背景:综合健康管理系统(IHMS),它将所有医疗保健相关机构团结在一个以健康为中心的组织框架下,对我国推进分级治疗制度和完善新医改具有重要意义。中国的IHMS政策包括不同层次、不同时期的多种政策,对这些政策缺乏全面的解释和分析,不利于IHMS在中国的进一步发展。
目的:本研究旨在全面分析和了解其特点,发展,以及中国IHMS政策的演变,为系统的设计和改进提供信息。
方法:我们遵循PRISMA(系统评价和荟萃分析的首选报告项目)指南,收集了152份政策文件。以政策工具和政策取向为核心,一个全面的6D框架,包括政策层面,政策性质,释放时间,政策工具,利益相关者,通过结合政策文本的内容来确定政策取向。然后使用内容分析对这些维度进行分析。
结果:首先,我们发现,关于政策工具和利益相关者的协调,中国的IHMS政策更倾向于使用基于环境的政策工具(1089/1929,56.45%),这表明需要进一步平衡政策工具的内部结构。对不同演员的关注各不相同,且医师和居民的参与度有待进一步提高(2019年65月,3.22%和2019年11月,0.54%,分别)。第二,在水平差异方面,上海的IHMS政策使用的基于需求的政策工具较少(43/483,8.9%),而国家IHMS政策和其他省市使用的基于供应的工具较少(61/357,17.1%和248/357,69.5%,分别)。国家IHMS战略更加重视智慧医疗建设(包括数字医疗;10/275,3.6%),而上海是健康社区和健康中国发展的领导者(9/158,5.7%和4/158,2.5%,分别)。第三,在时间演变方面,2014-2021年各类政策工具呈现先增后减的趋势,近3年环境型政策工具使用相对较多,需求型政策工具使用较少。中国IHMS政策的增长可以分为3个阶段:以疾病为中心的时期(2014-2017年),电子健康技术发展时期(2017-2019年),和以健康为中心的时期(2018-2021年)。
结论:政策制定者应该做出一些调整,例如协调政策工具和利益相关者之间的不平衡关系;根据地方特点把握关键政策优先事项;并注重横向,从社区开始多维整合卫生资源。本研究拓展了政策研究的对象,完善了政策分析的框架。这些发现为未来的政策制定和优化提供了一些可能的经验教训。
BACKGROUND: The integrated health management system (IHMS), which unites all health care-related institutions under a health-centered organizational framework, is of great significance to
China in promoting the hierarchical treatment system and improving the new health care reform.
China\'s IHMS policy consists of multiple policies at different levels and at different times; however, there is a lack of comprehensive interpretation and analysis of these policies, which is not conducive to the further development of the IHMS in China.
OBJECTIVE: This study aims to comprehensively analyze and understand the characteristics, development, and evolution of
China\'s IHMS policy to inform the design and improvement of the system.
METHODS: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to collect 152 policy documents. With the perspective of policy tools and policy orientation as the core, a comprehensive 6D framework including policy level, policy nature, release time, policy tools, stakeholders, and policy orientation was established by combining the content of policy texts. These dimensions were then analyzed using content analysis.
RESULTS: First, we found that, regarding the coordination of policy tools and stakeholders,
China\'s IHMS policy was more inclined to use environment-based policy tools (1089/1929, 56.45%), which suggests a need for further balance in the internal structure of policy tools. Attention to different actors varied, and the participation of physicians and residents needs further improvement (65/2019, 3.22% and 11/2019, 0.54%, respectively). Second, in terms of level differences, Shanghai\'s IHMS policy used fewer demand-based policy tools (43/483, 8.9%), whereas the national IHMS policy and those of other provinces and cities used fewer supply-based tools (61/357, 17.1% and 248/357, 69.5%, respectively). The national IHMS strategy placed more emphasis on the construction of smart health care (including digital health; 10/275, 3.6%), whereas Shanghai was a leader in the development of healthy community and healthy China (9/158, 5.7% and 4/158, 2.5%, respectively). Third, in terms of time evolution, the various policy tools showed an increasing and then decreasing trend from 2014 to 2021, with relatively more use of environment-based policy tools and less use of demand-based policy tools in the last 3 years. The growth of
China\'s IHMS policy can be divided into 3 stages: the disease-centered period (2014-2017), the e-health technology development period (2017-2019), and the health-centered period (2018-2021).
CONCLUSIONS: Policy makers should make several adjustments, such as coordinating policy tools and the uneven relationships among stakeholders; grasping key policy priorities in the context of local characteristics; and focusing on horizontal, multidimensional integration of health resources starting from the community. This study expands the objects of policy research and improves the framework for policy analysis. The findings provide some possible lessons for future policy formulation and optimization.