地方政府分级诊疗政策创新扩散研究——基于全国地级市数据的事件史分析

The local government's health policy reform initiative is of great significance for the improvement of China's healthcare system reform. Taking China's grading diagnosis and treatment policy as a good example of policy innovation, this study collected and constructed a database of 170 prefecture level cities in China during the period from 2014 to 2018. Factors influencing the local governments' introduction of hierarchical medical policy were examined using the event history analysis based on data mined from the database. The results showed that the patterns followed by the local government during healthcare reform present a bottom-up and horizontal competition model; health, medical insurance departments, and large public hospitals had significant influence in the formulation of the local government's hierarchical medical policy, while the role of primary healthcare institutions was not significant. This study is helpful to the expansion of applicability of the policy diffusion theory in health policy, and also has great practical significance for deepening the reform of China's healthcare system. This paper presents the following policy recommendations: (1) strengthen the coordination role of the central government in promoting hierarchical medical policy; (2) construct seamlessly integrated healthcare systems as incentive mechanisms for stakeholders; (3) highlight the great importance to open up the source of primary cares.