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Article(id=1324044892653093633, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044701648695723, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511035, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1762185600000, receivedDateStr=2025-11-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606501973, onlineDateStr=2026-11-02, pubDate=1779638400000, pubDateStr=2026-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606501973, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606501973, creator=13701087609, updateTime=1793606501973, updator=13701087609, issue=Issue{id=1324044701648695723, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='1779638400000', pubDateStr='2026-05-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606456434, creator='13701087609', updateTime=1793670074552, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311535425815306, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044701648695723, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311535425815307, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044701648695723, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1848, endPage=1854, ext={EN=ArticleExt(id=1324044892938306306, articleId=1324044892653093633, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=A quantitative analysis of China’s medical cluster policy texts based on a three-dimensional analytical framework, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the implementation effectiveness of medical cluster policies and promote high-quality primary healthcare.

Methods

Using a “policy tools-policy objectives-policy effectiveness” framework, text analysis and the PMC index model were applied to policy texts on medical clusters issued by China’s central government and Shanxi and Zhejiang provinces from 2014 to 2024.

Results

Current policies showed imbalanced policy tools, vague policy objectives, and weak incentive-constraint mechanisms.

Conclusion

Optimizing policy instruments, refining quantitative targets, and strengthening incentive and constraint measures can improve the effectiveness and quality of medical cluster policies, promoting high-quality primary healthcare development.

, authors=Shou-tong FENG1, Bao-xiang SONG1, 2, authorsList=Shou-tong FENG, Bao-xiang SONG, authorCompany=null, correspAuthors=Bao-xiang SONG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324044894146265867, articleId=1324044892653093633, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于三维分析框架的我国医共体政策文本量化研究, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

评估医共体政策实施效果，推动基层医疗服务高质量发展。

方法

本研究基于“工具—目标—效力”框架，采用内容分析法和PMC指数模型，对2014—2024年我国中央层面及山西、浙江两省医共体政策文本进行量化分析。

结果

目前我国医共体政策存在工具使用失衡、目标细化不足以及激励约束薄弱等问题。

结论

应优化政策工具结构、细化目标量化指标并强化激励约束措施，以全面提升医共体政策实施效果与建设质量，推动基层医疗服务体系高质量发展。

, authors=冯守桐1, 宋宝香1, 2, authorsList=冯守桐, 宋宝香, authorCompany=null, correspAuthors=宋宝香, authorNote=

冯守桐（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

, correspAuthorsNote=
宋宝香，E-mail：
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冯守桐（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

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(In Chinese), articleTitle=Quantitative evaluation of Jilin province digital economy policy based on PMC index model, refAbstract=null), Reference(id=1324045091152724556, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, doi=null, pmid=null, pmcid=null, year=2021, volume=38, issue=15, pageStart=125, pageEnd=134, url=null, language=null, rfNumber=［24］, rfOrder=44, authorNames=臧维, 张延法, 徐磊, journalName=科技进步与对策, refType=null, unstructuredReference=臧维，张延法，徐磊．我国人工智能政策文本量化研究——政策现状与前沿趋势[J]. 科技进步与对策，2021, 38(15):125-134., articleTitle=我国人工智能政策文本量化研究——政策现状与前沿趋势, refAbstract=null), Reference(id=1324045091240804941, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, doi=null, pmid=null, pmcid=null, year=2021, volume=38, issue=15, pageStart=125, pageEnd=134, url=null, language=null, rfNumber=［24］, rfOrder=45, authorNames=Zang W, Zhang YF, Xu L, journalName=Science & Technology Progress and Policy, refType=null, unstructuredReference=Zang W, Zhang YF, Xu L. Quantitative research on artificial intelligence policy text in China——policy status quo and frontier trends[J]. Science & Technology Progress and Policy, 2021, 38(15): 125-134. (In Chinese), articleTitle=Quantitative research on artificial intelligence policy text in China——policy status quo and frontier trends, refAbstract=null), Reference(id=1324045091333079630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, doi=null, pmid=null, pmcid=null, year=2025, volume=56, issue=6, pageStart=1498, pageEnd=1505, url=null, language=null, rfNumber=［25］, rfOrder=46, authorNames=李乔晟, 王婷, 简伟研, journalName=四川大学学报（医学版）, refType=null, unstructuredReference=李乔晟，王婷，简伟研．医务人员医防融合知信行现状与影响路径研究[J]. 四川大学学报（医学版），2025, 56(6):1498-1505., articleTitle=医务人员医防融合知信行现状与影响路径研究, refAbstract=null), Reference(id=1324045091442131535, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, doi=null, pmid=null, pmcid=null, year=2025, volume=56, issue=6, pageStart=1498, pageEnd=1505, url=null, language=null, rfNumber=［25］, rfOrder=47, authorNames=Li QS, Wang T, Jian WY, journalName=J Sichuan Univ（Med Sci）, refType=null, unstructuredReference=Li QS, Wang T, Jian WY. Current status and effect pathways of knowledge, attitude, and practice of medical care and prevention integration among medical professionals[J]. J Sichuan Univ（Med Sci） , 2025, 56(6): 1498-1505. (In Chinese), articleTitle=Current status and effect pathways of knowledge, attitude, and practice of medical care and prevention integration among medical professionals, refAbstract=null)], funds=[Fund(id=1324045085448471068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, awardId=24JZD043, language=CN, fundingSource=教育部哲学社会科学研究重大课题攻关项目(24JZD043), fundOrder=null, country=null), Fund(id=1324045085549134365, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, awardId=KYCX25_2441, language=CN, fundingSource=江苏省研究生科研与实践创新计划项目(KYCX25_2441), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324045073289183714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, xref=1., ext=[AuthorCompanyExt(id=1324045073301766627, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, companyId=1324045073289183714, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China), AuthorCompanyExt(id=1324045073343709668, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, companyId=1324045073289183714, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京中医药大学卫生经济管理学院，江苏 南京 210023)]), AuthorCompany(id=1324045073494704613, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, xref=2., ext=[AuthorCompanyExt(id=1324045073704419814, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, companyId=1324045073494704613, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.江苏省习近平新时代中国特色社会主义思想研究中心南京中医药大学理论研究基地)])], figs=[ArticleFig(id=1324045080859902466, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Fig.1, caption=A three-dimensional analytical framework for China’s medical Cluster policies, figureFileSmall=vFpl/+JGUeANcwbmwlWBqQ==, figureFileBig=ebEiOX1qNdX5FrA4h+bIDg==, tableContent=null), ArticleFig(id=1324045080960565763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=图1, caption=我国医共体政策的三维分析框架, figureFileSmall=vFpl/+JGUeANcwbmwlWBqQ==, figureFileBig=ebEiOX1qNdX5FrA4h+bIDg==, tableContent=null), ArticleFig(id=1324045081287721477, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Fig.2, caption=PMC surface of medical cluster policy texts, figureFileSmall=epxZhoEbxZjtst/IH+i9sA==, figureFileBig=xA4+F5lqRKcJ8kDEFGWENg==, tableContent=null), ArticleFig(id=1324045081384190470, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=图2, caption=医共体政策文本的PMC曲面, figureFileSmall=epxZhoEbxZjtst/IH+i9sA==, figureFileBig=xA4+F5lqRKcJ8kDEFGWENg==, tableContent=null), ArticleFig(id=1324045081669403143, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Fig.3, caption=X–Y dimensional analytical framework, figureFileSmall=JJaSVXm4R2LlR2aHOH16QQ==, figureFileBig=e12x4vA8ryXhnDhYgN6MEw==, tableContent=null), ArticleFig(id=1324045081744900616, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=图3, caption=X-Y维度分析框架, figureFileSmall=JJaSVXm4R2LlR2aHOH16QQ==, figureFileBig=e12x4vA8ryXhnDhYgN6MEw==, tableContent=null), ArticleFig(id=1324045081853952521, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Fig.4, caption=X-Y dimensional matrix coding of medical cluster policies, figureFileSmall=8jPw3jPPET8SL69lBJI4gA==, figureFileBig=WolfueYtWJB+4vjdCOyBHg==, tableContent=null), ArticleFig(id=1324045081921061386, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=图4, caption=医共体政策X-Y维度矩阵编码, figureFileSmall=8jPw3jPPET8SL69lBJI4gA==, figureFileBig=WolfueYtWJB+4vjdCOyBHg==, tableContent=null), ArticleFig(id=1324045082151748107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 1, caption=

List of China’s medical cluster policy texts (selected)

, figureFileSmall=null, figureFileBig=null, tableContent=
政策编号政策名称发布时间
1国务院办公厅关于推进医疗联合体建设和发展的指导意见2017-04-23
2国家卫生健康委、国家中医药管理局关于推进紧密型县域医疗卫生共同体建设的通知2019-05-15
…
38运城市人民政府办公厅关于印发加快建设运城市中心医院与部分县级医疗集团紧密型医疗联合体实施方案(试行)的通知2018-08-30
), ArticleFig(id=1324045082235634188, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表1, caption=

我国医共体政策文本列表（部分）

, figureFileSmall=null, figureFileBig=null, tableContent=
政策编号政策名称发布时间
1国务院办公厅关于推进医疗联合体建设和发展的指导意见2017-04-23
2国家卫生健康委、国家中医药管理局关于推进紧密型县域医疗卫生共同体建设的通知2019-05-15
…
38运城市人民政府办公厅关于印发加快建设运城市中心医院与部分县级医疗集团紧密型医疗联合体实施方案(试行)的通知2018-08-30
), ArticleFig(id=1324045082311131661, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 2, caption=

Coding scheme for policy content analysis units of China’s medical cluster policies (selected)

, figureFileSmall=null, figureFileBig=null, tableContent=
政策编号内容分析单元编码分类
1四、促进医联体内部优质医疗资源上下贯通（一）促进人力资源的有序流动。1-4-1资源配置
…
36（三）推进家庭医生签约服务。加强全科医生培养。36-3-3家庭医生签约服务
), ArticleFig(id=1324045082390823438, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表2, caption=

我国医共体政策内容分析单元编码表（部分）

, figureFileSmall=null, figureFileBig=null, tableContent=
政策编号内容分析单元编码分类
1四、促进医联体内部优质医疗资源上下贯通（一）促进人力资源的有序流动。1-4-1资源配置
…
36（三）推进家庭医生签约服务。加强全科医生培养。36-3-3家庭医生签约服务
), ArticleFig(id=1324045082512458255, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 3, caption=

Classification and definitions of policy tools

, figureFileSmall=null, figureFileBig=null, tableContent=
工具类型子工具含义
供给型资金支持有关部门资助县级医疗机构建设
人才培养医疗服务人才选拔、招聘及能力提升培训
基础设施支持进行软硬件建设，提高设施和技术水平
信息技术支持实施医疗卫生信息化建设
资源配置医疗资源整合和共享
医保支付改革医保支付方式，建立药品目录、医保报销制度
培训帮扶上级医疗机构提供技术指导和其他支持
需求型坚持公益坚持和保证基层医疗卫生服务的公益性
有序就医建立“双向转诊”机制和家庭医生签约制度
激励机制制定绩效激励考核机制和薪酬制度
环境型策略性措施政府多部门协调，细化医疗服务模式
组织创新创新体制机制，改变管理方式，建立长期机制
功能定位明确医疗机构间的分工协作机制
组织建设强化组织领导，政府积极推动县域医共体建设
行业引导鼓励引入社会资本与社会团体
政策宣传加强宣传县域医共体建设的意义
目标规划对医疗机构的建设进行全方面规划，明确其发展目标与任务
考核评估建立监测评估指标
), ArticleFig(id=1324045082583761424, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表3, caption=

我国医共体政策工具分类及含义

, figureFileSmall=null, figureFileBig=null, tableContent=
工具类型子工具含义
供给型资金支持有关部门资助县级医疗机构建设
人才培养医疗服务人才选拔、招聘及能力提升培训
基础设施支持进行软硬件建设，提高设施和技术水平
信息技术支持实施医疗卫生信息化建设
资源配置医疗资源整合和共享
医保支付改革医保支付方式，建立药品目录、医保报销制度
培训帮扶上级医疗机构提供技术指导和其他支持
需求型坚持公益坚持和保证基层医疗卫生服务的公益性
有序就医建立“双向转诊”机制和家庭医生签约制度
激励机制制定绩效激励考核机制和薪酬制度
环境型策略性措施政府多部门协调，细化医疗服务模式
组织创新创新体制机制，改变管理方式，建立长期机制
功能定位明确医疗机构间的分工协作机制
组织建设强化组织领导，政府积极推动县域医共体建设
行业引导鼓励引入社会资本与社会团体
政策宣传加强宣传县域医共体建设的意义
目标规划对医疗机构的建设进行全方面规划，明确其发展目标与任务
考核评估建立监测评估指标
), ArticleFig(id=1324045082659258897, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 4, caption=

Statistical distribution of policy tools

, figureFileSmall=null, figureFileBig=null, tableContent=
政策工具类型运用次数（次）占比（%）子工具类型运用次数（次）占比（%）
供给型26837.96%资金支持212.97%
人才培养304.25%
基础设施支持131.84%
信息技术支持496.94%
资源配置8612.18%
医保支付334.67%
培训帮扶365.10%
需求型15521.95%坚持公益324.53%
有序就医10014.16%
激励机制233.26%
环境型28340.08%策略性措施223.12%
组织创新294.11%
功能定位557.79%
组织建设365.10%
行业引导253.54%
政策宣传253.54%
目标规划365.10%
考核评估557.79%
), ArticleFig(id=1324045082730562066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表4, caption=

政策工具占比情况统计表

, figureFileSmall=null, figureFileBig=null, tableContent=
政策工具类型运用次数（次）占比（%）子工具类型运用次数（次）占比（%）
供给型26837.96%资金支持212.97%
人才培养304.25%
基础设施支持131.84%
信息技术支持496.94%
资源配置8612.18%
医保支付334.67%
培训帮扶365.10%
需求型15521.95%坚持公益324.53%
有序就医10014.16%
激励机制233.26%
环境型28340.08%策略性措施223.12%
组织创新294.11%
功能定位557.79%
组织建设365.10%
行业引导253.54%
政策宣传253.54%
目标规划365.10%
考核评估557.79%
), ArticleFig(id=1324045082944471571, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 5, caption=

Statistical summary of policy objectives (selected)

, figureFileSmall=null, figureFileBig=null, tableContent=
政策编号政策目标
12017年，基本搭建医联体制度框架…到2020年，形成较为完善的医联体政策体系。
…
38探索对纵向合作的医联体等分工协作模式…引导医联体内部初步形成较为科学的分工协作机制。
), ArticleFig(id=1324045083011580436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表5, caption=

政策目标统计表（部分）

, figureFileSmall=null, figureFileBig=null, tableContent=
政策编号政策目标
12017年，基本搭建医联体制度框架…到2020年，形成较为完善的医联体政策体系。
…
38探索对纵向合作的医联体等分工协作模式…引导医联体内部初步形成较为科学的分工协作机制。
), ArticleFig(id=1324045083091272213, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 6, caption=

PMC policy text information table (selected)

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策名称发文时间
P1国务院办公厅关于推进医疗联合体建设和发展的指导意见2017-04-23
…
P31山西省卫生健康委员会关于印发《城市医联体建设工作实施方案》的通知2019-05-17
), ArticleFig(id=1324045083363901974, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表6, caption=

PMC政策文本信息表（部分）

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策名称发文时间
P1国务院办公厅关于推进医疗联合体建设和发展的指导意见2017-04-23
…
P31山西省卫生健康委员会关于印发《城市医联体建设工作实施方案》的通知2019-05-17
), ArticleFig(id=1324045084479586840, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 7, caption=

Evaluation index system for the policy effectiveness of China’s medical cluster policies

, figureFileSmall=null, figureFileBig=null, tableContent=
一级变量二级变量依据
政策性质X1建议X1：1Estrada[15]，张永安[19]
描述X1：2
预测X1：3
监管X1：4
引导X1：5
其他X1：6
政策时效X2长期X2：1薛惠元[20]
中期X2：2
短期X2：3
政策评价X3依据充分X3：1张永安[19]
目标明确X3：2
方案科学X3：3
政策内容X4管理体制X4：1基于文本挖掘
资源下沉X4：2
医保支付方式改革X4：3
信息化建设X4：4
政策主体X5省市级人民政府X5：1根据卿华[21]改编
省市级卫健委X5：2
其他部门X5：3
政策视角X6宏观X6：1张永安[22]，蔡冬松[23]
微观X6：2
激励约束X7法律保障X7：1臧维[24]及基于文本挖掘
经济投入X7：2
人才引进X7：3
部门协同X7：4
绩效考核X7：5
作用对象X8医疗机构X8：1基于文本挖掘
医务人员X8：2
参保部门X8：3
政府部门X8：4
政策公开X9-Estrada[15]
), ArticleFig(id=1324045084559278617, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表7, caption=

我国医共体政策效力评价指标体系

, figureFileSmall=null, figureFileBig=null, tableContent=
一级变量二级变量依据
政策性质X1建议X1：1Estrada[15]，张永安[19]
描述X1：2
预测X1：3
监管X1：4
引导X1：5
其他X1：6
政策时效X2长期X2：1薛惠元[20]
中期X2：2
短期X2：3
政策评价X3依据充分X3：1张永安[19]
目标明确X3：2
方案科学X3：3
政策内容X4管理体制X4：1基于文本挖掘
资源下沉X4：2
医保支付方式改革X4：3
信息化建设X4：4
政策主体X5省市级人民政府X5：1根据卿华[21]改编
省市级卫健委X5：2
其他部门X5：3
政策视角X6宏观X6：1张永安[22]，蔡冬松[23]
微观X6：2
激励约束X7法律保障X7：1臧维[24]及基于文本挖掘
经济投入X7：2
人才引进X7：3
部门协同X7：4
绩效考核X7：5
作用对象X8医疗机构X8：1基于文本挖掘
医务人员X8：2
参保部门X8：3
政府部门X8：4
政策公开X9-Estrada[15]
), ArticleFig(id=1324045084659941914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=EN, label=Table 8, caption=

PMC index and grade evaluation

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政策X1X2X3X4X5X6X7X8X9PMC指数排序等级
P10.670.331.001.001.001.000.801.001.007.803优秀
P20.830.331.001.001.001.000.801.001.007.972优秀
P60.670.331.001.001.001.000.801.001.007.804优秀
P100.830.331.000.750.671.000.600.751.006.938可接受
P131.000.331.001.001.001.000.801.001.008.131优秀
P181.000.331.001.000.331.000.801.001.007.475优秀
P240.830.331.001.000.331.000.401.001.006.909可接受
P271.000.331.001.000.331.000.801.001.007.476优秀
P310.670.331.001.000.331.000.801.001.007.137优秀
), ArticleFig(id=1324045084777382427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044892653093633, language=CN, label=表8, caption=

PMC指数及等级评价

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政策X1X2X3X4X5X6X7X8X9PMC指数排序等级
P10.670.331.001.001.001.000.801.001.007.803优秀
P20.830.331.001.001.001.000.801.001.007.972优秀
P60.670.331.001.001.001.000.801.001.007.804优秀
P100.830.331.000.750.671.000.600.751.006.938可接受
P131.000.331.001.001.001.000.801.001.008.131优秀
P181.000.331.001.000.331.000.801.001.007.475优秀
P240.830.331.001.000.331.000.401.001.006.909可接受
P271.000.331.001.000.331.000.801.001.007.476优秀
P310.670.331.001.000.331.000.801.001.007.137优秀
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基于三维分析框架的我国医共体政策文本量化研究
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冯守桐 1 , 宋宝香 1, 2
现代预防医学 | 卫生政策与管理 2026,53(10): 1848-1854
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现代预防医学 |卫生政策与管理 2026 , 53 (10) : 1848 -1854
基于三维分析框架的我国医共体政策文本量化研究
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冯守桐（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

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冯守桐（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

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冯守桐1, 宋宝香1, 2
作者信息
  • 1.南京中医药大学卫生经济管理学院，江苏 南京 210023
  • 2.江苏省习近平新时代中国特色社会主义思想研究中心南京中医药大学理论研究基地
通讯作者:
宋宝香，E-mail：
作者简介:

冯守桐（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

A quantitative analysis of China’s medical cluster policy texts based on a three-dimensional analytical framework
Shou-tong FENG1, Bao-xiang SONG1, 2
Affiliations
  • School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China
出版时间: 2026-05-25 doi: 10.20043/j.cnki.MPM.202511035
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摘要
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目的

评估医共体政策实施效果，推动基层医疗服务高质量发展。

方法

本研究基于“工具—目标—效力”框架，采用内容分析法和PMC指数模型，对2014—2024年我国中央层面及山西、浙江两省医共体政策文本进行量化分析。

结果

目前我国医共体政策存在工具使用失衡、目标细化不足以及激励约束薄弱等问题。

结论

应优化政策工具结构、细化目标量化指标并强化激励约束措施，以全面提升医共体政策实施效果与建设质量，推动基层医疗服务体系高质量发展。

医共体  /  文本分析  /  政策工具  /  政策目标  /  政策效力
Objective

To evaluate the implementation effectiveness of medical cluster policies and promote high-quality primary healthcare.

Methods

Using a “policy tools-policy objectives-policy effectiveness” framework, text analysis and the PMC index model were applied to policy texts on medical clusters issued by China’s central government and Shanxi and Zhejiang provinces from 2014 to 2024.

Results

Current policies showed imbalanced policy tools, vague policy objectives, and weak incentive-constraint mechanisms.

Conclusion

Optimizing policy instruments, refining quantitative targets, and strengthening incentive and constraint measures can improve the effectiveness and quality of medical cluster policies, promoting high-quality primary healthcare development.

Medical cluster  /  Text analysis  /  Policy tools  /  Policy objectives  /  Policy effectiveness
冯守桐, 宋宝香. 基于三维分析框架的我国医共体政策文本量化研究. 现代预防医学, 2026 , 53 (10) : 1848 -1854 . DOI: 10.20043/j.cnki.MPM.202511035
Shou-tong FENG, Bao-xiang SONG. A quantitative analysis of China’s medical cluster policy texts based on a three-dimensional analytical framework[J]. Modern Preventive Medicine, 2026 , 53 (10) : 1848 -1854 . DOI: 10.20043/j.cnki.MPM.202511035
正文
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我国医疗资源长期分布不均，基层医疗服务能力薄弱，导致“看病难、看病贵”问题日益突出。为应对这一局面，中共中央、国务院于2009年在《关于深化医药卫生体制改革的意见》中提出了“保基本、强基层、建机制”的核心理念，其中“强基层”是解决医疗资源分布不均、医疗服务能力薄弱的根本途径[1]。医共体作为国家探索整合型医疗卫生服务体系的实践成果之一，通过卫生服务供给侧改革，有效整合了县域医疗卫生服务资源，增强基层卫生服务能力[2]。2023年国家卫健委发布《关于全面推进紧密型县域医疗卫生共同体建设的指导意见》，明确了医共体建设的核心任务，旨在通过强化基层医疗服务体系，解决基层医疗服务能力不足的问题。2025年10月，《中共中央关于制定国民经济和社会发展第十五个五年规划的建议》进一步提出，应推动医疗、医保和医药协同发展，提升公共卫生服务能力，并增强医疗资源的可及性。在政策的持续推进下，医共体建设成效显著，截止2025年11月，全国已建成3 099个紧密型县域医共体，覆盖2 199个县（市）及约三分之一的城市区，受益人口达9.24亿。
近年来，随着分级诊疗制度和县域医疗卫生体制改革的持续推进，县域医共体逐渐成为国内外学界关注的重要议题。国内研究多主要从政策注意力[3]、政策扩散[4]及政策文本量化[5]等角度进行分析。国外关于整合型医疗服务体系的研究则更多聚焦于制度模式与治理逻辑的比较分析，相关研究以美国凯撒医疗集团[6]、英国国家医疗服务体系[7]、德国公共合同型医疗模式[8]、新加坡医疗集团模式以及日本分级协作型服务体系为代表，从组织整合、支付机制、信息共享等方面系统总结了整合型医疗服务体系的实现路径[8-10]。从研究方法来看，政策文本量化研究主要运用统计分析[11]、内容分析[12]、以及LDA[13]指数模型等方法，对政策文本进行量化研究。
尽管现有研究在方法上逐步成熟，但在医共体领域多运用单一研究方法，缺乏多方法结合的系统性研究。因此本研究在借鉴既有成果的基础上，进一步构建以三维分析体系为核心的研究框架，并运用政策一致性指数模型（Policy Modeling Consistency Index model，PMC指数模型）测量政策的表现情况来探讨现行政策中存在的问题，为我国医共体政策的制定与优化提供合理可行的建议。
1　资料与方法
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1.1　资料来源
鉴于山西和浙江是我国医共体建设的首批试点省份，本研究选取两省及中央层面发布的医共体政策文件作为主要研究对象，以国家卫生健康委及各省级政府的官方网站作为政策文本的主要来源，并以北大法宝数据库的相关资料作为补充，以“医共体”、“医疗共同体”、“医疗卫生共同体”、 “医疗联合体”等为关键词，检索我国在中央层面以及浙江和山西省级层面发布的政策文本，检索时限为2014年6月至2025年11月。经过筛选整理，本研究最终纳入政策文本共38篇，其中中央层面9篇，浙江17篇，山西12篇。按照地区分类排序，部分政策列示于表1。
1.2　研究方法
本研究构建了以政策工具、目标、效力三个维度为核心的理论框架，运用内容分析法，并借助Nvivo 12软件进行分析，以句子或段落为单元提取政策条款，并按照“政策编号-章号-节号”进行编码。经过分类整理，最终得到1 143个编码，部分编码如表2所示。同时，在政策效力维度采用PMC指数模型进行评估。
由于医共体政策实施具有复杂性和多样性，为全面分析政策，需要同时考察政策目标、政策工具以及政策效力三个方面。在借鉴石岩[14]、Estrada[15]等人政策理论研究的基础上，本文构建了如图1所示的三维分析框架。
1.2.1　X维度：政策工具维度
本研究在借鉴Rothwell[16]和石岩[14]等人研究的基础上，将我国医共体政策工具按供给型、环境型和需求型三类进行划分，如表3所示。
1.2.2　Y维度：政策目标维度
郝翔宇[17]等学者对医共体目标进行了研究，并对政策目标的框架进行了整理和初步分类，分别是医疗机构整合、家庭医生签约服务、构建覆盖基层的信息平台、完善分工协作机制、推进区域资源共享、建立分级诊疗机制、提升基层专业技能、提高基层管理水平、满足群众健康需求以及提高公共卫生事件应急能力。
1.2.3　Z维度：政策效力维度
政策效力是衡量政策科学性的指标，也是评估政策制定与实施效果的重要手段[16]。本文采用Estrada[15]提出的变量确定方式，并参考相关文献，构建政策效力评价指标体系。
2　结果
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2.1　单维度分析
2.1.1　X维度：政策工具
通过对38份政策文本的分析，累计运用政策工具706次，结果显示环境型工具占比最高，节点数量为283，占比40.08%；供给型工具节点数量为268，占比37.96%；而需求型工具仅有155个节点，占比21.95%，具体结果见表4。这种政策工具运用的不均衡性，反映出当前医共体政策在发展上存在一定程度 “重视环境供给，轻需求”的倾向。
2.1.2　Y维度：政策目标
从政策目标统计分析结果来看，各维度相互关联、相互促进，共同构建了医疗联合体建设的框架，以推动服务模式转型和提升医疗体系效能，部分统计结果如表5所示。
2.1.3　Z维度：政策效力
为避免主观偏差的影响，本研究综合考虑医共体政策的各种类型、目标类别，以及发文形式，最终选取9篇具有代表性的政策文本作为政策效力评估的研究对象，其中包含中央层面的3份文本，以及浙江和山西各3份地方政策文本。选取的政策文本部分信息如表6所示。
本文基于Estrada构建的PMC指数模型[15]，借鉴多位学者对医共体政策的分析[14,18]，并结合政策文本内容挖掘的结果，构建了本研究的PMC指数模型评价指标体系，包括9个一级变量和31个二级变量。具体变量见表7。
根据PMC模型的计算公式计算出医共体政策的PMC指数及等级评价表，结果见表8。
结果显示，9项政策的平均指数为7.51，整体集中在“优秀”和“可接受”两个等级，总体差距不大，且表现较为优秀。结合PMC曲面图（图2）可以看出，两项“可接受”政策在政策性质维度的监管、引导及主体维度方面得分偏低，因此总体PMC评分相对较低。
2.2　X-Y交叉维度分析
政策目标是指在政策执行过程中预期实现的成果，也是评判政策工具运用科学性与合理性的重要标准。因此，本研究将医疗机构的政策目标维度纳入其中，形成了X-Y的二维分析框架，如图3所示。
图4显示，医共体政策虽然运用丰富的工具实现其目标，但仍然存在着部分政策工具运用不充分或是目标与工具匹配不佳的问题。供给型工具强调通过资源整合与信息化建设完善硬件条件，但对分级诊疗与分工协作等制度建设的作用相对有限。环境型工具侧重分工协作机制，主要依托功能定位和目标规划两类手段，但在组织创新、行业引导等方面较为薄弱。需求型工具主要通过“有序就医”引导患者合理分流，有效推动新型就医模式的形成。
3　结果与讨论
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3.1　构建协同化、多维度的政策工具体系
X维度分析表明，医共体政策工具结构失衡，供给型政策工具运用较多，而需求型与环境型相对不足，从而影响政策成效。应强化需求型工具，通过“坚持公益”保障基层的普惠性，以“有序就医”推动双向转诊和家庭医生签约制度，并完善绩效激励和薪酬机制，提高基层医务人员的积极性。同时应优化环境型工具，加强部门协同、社会参与和监测评估，以提升医共体建设的系统性和可持续性。
3.2　细化目标并构建可评估的指标体系
Y维度结果显示，医共体政策目标整体偏向宏观制度建设，微观层面的行为导向和量化标准相对不足。为此，应将宏观目标进一步分解为层次清晰、任务明确的子目标，并在此基础上构建可量化的指标体系，以增强政策执行的导向性和可控性。
3.3　健全激励约束并行的执行机制
PMC曲面分析显示，尽管医共体政策在内容完整性和导向性方面表现良好，但部分政策在监管引导和激励约束维度仍然存在短板。应构建多维度激励体系，包括绩效考核、薪酬分配、职称晋升与荣誉评定等，以提高医务人员和机构的积极性[25]。同时，完善约束机制，引入三方评估和社会监督，提高执行的透明度与规范性。
基金
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  • 教育部哲学社会科学研究重大课题攻关项目(24JZD043)
  • 江苏省研究生科研与实践创新计划项目(KYCX25_2441)
文献
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2026年第53卷第10期
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doi: 10.20043/j.cnki.MPM.202511035
  • 接收时间：2025-11-04
  • 首发时间：2026-11-02
  • 出版时间：2026-05-25
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  • 收稿日期：2025-11-04
基金
教育部哲学社会科学研究重大课题攻关项目(24JZD043)
江苏省研究生科研与实践创新计划项目(KYCX25_2441)
作者信息
    1.南京中医药大学卫生经济管理学院，江苏 南京 210023
    2.江苏省习近平新时代中国特色社会主义思想研究中心南京中医药大学理论研究基地

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宋宝香，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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