Policy texts and actions: quantitative evaluation of the hierarchical medical system policy in China based on the...

China has made significant strides in healthcare, greatly enhancing health outcomes for its large population. However, disparities in medical resource distribution and utilization remain, making healthcare financially burdensome and geographically inaccessible. To mitigate these challenges, the Chinese government has implemented the hierarchical medical system (HMS). However, the effectiveness of HMS policies requires continuous refinement. A comprehensive evaluation of HMS policies is essential to maximize their impact, streamline execution, and ensure the system's sustainability and efficiency.

This study develops an assessment system for HMS policies using the Policy Modeling Research Consistency Index (PMC-Index) model and then conducts a quantitative analysis of 137 HMS policies from the central government and 30 provinces. Additionally, we use academic attention, media coverage, and joint attention as policy implementation indicators and employ the Logit model to analyze the relationship between policy formulation and implementation.

The results show that the average PMC index of 137 HMS policies is 6.53 (Good) overall, with potential for improvement in policy tools, issuing subjects, and policy fields. Regional heterogeneity reveals that the PMC index is highest in the East, followed by the Central and Northeast, and lowest in the West. Stage heterogeneity indicates that the PMC index scores highest in the development stage (2015-2017), followed by the breakthrough stage (2021-present), and finally, the exploration stage (2013-2014) and the diffusion stage (2018-2020). Additionally, Logit analysis demonstrates a significant correlation between the PMC index and implementation.

This study indicates that the overall consistency of HMS policies is good and illustrates a significant positive correlation between the policy formulation and implementation of the HMS.