Overview,Changes And Developing Trend Of China’s Hierarchical Medical Policies

Research purpose: Since the New Medical Reform,the Hierarchical Medical System,which is the first of the five basic medical systems,has received extensive attention.From 1949 to 2019,the government has issued a series of policy documents to support the construction of Hierarchical Medical System.With the development of practice,domestic academic research on hierarchical medical is becoming more and more abundant.At present,domestic hierarchical medical policy research is still very immature as an emerging research field.There are still many questions in the research that need to be discussed and answered,among which an important and fundamental problem is the lack of systematic understanding of the hierarchical medical policy system.In order to understand China’s hierarchical medical policy system,sort out the development context and understand the laws of change,this study systematically analyzes China’s hierarchical medical policies since the founding of New China from the perspective of policy tools and bibliometrics.Research methods: Text Analysis,first of all,encode the hierarchical medical policies according to certain principles,secondly,construct quantitative analysis models from the three dimensions of policy tools,medical activity stakeholders,and time series,and finally use analysis model sorts out the usage status of China’s hierarchical medical policy tools;Bibliometrics Analysis,first categorizes the hierarchical medical policies in the same period into an analysis text,establishes a text analysis database,and secondly uses the text analysis software ROSTCM6 to obtain the high-frequency words of the policy text in each period,and finally draw a multi-dimensional scale map based on high-frequency words,and analyze the relationship between high-frequency words.Research conclusions:(1)Characteristics of each stage of China’s hierarchical medical policy: Policy budding period: medical institutions,rural health and free medical care system are mainly concerned;Policy exploration period: medical institutions,especially primary medical institutions,are the focus of attention,beginning to pay attention to talents and use financial means;Policy development period: pay more attention to the use of economic means and increase the emphasis on medical staff;Policy improvement period: introduce multiple subjects to participate in system construction,and gradually refine the content of system construction.(2)China’s hierarchical medical policy changes have three characteristics: the policy philosophy is from "management" to "governance",from "treatment" to "health",and the policy structure from "loose" to "close",Policy implementation from " heavy input " to " input and output consideration ".(3)Five problems faced by China’s hierarchical medical policy: first,supply-based and environmental-based tools overflow,demand-based tools are insufficient,and second,use of policy tools of medical institutions and patients are insufficient.Third,insufficient attention is paid to social forces.Fourth,a policy evaluation system has not been established.Fifth,the importance of preventive health care has declined.