Signing But Not Fulfilling: A Study Of Family Doctor Policy Implementation Strategies From The Perspective Of Street-level Bureaucracy

As a core policy and important support for deepening the reform of primary health care and promoting the healthy China strategy,the signing rate of family doctors' signing service policy in the whole country is increasing.A huge leap has been achieved at the level.However,at the "quality" level,the compliance rate of family doctors' contracting services is still low,and the phenomenon of "signing inconsistency" is very prominent.Therefore,based on the theoretical perspective of street bureaucrats and the practical experience of participatory observation,following the analytical logic of "the logic of policy implementation strategy-the choice of policy implementation strategy-leading to family doctors signing but not contracting",this paper constructs the policy implementation strategy of community medical staff and its logical analysis framework,and takes D Street Community Health Service Center in A City as an example to examine the policy implementation strategy.This paper examines the specific implementation strategies of community medical staff in the implementation of family doctor policy and the underlying logic,in order to deeply analyze the reasons for family doctor's "signing but not signing".The findings are as follows: First of all,in terms of the implementation strategies of family doctors' policies,in the signing stage,the community medical staff mainly adopted the policy implementation strategies such as information power,perfunctory implementation,service reconstruction,while in the signing stage,the medical staff adopted a series of implementation strategies such as selective implementation,service distribution,reciprocal cooperation,which led to the phenomenon of "signing but not fulfilling" appear.Secondly,behind the above-mentioned policy implementation strategies,there are three levels of production logic: institutional organization,bureaucratic individuals and service objects,which provide the space and driving force for medical staff to adopt the above-mentioned implementation strategies.Finally,this study combines the basic policy implementation strategy and the logic behind it,and puts forward policy suggestions to promote the transformation of family doctor's contract service from "signing without signing" to "signing without signing" based on institutional organization,bureaucratic individuals and clients.