School of Public Administration, Central South University, Changsha 410083, China.
School of Nursing, Xi'an Jiaotong University, Xi'an 710061, China.
Int J Environ Res Public Health. 2020 Mar 30;17(7):2327. doi: 10.3390/ijerph17072327.
Facing the aggravating trend of an aging population and a fragmented medical service delivery system, the Chinese Central Government has introduced a series of policies to promote the development of integrated care against the background of the "Healthy China Strategy". The achievement of integrated care depends on the choice of policy instruments. However, few studies have focused on how policy instruments promote the practice of integrated care in China. This article aims to obtain a deeper understanding of the use of policy instruments in the development of integrated care in China. Policy documents are the carriers of policy instruments. National-level integrated care policy documents from 2009 to 2019 were selected. Using the qualitative document analysis method, this paper conducts an analysis of integrated care policy instruments. In order to comprehensively view the integrated care policy instruments, a three-dimensional analytical framework consisting of the policy instruments dimension, stakeholders dimension, and health service supply chains dimension is proposed. The results are as follows. (1) From the perspective of policy instruments, the integrated care policy has adopted supply-side policy instruments, demand-side policy instruments, and environmental policy instruments. Among the three types of policy instruments, environmental policy instruments are used most frequently, supply-side policies are preferred, while demand-side policy instruments are relatively inadequate. (2) As for the stakeholders dimension, the central policy instruments focus on the health service providers, while less attention is paid to the health service demanders. (3) In terms of health service supply chains, the number of policy instruments used in the prevention stage is the highest, followed by the treatment stage, whereas less attention paid to the rehabilitation stage. Finally, suggestions were made for the development of integrated care by better perfecting policy instruments.
面对人口老龄化加剧和医疗服务提供系统碎片化的趋势，中国中央政府在“健康中国战略”背景下推出了一系列政策，以促进整合护理的发展。整合护理的实现取决于政策工具的选择。然而，很少有研究关注政策工具如何促进中国整合护理的实践。本文旨在更深入地了解中国在发展整合护理中政策工具的使用。政策文件是政策工具的载体。本文选取了 2009 年至 2019 年的国家级整合护理政策文件，采用定性文件分析方法，对整合护理政策工具进行了分析。为了全面了解整合护理政策工具，提出了一个由政策工具维度、利益相关者维度和卫生服务供应链维度组成的三维分析框架。结果如下。(1)从政策工具的角度来看，整合护理政策采用了供给侧政策工具、需求侧政策工具和环境政策工具。在这三种政策工具中，环境政策工具使用最频繁，供给侧政策优先，而需求侧政策工具相对不足。(2)就利益相关者维度而言，中央政策工具侧重于卫生服务提供者，而对卫生服务需求者的关注较少。(3)在卫生服务供应链方面，预防阶段使用的政策工具数量最高，其次是治疗阶段，而对康复阶段的关注较少。最后，提出了完善政策工具以促进整合护理发展的建议。
