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零售药店纳入门诊统筹管理政策实施的阻滞因素与疏通路径
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| 篇名： | 零售药店纳入门诊统筹管理政策实施的阻滞因素与疏通路径 |
| TITLE： | Barriers to and facilitating pathways for incorporating retail pharmacies into outpatient pooling policies |
| 摘要： | 目的 剖析零售药店纳入门诊统筹管理政策在执行过程中的阻滞因素，并探索提升政策执行效能的实践路径。方法基于史密斯政策执行过程模型，构建政策分析框架。选取湖南省为典型样本，综合运用政策文本分析与半结构化访谈法，对相关政策文件进行深度解读，并对医保行政部门、定点医疗机构、零售药店及参保人员等多方关键主体共计42位进行访谈，对访谈文本进行分析。结果与结论零售药店纳入门诊统筹管理政策的有效执行主要面临四维阻滞：一是政策自身存在系统性设计不完善与协调性不足的问题，导致源头性制约；二是执行主体间缺乏有效协同机制，服务与监管呈碎片化；三是目标群体存在政策认知偏差，且在利益驱动下行为发生扭曲；四是医保基金压力与传统就医观念等环境因素叠加，制约了政策的落地空间。为此，本研究建议，应进一步强化顶层设计，消弭规则模糊与执行偏差；健全多方协同机制，提升政策运行效能；深化政策解读与利益协调，引导目标群体作出理性行为；破除环境壁垒，构建适应政策发展的外部生态，以推动零售药店纳入门诊统筹管理工作的高质量发展。 |
| ABSTRACT： | OBJECTIVE To analyze the deep-seated impeding factors in the implementation process of the policy integrating retail pharmacies into the outpatient pooling system， and explore practical paths to improve policy implementation efficiency. METHODS Based on Smith’s policy implementation process model， an analytical framework was constructed. Selecting Hunan province as a typical sample， this study combined policy text analysis and semi-structured interviews to conduct an in-depth interpretation of relevant policy documents and interviewed a total of 42 key stakeholders from multiple parties， including medical insurance administrative departments， designated medical institutions， retail pharmacies， and insured persons， and the interview texts were analyzed. RESULTS & CONCLUSIONS The study indicated that the effective implementation of this policy faces four dimensions of impediments： first， the policy itself suffered from systemic design problems and insufficient coordination， leading to source-based constraints； second， there was a lack of effective synergy mechanisms among implementing agencies， resulting in fragmented service and supervision capabilities， and their behaviors were distorted by interest-driven motives； third， there were cognitive biases regarding the policy among the target group， and their behaviors were distorted by interest-driven motives； fourth， environmental factors such as pressure on medical insurance funds and traditional medical-seeking concepts overlapped to restrict the space for policy implementation. Therefore， the following optimization strategies are proposed： strengthening top-level design to eliminate rule ambiguity and implementation deviation； improving multi-party synergy mechanisms to enhance policy operational efficiency； deepening policy interpretation and interest coordination to guide rational behavior among the target group； and breaking environmental barriers to build an external ecosystem adaptable to policy development， thereby promoting the high quality development of incorporating retail pharmacies into the outpatient pooling system. |
| 期刊： | 2026年第37卷第05期 |
| 作者： | 李立清；腾佳杉；仲光金 |
| AUTHORS： | LI Liqing，TENG Jiashan，ZHONG Guangjin |
| 关键字： | 零售药店；门诊统筹；史密斯政策执行过程模型；政策执行效能 |
| KEYWORDS： | retail pharmacies； outpatient pooling； Smith policy implementation process model； policy implementation |
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