我国疾病预防控制体系建设政策效力与政策效果评估

目的 评估我国疾病预防控制体系建设相关政策文件效力和实施效果,为我国疾病预防控制体系政策制定建言献策。方法 通过国家卫生健康委员会官网、“北大法宝”检索系统以“疾病预防控制”、“疾控体系”、“疾控”为主要检索词检索2003—2022年中央、国家及各部委发布的政策文件,经筛选后最终纳入52项疾病预防控制相关政策。将政策效力划分为政策力度、政策措施、政策目标3个维度,用疾病预防控制支出表示政策效果,通过构建多元线性回归模型对环境型、供给型、需求型三种不同政策工具疾病预防控制体系建设政策实施效果进行回归分析。结果 2003—2022年,我国疾控体系建设相关政策数量与总体效力值呈现平稳波动,且具有明显的正相关关系,政策平均效力值呈M型稳定变化趋势,整体水平偏低; 政策措施得分最高,政策目标次之,政策力度得分最低。相较于其他两种政策工具,环境型政策工具使用频率最高,需求型政策工具使用频率最低; 环境型(Coef.=0.732,P=0.015)、供给型(Coef.=0.64,P=0.010)、需求型(Coef.=0.523,P=0.035)三种政策工具对政策实施效果均具有促进作用,滞后期保持在1～2年; 上一年度的疾控支出对下一年度的政策效果具有促进作用(Coef.=0.74,P=0.032)。结论 我国疾病预防控制政策效力不断提高主要源于政策颁布数量的累计效应; 不同政策工具使用过程中存在不平衡、不充分问题; 三类政策工具均对我国疾病预防控制体系政策实施效果起到一定影响,且环境型政策工具最优; 疾病预防控制相关支出会强化政策实施效果,推动疾控体系建设快速发展。

Evaluation of policy effectiveness and policy effects of China’s Disease Prevention and Control system construction

Objective To evaluate the effectiveness and implementation effect of policy documents related to the construction of China’s disease prevention and control system, and to provide suggestions for the formulation of China’s disease prevention and control system policy. Methods Through the official website of the National Health Commission and the search system of "PKULAW", we searched for "disease prevention and control", "disease control system", "disease prevention and control", "disease control" and "disease prevention and control" from 2003 to 2022. The main search terms were "disease prevention and control", "disease control system", "disease control", and "disease prevention and control", and the policy documents issued by the central government, the state, and various ministries from 2003 to 2022 were searched. The policy effectiveness was divided into three dimensions: policy strength, policy measures, and policy objectives, and the policy effects were expressed in terms of disease prevention and control expenditures, and regression analysis was conducted by constructing multiple linear regression models for the implementation effects of three different policy tools: environmental, supply, and demand-based disease prevention and control system construction policies. Results From 2003 to 2022, the number of policies related to the construction of the disease control system in China showed a smooth fluctuation with an obvious positive correlation with the overall effectiveness value, and the average effectiveness value of the policies showed an M-shaped stable change trend with a low overall level; the policy measures scored the highest, the policy objectives the second highest, and the policy strength the lowest. Compared to the other two policy tools, the environmental policy tool was used most frequently and the demand policy tool was used least frequently; the three policy tools all had a significant contribution to the effect of policy implementation(P<0.05), with the lag period remaining at 1 to 2 years; the CDC expenditures in the previous year formed a significant contribution to the policy effect in the following year(Coef.=0.74, P=0.032). Conclusion There are uneven and insufficient problems in the use of different policy tools; all three types of policy tools have a significant impact on the policy implementation effect of China’s disease prevention and control system, and environment-based policy tools are the best; disease prevention and control-related expenditures will strengthen the policy implementation effect and promote the rapid development of disease control system construction.