摘要
背景社区健康管理服务作为预防疾病、提升居民健康水平的重要方式,逐渐被各级政府部门重视,并陆续出台相关政策,但由于政策主体、类型多样,该领域政策的创新扩散路径和特点尚不清楚,缺乏系统的梳理和研究。目的基于创新扩散理论的视角与方法探索我国社区健康管理服务政策扩散的过程与特点,为社区健康管理政策制定及推广提供参考依据。方法于2021年6—9月,在各级政府和卫生行政部门官方网站、“北大法宝”等权威数据库中检索1997年1月至2021年7月发布的涉及社区健康管理服务的政策文件。采用政策参照网络分析法和关键词时序分析法,从政策扩散强度、广度、速度、方向4个维度对社区健康管理服务政策扩散过程和特点进行量化分析。结果共纳入政策文件1540件,包括中央政策159件、地方政策1381件。将目前国内社区健康管理服务的发展划分为萌芽期(1997—2004年)、形成期(2005—2008年)、转折期(2009—2012年)、初步发展期(2013—2015年)、创新开拓期(2016—2021年)共5个阶段。社区健康管理服务政策中扩散强度和广度较大的政策发布机构基本为行政级别较高的中央机构,且政策类型主要以规划、意见、法律为主,扩散强度排在前10位政策的绝对扩散广度均超过30,扩散广度排在前10位政策的绝对扩散广度均超过20。大部分政策的扩散速度随时间呈现先增长后减缓的变化趋势。中医药健康管理服务在政策发布机构间的扩散方向主要呈现同级平行扩散和中央向地方自上而下的扩散特点。结论通过政策扩散研究系统、全面地了解了我国社区健康管理服务政策扩散的过程和特点,并得出我国社区健康管理服务政策发展主要经历五大阶段,其政策扩散过程受发布机构行政级别、政策类型等自身属性影响,具有多重路径特点,存在学习和模仿等多种机制,在时间上呈“先骤增、后减缓”变化等结论。
Background All levels of China gevernment departments have attached importance to community health management services,an important way for disease prevention and resident saveealth improvement,and successively promulgated relevant management policies.However,there is a lack of systematic review and research on the diffusion paths and characteristics of these policies,which are still unclear due to the diversity of promulgating agencies and types of polices.Objective To explore the process and features of the diffusion of China community health management policies,providing a reference for the formulation and promotion of these kinds of policies.Methods From June to September 2021,we searched policy documents related to community health management services published from January 1997 to September 2021 in the official websites of all levels of government and health administrative departments,as well as authoritative databases such as PKULAW.com and so on,then quantitatively analyzed the process and features of diffusion of them in terms of four aspects(intensity,breadth,speed,and direction of diffusion)using policy network analysis and keyword analysis by time series.Results A total of 1540 policies related to community health management were retrieved(including 159 central policies and 1381 local policies).The development of community health management services in China may be divided into five stages:germination(1997—2004),formation(2005—2008),transition(2009—2012),initial development(2013—2015)and innovation and development(2016—2021).Policies which were diffused more intensively and widely were promulgated by central agencies of higher administrative levels,and mainly classified as planning,opinions,and laws.The absolute diffusion breadth of the top 10 policies in terms of diffusion intensity exceeded 30,and the absolute diffusion breadth of the top 10 policies in terms of spreading breadth exceeded 20.The diffusion speed of most policies showed a trend of first increasing and then slowing down over time.The diffusion of Chinese medicine health management policies mainly presented parallel diffusion among policy promulgating agencies at the same level,and top-to-bottom diffusion from the central policy promulgating agencies to the local ones.Conclusion Through policy diffusion research,we had a comprehensive understanding of the process and characteristics of diffusion of China's community health management policies,and drew a number of conclusions,including the five-stage development of these policies,and the policy diffusion process may be affected by the attributes of the administrative level of the promulgating agencies and types of policies.In addition,the diffusion of these policies could be achieved via multiple paths,with many mechanisms of action such as learning and imitation,with a speed of"first increasing,then slowing down"over time.
作者
许航
马晓静
代涛
XU Hang;MA Xiaojing;DAI Tao(Peking Union Medical College,Beijing 100730,China;Institute of Medical Information,Chinese Academy of Medical Sciences,Beijing 100020,China)
出处
《中国全科医学》
CAS
北大核心
2022年第16期1995-2002,共8页
Chinese General Practice
基金
国家自然科学基金青年科学基金项目(71804192)
中国医学科学院医学与健康科技创新工程“揭榜挂帅”项目(2021-I2M-1-046)。
关键词
社区卫生服务
健康管理
卫生政策
政策创新扩散
Community health services
Health management
Health policy
Policy innovation diffusion
