Research On Family Doctor Policy Implementation From The Perspective Of Street-level Bureaucracy

The key to achieving national stability lies in reassuring the people.In recent years,promoting the construction of a healthy China is a major strategy of the Party and the country.Comrade Xi Jinping pointed out in the report of the 19 th National Congress: "It is necessary to improve the national health policy and provide the people with all-round and full-cycle health services." In this context,the family doctor contract service policy arises at the historic moment.With the continuous advancement of the policy,the contracting service of family doctors has achieved certain results,and the contracting rate of key groups in the country has exceeded 70%.However,it can not be ignored that behind the increasing number of signing contracts,there are still problems in the quality of family doctors’ signing services.In view of this problem,the existing researches are mostly from the macro level,and lack of subtle observation on the implementation of family doctor policy at grassroots level.From the perspective of disciplines,most existing literatures focus on the medical field,and few literatures do scientific analysis and induction of this policy from the public administration discipline.In addition,researchers mostly use western policy implementation models to analyze the process of policy implementation,lacking consideration of factors influencing policy implementation in Chinese context.Therefore,from the micro perspective of the street bureaucracy theory,it is necessary to deeply analyze the dilemma and reasons of the implementation of this policy,and to enhance the theoretical,local and in-depth research.In order to make up for the lack of attention to street-level bureaucracy in existing studies,based on the theory of street bureaucracy,through a panoramic observation of the policy implementation process of S street community health service center in N City,explore the implementation dilemma of family doctor policy.Through analysis,it is found that when implementing the family doctor policy,community medical workers,as street bureaucrats,assume multiple roles of policy executor,service provider,policy "redecision" and policy innovator,and are active in the four action Spaces of window,community,street and network.Faced with a complex policy implementation environment characterized by limited resources,conflicting work objectives and involuntary work targets,a variety of action strategies including wait-and-see implementation,selective implementation and innovative implementation were adopted.The reasons are mainly reflected in the following five aspects:the comprehensive quality of street bureaucrats is low,the family doctor policy is not perfect,the resources for policy implementation are insufficient,the motivation of the incentive mechanism is insufficient,and the supervision and assessment are unscientific.In view of this,this study attempts to put forward suggestions to optimize the implementation of family doctor signing policy,and points out the need to improve the comprehensive quality of street bureaucrats,improve family doctor policy,enhance policy implementation resource support,and improve incentive,assessment and supervision mechanism,hoping to be beneficial to the development of medical and health industry.