零售药店纳入门诊统筹管理政策实施的阻滞因素与疏通路径

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中图分类号R95 文献标志码A 文章编号 1001-0408（2026）05-0571-07

DOI 10.6039/j.issn.1001-0408.2026.05.04

Barriers to and facilitating pathways for incorporating retail pharmacies into outpatient pooling policies LI Liqing'2，TENG Jiashan’，ZHONG Guangjin1（1.College of Public Administration and Law，Hunan Agricultural University，Changsha 41O128，China;2.Hunan Medical Security Research Association，Changsha 410128，China）

ABSTRACTOBJECTIVEToanalyze thedeep-seated impedingfactors in the implementationprocessof the policyintegrating retailpharmaciesintotheoutpatientpolingsystem，andexplorepracticalpathstoimprovepolicyimplementationefciency. METHODS BasedonSmith’spolicyimplementation processmodel，ananalytical framework wasconstructed.Selecting Hunan provinceasatypical sample，thisstudycombinedpolicytextanalysisandsemi-structuredinterviews toconductanin-depth interpretationofrelevantpolicydocumentsandinterviewedatotalof42keystakeholdersfrommultipleparties，includingmedical insuranceadministrativedepartments，designatedmedicalinstutions，retailpharmacies，andinsuredpersons，andtheinterview texts wereanalyzed.RESULTS&CONCLUSIONSThestudyindicatedthattheefectiveimplementationofthispolicyfaces four dimensiosofimpediments：first，thepolicyitselfsuffredfromsystemicdesignproblemsndinsuffcientcoordination，leadngto source-basedconstraints；second，therewasalack of efectivesynergymechanismsamongimplementing agencies，resulting in fragmentedserviceandsupervisioncapabilities，andtheirbehaviorsweredistortedbyinterest-drivenmotives；third，therewere cognitive biasesregarding thepolicyamongthetarget group，andtheirbehaviors weredistortedbyinterest-driven motives；fourth， environmentalfactorssuchaspresureonmedicalinsurance fundsandtraditionalmedical-sekingconceptsoverlappedtoestrict thespaceforpolicyimplementation.Therefore，thefolowingoptimizationstrategiesareproposed：strengtheningtop-leveldesignto eliminateruleambiguityand implementationdeviation；improvingmulti-partysynergymechanisms toenhancepolicyoperational eficiency；deepeningpolicyinterpretationandinterestcoordinationtoguiderationalbehavioramongthetargetgroup;andbreaking environmentalbarierstobuildanextermalecosystemadaptabletopolicydevelopment，therebypromotingthehighquality development of incorporating retail pharmacies into the outpatient pooling system.

KEYWORDSretail pharmacies；outpatientpoling；Smithpolicy implementationprocessmodel；policyimplementation efficiency

医保制度是减轻群众就医负担、增进民生福祉、维护社会和谐稳定的重要制度安排。（剩余13101字）