Li B, Bao Y, Feng X
Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China.
Medical Affairs Department, People's Hospital of Golog Tibetan Autonomous Prefecture, Golog Tibetan Autonomous Prefecture 814000, Qinghai, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Jun 18;57(3):417-422. doi: 10.19723/j.issn.1671-167X.2025.03.002.
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.
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.
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.
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.
本研究对国家层面发布的与医疗联合体相关的政策文件进行文本分析，识别中国医疗联合体政策工具的结构特征与运用情况，评估其与政策目标的契合度，揭示政策设计中的结构矛盾，为优化医疗联合体制度提供依据。
本研究利用“医疗联合体”等关键词，在北大法宝数据库、知网政府文件数据库中系统检索国家层面的医疗联合体政策文件。基于政策工具理论构建“政策工具—政策目标”二维分析框架，对政策工具与目标之间的频次、分布特征及互动关系进行量化分析。
共纳入2009年至2024年国家层面的50份医疗联合体政策文件，其中56%由单个部门单独发布。政策文本分析结果显示，政府可运用多种政策工具实现目标，但存在结构失衡问题，环境政策工具占比最高（46.48%），主要集中在制度保障（27.27%）和组织治理（22.73%），对公众意识引导关注最少（6.82%）。供给侧政策工具（38.38%）过度依赖信息技术基础设施建设（24.77%）和医疗资源合理配置（24.77%），对劳动力能力建设（9.17%）和财政投入（4.59%）关注不足。需求侧政策工具仅占15.14%，以医保支付（37.21%）和试点项目推广（32.56%）为主，而服务外包等市场化工具（9.30%）使用较少。互动分析表明，政策工具集中于提升基层医疗服务能力，但对优化医疗资源配置支持不足，这表明政策工具与政策目标存在错位。
中国医疗联合体政策部门间协调性弱且结构失衡，表现为过度依赖环境和供给侧工具，需求侧工具使用不足，工具类别内部存在错位，且政策工具与目标匹配不佳。为解决这些问题，未来政策制定应加强跨部门协作，丰富政策工具，优化其内部结构，提高工具与目标的契合度。
