数字时代下分级诊疗政策的演变趋势和网络结构变迁--基于2009-2024年政策文本的实证分析

The evolution trend and the change of network structure of hierarchical medical system policy in the digital age:Empirical analysis based on policy texts from 2009 to 2024

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摘要数字时代背景下,信息化技术的嵌入不仅创新了新型医疗服务供给模式,也引起了分级诊疗政策涉及的主体及其结构关系的变化。为深化医疗体制改革和推进分级诊疗的进一步落实,研究分级诊疗政策的演变过程和政策主体间网络结构的演化态势具有重要意义。文章以2009年至2024年我国分级诊疗政策的相关文本作为数据集,结合文本分析和社会网络分析法,从内容变化和结构演变两个维度描绘了分级诊疗政策的演进趋势和政策网络的结构特征,并探讨数字时代背景下信息技术嵌入对分级诊疗政策的作用效果。研究结果表明:15年间分级诊疗政策的话语体系呈现从“规范化”到“一体化”再到“多元化”的演进过程;在网络结构层面,分级诊疗政策网络整体上随着时间的发展日益呈现复杂化态势,以政府各级部门、医疗机构和患者为核心主体的网络结构不断强化,但基层医疗机构在网络中的个体中心地位明显提升,其作为政策网络中的中介主体,关联着网络成员之间的利益联系;通过对比有无信息化情景的网络分析,结果表明,在数字技术的介入下,分级诊疗政策网络结构得以优化,主体之间的合作模式更加稳定、合作路径更加多样。数字技术在政策网络中承担着各个部门中间人的角色。 This article uses the relevant texts of China's hierarchical medical system policy from 2009 to 2024 as a dataset and then describes the evolution trend and structural characteristics of the policy from two dimensions of content change and structural evolution by combining text analysis and social network analysis.lIt also explores the effect of information technology embedding on the hierarchical medical system policy in the context of the digital age.The results show that the discourse system of the hierarchical medical system policy has evolved from"standardization"to"integration"to"diversification"over the past 15 years;At the level of network structure,the hierarchical medical system network has become increasingly complex over time.The network structure with government departments at all levels,medical institutions and patients as the core subjects has been continuously strengthened.However,the individual central position of grassroots medical institutions has significantly improved.As intermediary subjects in the policy network,they control the interest connections between network members;Through network analysis comparing the scenarios with and without information technology,the results show that with the intervention of digital technology,the network structure of the hierarchical medical system policy has been optimized,digital technology plays the role of a middleman between various departments in the policy network.

作者于思航 YU Sihang(ZhouEnlai School of Government Management,Nankai University,Tianjin 300350,China)

机构地区南开大学周恩来政府管理学院

出处《未来与发展》 2025年第7期70-77,共8页 Future and Development

关键词分级诊疗医疗机构信息化政策网络数字时代 hierarchical medical system medical institutions promotion of information technology policy networks digital age

分类号 R473.5 [医药卫生—护理学] G322.0 [文化科学]

作者简介于思航,南开大学周恩来政府管理学院博士研究生,研究方向:基本医疗健康服务与基本公共服务供给。