' s contracted family doctor service system is of paramount importance in achieving national health objectives. Despite the introduction of relevant policies in recent years, there is still a paucity of systematic quantitative research on the content of family doctor policies. The objective of this study is to employ a quantitative analysis of the textual content of China ' s contracted family doctor service policies. This analysis will be conducted in order to summarize the characteristics and shortcomings of the existing policies, and to provide suggestions for further improvement of the system. Methods Collect national level family doctors from January 2011 to June 2024 on the official government website on 1 July, 2024. A three-dimensional analysis framework, based on the "Tool-Element-Strength" model was constructed. The content analysis method was employed, and NVivo was used to encode the included policy text content. The policy text was then analyzed from three dimensions. Results Following the coding of 23 family doctor contract service policies, a total of 133 codes were obtained. There is a notable imbalance in the utilization of policy tools, particularly the underutilization of Inducements (11.28%, 15), symbolic and Hortatory (9.77%, 13), and system-changing (6.02%, 8) tools. The policy elements are also uneven, indicating that the service target (11.28%, 15), content (10.53%, 14) and method (9.02%, 12) require greater focus. The strength of the family doctor policy is at a relatively low level, with an average score of 2.13. Furthermore, there is a dearth of interconnectivity between the three dimensions. Conclusion It is recommended that the application of policy tools be improved and that the different elements internal structure of family doctor policy tools be optimized. It is important to consider the different elements of the policy and to enhance the content of family doctor policies accordingly. Emphasize the synergy between three dimensions and improve the policy system for China ' s contracted family doctor service. -
Key words:
- Contracted family doctor service /
- Policy tools /
- Policy elements /
- Policy strength /
- Text analysis
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图 1 家庭医生政策文本分析的三维框架
Figure 1. Three dimensional analysis framework of family doctor policy
图 2 家庭医生政策要素与政策工具、政策力度的三维结构
Figure 2. Three dimensional structure diagram of policy elements, policy tools, and policy strength
图 3 家庭医生政策工具与政策要素、政策力度的三维结构
Figure 3. Three dimensional structure diagram of policy tools, policy elements, and policy strength
表 1 纳入分析的我国家庭医生政策文本
Table 1. China's family doctor policies included in the study
序号 政策名称 发文机构 发布日期 1 关于建立全科医生制度的指导意见(国发〔2011〕23号) 国务院 2011年7月1日 …… …… …… 23 关于推进家庭医生签约服务高质量发展的指导意见(国卫基层发〔2022〕10号) 国家卫生健康委、财政部、人力资源社会保障部等 2022年3月3日 
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表 2 我国家庭医生政策力度量化标准
Table 2. Quantitative standards for the strength of China's family doctor policy
评价标准 政策力度得分(分) 全国人民代表大会及其常务委员会颁布的法律 5 国务院颁布的决定、条例、意见、纲要 4 国务院颁布的通知 3 2个及以上部委的联合发文 2 单个部委发布的意见、办法、通知、公告 1
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表 3 基于政策工具维度的我国家庭医生政策文本分布情况
Table 3. Frequency distribution of family doctor policy texts based on the dimension of policy tools in China
政策工具 条数(%) 子工具 条数(%) 命令规制型 67(50.38) 标准设计 27(20.30) 法规管制 15(11.28) 考核监督 9(6.77) 目标规划 16(12.03) 激励型 15(11.28) 精神激励 5(3.76) 物质激励 10(7.52) 能力建设型 30(22.56) 基础设施建设 4(3.01) 经费保障 7(5.26) 人才建设 10(7.52) 信息化建设 9(6.77) 系统变革型 8(6.02) 组织变革 8(6.02) 信息劝诫型 13(9.77) 试点示范 3(2.26) 舆论宣传 10(7.52)
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表 4 基于政策要素维度的我国家庭医生政策文本分布情况
Table 4. The distribution of family doctor policy texts based on the dimension of policy elements in China
政策要素 条数(%) 服务体系 34(25.56) 服务主体 29(21.80) 服务对象 15(11.28) 服务内容 14(10.53) 服务方式 12(9.02) 服务保障 29(21.80)
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表 5 我国家庭医生政策力度得分与分布情况
Table 5. Scoring and distribution of policy strength for family doctor policy in China
年份 政策条数 力度均分(分) 不同政策力度下的政策分布(条) 力度1 力度2 力度3 力度4 力度5 2011 1 4.00 0 0 0 1 0 2012 1 3.00 0 0 1 0 0 2015 2 2.50 1 0 0 1 0 2016 3 2.67 0 1 2 0 0 2017 6 1.83 4 0 1 1 0 2018 7 2.00 4 1 0 2 0 2019 2 1.00 2 0 0 0 0 2022 1 2.00 0 1 0 0 0 合计 23 2.13 11 3 4 5 0
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