深化医改以来社会办医政策的内容、特点与趋势

目的:分析深化医改以来的社会办医相关政策的内容、特点和趋势,为社会办医政策的完善和实施提供参考。方法:将2009—2017年间国家层面出台的39份社会办医相关的政策文本作为研究对象。基于Rothwell和Zegveld对政策工具的分类,构建政策分析框架。对政策文本进行编码、归类,分析政策工具使用情况。结果:社会办医相关政策出台主要集中在2015年以前。深化医改以来,在政策工具利用方面,环境型政策工具(77. 29%)使用最多,其次为供给型政策工具(13. 56%)和需求型政策工具(9. 15%)。2009年,社会办医政策仅使用了环境型政策工具(83.33%)和需求型政策工具(16. 67%)。2010—2015年,环境型政策工具的占比呈现先上升后下降的趋势,供给型和需求型政策工具使用频率均呈先下降后上升的变化趋势。2016—2017年,环境型政策工具占比高达92%。结论:我国现有社会办医的政策工具以环境型为主,未来对环境型政策工具使用的结构有待进一步优化。政策中需求型和供给型政策工具的使用仍有待加强。

Analysis on the contents, features and trends of private health institutions in deepening healthcare system

Objective:To analyze the contents, features and trends of private health institutions in deepening the healthcare system reform in order to provide reference for the future improvements and implementation of private health institutions'' social medical policies. Methods:This study considered 39 private health institutions which were promulgated at the national level between 2009 and 2017 as research objects. Based on the classification of policy tools and instruments of Rothwell and Zegveld, a policy analysis framework was constructed. This paper encoded and classified the contents of the policies, and analyzed the use of policy tools and instruments. Results:Private health institutions'' policies related to social medical treatment were mainly promulgated before 2015. Since the deepening of healthcare system reform, environmental policy tools and instruments have been mostly used where the proportions of 77.29% were obtained in terms of their utilization, followed by supply-side with 13.56% and 9.15% for the demand-side policy tools and instruments. In 2009, only the environmental policy tools and instruments (83.33%) and the demand-side ones (16.67%) were used. From 2010 to 2015, the proportion of environmental policy tools and instruments first showed an increasing trend and then declined, while both of the supply-side and demand-side ones showed an opposite trend. From 2016 to 2017, environmental policy tools and instruments accounted for as much as 92%. Conclusion:It has been observed that the existing private health institutions mainly based on environmental policy tools and instruments which are recommended optimization in the future. The application of supply-side and demand-side policy tools and instruments still needs to be strengthened.