Research On Policy Barriers And Countermeasures Of Multiple-site Physician Practice From The Perspective Of Policy Implementation

Recent years,China has increased the investment in medicine and health gradually,which attract more attention of the government and society.But the field,medicine and health,is still facing many problems.One of the main problems of the Health Service System is that the amount of health resource is inadequate also the disposition is uneven.As the chief part of the health resource,how to solve the allocation of Physicians Resource become the prominent problem.The policy of doctors multi-sited physician practice was conceived in 2009 and implemented nationwide in 2015.However,by 2019,only less than 5%physicians'participating in doctors multi-sited physician practice.According to the fact,the police outcome,that the local government did not implement the policy,and the policy documents communicate from the central government to the local have been recreated,I consider that the policy of multi-sited physician practice has encountered "symbolic policy implementation".Since there are few researchers adopt the view of Policy Implementation to research the policy process of multi-sited physician practice.form this point of view,the paper code the policy tool by both microscopic and macroscopic analysis.The coded tools are classified by the X axis,which is divided into supply-oriented policy tools,demand-oriented policy tools and environment-oriented policy tools,and Y axis,which is divided by the targeted position of the tools into the improvement of physician training system,optimization of physician practice environment,optimization of physician practice environment.Analyzing the classification of policy tools,we can find that the selection of central policy tools mainly focuses on the supply type that improves the political potential,incentive demand type tools and supporting environmental type tools are obviously insufficient,and the supply type tools are shown to be targeted and fuzzy in the Y dimension and have weak effects.In the macro environment,where lack political potential push and stimulating pull,also supporting policies is not standard,micro analysis is carried out on policy implementation participants such as local ministries,hospitals,doctors and patients.Through comparative analysis,it is found that the local ministries adopt creative measure to improve the policy tools.For example,through administrative orders to form quantitative evaluation and supervisory mechanism for lower level participants,we can increase the political potential,finally push the local policy pursues the policy of multi-sited physician practice.By analyzing the behavior logic of hospitals and doctors,it is found that environment-oriented policy tools should be implemented,such as improving the physician liability insurance,optimizing the salary system of hospitals,setting up the Platforms for multi-sited practice,to push the policy implementation.In addition,doctors have their own independent choice of "vested interests"and "future interests" in the process of policy implementation,therefore,strengthening demand-oriented policy tools to positively stimulate physicians can help them break the constraint and choose multi-sited practice.