政策工具视角下我国基本医保市级统筹推进的政策文本分析与启示

目的：通过对我国261份基本医保市级统筹政策文本进行量化分析，发现在政策时间、政策工具类型和政策目标不同维度上的分布特征，为进一步完善基本医保市级统筹、推进省级统筹提供参考。方法：通过内容分析和定量分析方法，构建“政策工具类型—政策目标—政策时间”三维框架，对地市级层面医保统筹政策条目进行多维分类和交叉分析。结果：从政策工具类型维度来看，需求型和环境型政策工具不断完善，医保与医疗服务协同、权责关系划分等日益得到重视，但局部政策子工具缺失等问题突出；从政策目标维度来看，政策目标多维覆盖，但缺乏协同性；从政策时间维度来看，政策工具的发展呈现循序渐进、行政指令层级扩散的特点。启示：优化多种政策工具，完善政策内容与目标适配性，形成政策合力；总结基本医保市级统筹政策变迁及政策工具应用的经验，为我国推进省级统筹提供参考。

Policy text analysis and its implications of prefectural-level basic medical insurance risk pooling in China from the perspective of policy tools

Objective: To make a quantitative analysis of the policy tools of 261 prefectural-level basic medical insurance risk pooling policy text, analyze the distribution characteristics in dimensions including phases, tools and objectives, so as to provide references for the optimization of China''s basic medical insurance risk pooling policy. Methods: Content analysis and quantitative analysis method were performed, a three-dimensional framework of “tools(X-dimension)-objectives(Y-dimension)-phases(Z-dimension)”was constructed, which was used to perform multi-dimensional classification and cross-comparison analysis on policy items. Results: According to the X-dimension, environmental and demand-based policy tools were constantly improving, but partial policy sub-tools are seriously missing. From the Y-dimension, policy objectives covered multiple dimensions but failed to complement each other. From the Z-dimension, the use of policy tools in different stages shows the characteristics of gradual progressive and hierarchical diffusion. policy suggestions are put forward: Optimize the combination of various policy tools, improve the adaptability of policy content and objectives, and form inter-dimensional policy synergy. On the basis of the summarized experience in the application of policy tools, providing references for provincial-level basic medical insurance risk pooling in China.