中国医疗联合体建设的政策目标与政策工具——基于政策文本的量化研究

doi:10.19723/j.issn.1671-167X.2025.03.002

摘要/Abstract

摘要：

目的: 对国家层面出台的医疗联合体(以下简称“医联体”)相关政策进行文本分析，揭示我国医联体政策工具的使用情况及其与政策目标的匹配关系，发现政策设计的结构性矛盾，为优化医联体制度提供依据。方法: 通过访问北大法宝、中国知网政府文件数据库和政府官方网站，以“医联体”“医疗联合体”等作为关键词，收集相关政策文件。结合政策文本内容，构建“政策工具-政策目标”的二维分析框架，量化分析政策工具的使用频率、分布特征及其与政策目标的交互关系。结果: 研究共纳入2009—2024年50份政策文件，文件类型主要以单独发布(56%)为主。文本分析结果显示，政府能够使用各种政策工具完成政策目标，但是政策工具存在使用失衡的情况。环境型政策工具占比最高(46.48%)，集中于制度保障(27.27%)与组织管理(22.73%)，但宣传引导(6.82%)薄弱；供给型政策工具(38.38%)过度依赖信息化建设(24.77%)与合理配置医疗资源(24.77%)，人才队伍建设(9.17%)与资金投入(4.59%)不足；需求型政策工具仅占15.14%，由医保支付(37.21%)与推进试点(32.56%)主导，服务外包(9.30%)等市场化工具应用匮乏。交互分析结果显示，政策工具主要集中于提升基层卫生服务能力政策目标，对优化医疗卫生资源配置政策目标支撑不足，政策工具与政策目标不能合理匹配。结论: 医联体政策制定在不同部门间的协同较弱，且政策工具呈现结构性失衡，高度依赖环境型政策工具与供给型政策工具，需求型政策工具应用严重不足，各个类型政策工具内部也存在不同的使用偏好，政策工具与政策目标匹配不佳。未来政策制定需要加强不同部门之间的合作，探索使用不同类型的政策工具，同时优化政策工具内部结构，强化政策工具对政策目标的支撑。

关键词: 医疗联合体, 政策分析, 政策工具, 政策目标

Abstract:

Objective: This study conducts a text analysis of the policy documents related to Medical Consortium issued at the national level, identify the structural characteristics and utilization of Chinese Medical Consortium policy instruments, evaluate their alignment with policy objectives, uncover the structural contradictions in policy design, and provide a basis for optimizing the Medical Consortium system. Methods: This study systematically searched national-level Medical Consortium policy documents from the PKU Law Database, CNKI Government Document Database using keyword like Medical Consortium. A two-dimensional "policy instrument-policy objective" analytical framework was constructed based on policy instrument theory to quantitatively analyze the frequency, distribution characteristics, and interactive relationships between policy instruments and objectives. Results: A total of 50 national-level Me-dical Consortium policy documents from 2009 to 2024 were included, with 56% issued solely by single departments. The policy text analysis results showed that the government could use diverse policy instruments to achieve objectives, but the structural imbalances existed, environmental policy instruments accounted for the highest proportion (46.48%), mainly focusing on institutional safeguards (27.27%) and organizational governance (22.73%), with minimal focus on public awareness guidance (6.82%). Supply-side policy instruments (38.38%) overly relied on IT infrastructure development (24.77%) and rational allocation of medical resources (24.77%), with insufficient attention to workforce capacity building (9.17%) and financial input (4.59%). Demand-side policy instruments constituted only 15.14%, dominated by health insurance payment (37.21%) and pilot program promotion (32.56%), while market-oriented instruments such as service outsourcing (9.30%) were rarely used. Interaction analysis revealed that policy instruments were concentrated on enhancing primary care service capacity but provided inadequate support for optimizing allocation of medical resources, which indicated a misalignment between policy instruments and policy objective. Conclusion: Chinese Medical Consortium policies exhibit weak interdepartmental coordination and structural imbalances, characterized by excessive reliance on environmental and supply-side instruments, underuse of demand-side tools, and internal misalignment within instrument categories. And policy instruments and objectives are not well matched. To address these issues, future policy formulation should strengthen cross-departmental collaboration, diversify policy instruments, optimize their internal structures, and improve the alignment between instruments and objectives.

Key words: Medical Consortium, Policy analysis, Policy tools, Policy objectives

中图分类号:

R197.1

李彪, 鲍羊措吉, 冯星淋. 中国医疗联合体建设的政策目标与政策工具——基于政策文本的量化研究[J]. 北京大学学报（医学版）, 2025, 57(3): 417-422.

Biao LI, Yangcuoji BAO, Xinglin FENG. Policy objectives and tools for the construction of Chinese Medical Consortium: A quantitative study based on policy texts[J]. Journal of Peking University (Health Sciences), 2025, 57(3): 417-422.

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参考文献 14

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Instrument type	Instrument name	Frequency	Percentage/%
Supply-side policy instruments	Financial input	5	4.59
	Workforce capacity building	10	9.17
	IT infrastructure development	27	24.77
	Primary care capacity building	24	22.02
	Enhancing service continuity	16	14.68
	Rational allocation of medical resources	27	24.77
Demand-side policy instruments	Service outsourcing	4	9.30
	Price adjustment	3	6.98
	Health insurance payment	16	37.21
	Pilot program promotion	14	32.56
	Incentive guarantees	6	13.95
Environmental policy instruments	Objective planning	29	21.97
	Monitoring & Evaluation	17	12.88
	Public awareness guidance	9	6.82
	Organizational governance	30	22.73
	Institutional safeguards	36	27.27
	Functional positioning	11	8.33

Objective	Specific objectives	Frequency	Percentage/%
Enhance primary care service capacity	Improve management proficiency	44	38.94
	Elevate service quality	43	38.05
	Establish digital health platforms	27	23.89
Optimize allocation of medical resources	Strengthen collaborative coordination	13	24.53
	Achieve regional resource sharing	30	56.60
	Implement two-way referral systems	10	18.87

Dimension	Enhance primary care service capacity			Optimize allocation of medical resources
Dimension	Elevate service quality	Improve management proficiency	Establish digital health platforms	Implement two-way referral systems	Achieve regional resource sharing	Strengthen collaborative coordination
Supply-side policy instruments
Enhancing service continuity	0	2	0	10	1	2
Primary care capacity building	19	1	0	0	3	0
Workforce capacity building	10	0	0	0	0	0
IT infrastructure development	0	0	27	0	1	0
Rational allocation of medical resources	3	0	0	0	22	1
Financial input	2	0	0	0	0	0
Total	34	3	27	10	27	3
Percentage/%	32.69	2.88	25.96	9.62	25.96	2.88
Environmental policy instruments
Functional positioning	0	0	0	0	0	10
Monitoring & Evaluation	1	2	0	0	0	0
Objective planning	1	1	0	0	1	0
Public awareness guidance	0	0	0	0	0	0
Institutional safeguards	7	15	0	0	2	0
Organizational governance	0	24	0	0	0	0
Total	9	42	0	0	3	10
Percentage/%	14.06	65.63	0.00	0.00	4.69	15.63
Demand-side policy instruments
Incentive guarantees	0	1	0	0	0	0
Service outsourcing	0	0	0	0	1	0
Price adjustment	0	0	0	0	0	0
Pilot program promotion	2	0	0	0	0	0
Health insurance payment	0	2	0	0	1	0
Total	2	3	0	0	2	0
Percentage/%	28.57	42.86	0.00	0.00	28.57	0.00