中國醫療衛生政策變遷的過程、邏輯與走向：基於1949～2019年政策文本的分析

黨的十九大要求提高保障和改善民生水準，部署實施“健康中國”戰略，使全體人民享有更高水準的醫療衛生服務成為我國“兩個百年”目標的重要組成部分。文章基於公共政策變遷的視角和改革的主線，將1949～2019年中國醫療衛生政策變遷劃分為改革孕育階段、改革起步階段、改革發展階段和改革深化階段。針對中共中央、國務院及其相關部門出台的醫療衛生政策文本，文章運用社會網絡分析方法對各階段政策的主題熱點進行量化分析，挖掘其在政策內容、政策目標、價值取向和政策工具方面的階段特徵和總體變化特徵。研究發現，中國醫療衛生政策的變遷實際上是解決不同階段醫療衛生領域存在的主要問題和主要矛盾的過程，其變遷邏輯是政治因素、經濟因素和社會因素三者共同作用的結果。新時代醫療衛生政策改革應在全民公平享有和受益的基礎上向縱深推進，回歸基本醫療衛生事業的公益性，為人民群眾提供全方位全週期健康服務，支援社會辦醫以促進醫療衛生服務供給主體和方式多元化。
The 19th National Congress of the Communist Party of China (CPC) called for better ensuring and improving people’s lives, implementing the Healthy China initiative, and making it an important part of China’s Two Centenary Goals so that all the people enjoy a higher level of medical and health services. Based on the perspective of public policy change and the main thread of reform, this paper divides medical and health policy changes from 1949 to 2019 into the stages of reform initiation, reform initiation, reform development and reform deepening. In view of the medical and health policies issued by the CPC Central Committee, the State Council and relevant departments, this paper uses the social network analysis method to conduct a quantitative analysis on the topics and hot spots of policies at each stage, and explores the stage characteristics and overall change characteristics of policies in terms of policy content, policy objectives, value orientation and policy tools. It is found that medical and health policy change is actually the process of solving the main problems and main tensions in the field of medical and health in different stages, and its change logic is the result of the joint action of political factors, economic factors and social factors. The reform of medical and health policies in the new era should be advanced on the basis of equal access and benefits for all, return to the public welfare of basic medical and health services, provide all-around and full-cycle health services for the people, and support nongovernmental medical institutions to promote the diversification of medical and health services. Copyright © 2020 中央黨史和文獻研究院.