Evaluation of hospice and palliative care policies in China: a Theme-Instrument-Effectiveness (TIE) framework based...

China is undergoing rapid population aging, which has substantially increased the demand for hospice and palliative care (HPC). Systematic and quantitative evaluation of China's HPC policy corpus remains limited. This study addresses this gap through an integrated three-dimensional analytical framework examining policy themes, policy instruments, and text-based policy effectiveness.

A corpus of 95 national-level, provincial-level, and selected sub-provincial pilot HPC policy documents (January 2011-May 2026) was analyzed using a Theme-Instrument-Effectiveness (TIE) framework combining three approaches: (1) Latent Dirichlet Allocation (LDA) topic modeling optimized by coherence score and perplexity, with labels reviewed by two independent coders until consensus; (2) NVivo-assisted content coding with substantial inter-coder reliability for policy-instrument coding (Cohen's κ = 0.75); and (3) a Policy Modeling Consistency (PMC) Index Model applied to 28 analytically representative policies across nine dimensions using binary coding with equal-weight aggregation.

Eight latent topics were identified, covering cancer prevention and control, digital economy, medical and health care, medical insurance management, elderly health, elderly care services, hospice and palliative care, and population development. Equity-oriented themes concerningrural elderly care, disabled and dementia elderly groups, grassroots service accessibility, rare disease prevention and treatment, and regionally balanced medical-resource allocation were not represented as standalone topics. Content coding of 1,784 coded text segments revealed a supply-dominant instrument structure (supply-side: 51.18%; environment-side: 29.99%; demand-side: 18.83%), with public awareness (1.01%) and financial support (2.86%) being the least-used subcategories. PMC evaluation yielded a mean score of 6.73 (Excellent); Policy Instruments (X4 = 0.98) and Policy Objectives (X5 = 0.87) performed strongest, while Policy Timeliness (X2 = 0.33) and Policy Perspective (X3 = 0.60) received comparatively lower scores, although the uniform X2 score was partly attributable to its operational definition.

China's HPC policy system has established a broad institutional foundation but retains structural gaps in equity coverage and instrument balance. Future policies should strengthen legal safeguards, rebalance instruments toward demand- and environment-side mechanisms, expand coverage of underserved populations, and embed performance evaluation provisions to improve the internal coherence, operability, and accountability of policy texts.