Page 25 - 《中国药房》2026年5期

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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李立清 1， 2＊ ，腾佳杉 ，仲光金（1.湖南农业大学公共管理与法学学院，长沙 410128；2.湖南省医疗保障研究会，
长沙 410128）

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

摘 要 目的 剖析零售药店纳入门诊统筹管理政策在执行过程中的阻滞因素，并探索提升政策执行效能的实践路径。方法 基
于史密斯政策执行过程模型，构建政策分析框架。选取湖南省为典型样本，综合运用政策文本分析与半结构化访谈法，对相关政
策文件进行深度解读，并对医保行政部门、定点医疗机构、零售药店及参保人员等多方关键主体共计42位进行访谈，对访谈文本
进行分析。结果与结论 零售药店纳入门诊统筹管理政策的有效执行主要面临四维阻滞：一是政策自身存在系统性设计不完善与
协调性不足的问题，导致源头性制约；二是执行主体间缺乏有效协同机制，服务与监管呈碎片化；三是目标群体存在政策认知偏
差，且在利益驱动下行为发生扭曲；四是医保基金压力与传统就医观念等环境因素叠加，制约了政策的落地空间。为此，本研究建
议，应进一步强化顶层设计，消弭规则模糊与执行偏差；健全多方协同机制，提升政策运行效能；深化政策解读与利益协调，引导目
标群体作出理性行为；破除环境壁垒，构建适应政策发展的外部生态，以推动零售药店纳入门诊统筹管理工作的高质量发展。
关键词 零售药店；门诊统筹；史密斯政策执行过程模型；政策执行效能

Barriers to and facilitating pathways for incorporating retail pharmacies into outpatient pooling policies
LI Liqing ，TENG Jiashan ，ZHONG Guangjin （1. College of Public Administration and Law， Hunan
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1， 2
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Agricultural University， Changsha 410128， China；2. Hunan Medical Security Research Association， Changsha
410128，China）
ABSTRACT OBJECTIVE To analyze the deep-seated impeding factors in the implementation process of the policy integrating
retail pharmacies into the outpatient pooling system， and explore practical paths to improve policy implementation efficiency.
METHODS Based on Smith’s policy implementation process model， an analytical framework was constructed. Selecting Hunan
province as a typical sample， this study combined policy text analysis and semi-structured interviews to conduct an in-depth
interpretation of relevant policy documents and interviewed a total of 42 key stakeholders from multiple parties， including medical
insurance administrative departments， designated medical institutions， retail pharmacies， and insured persons， and the interview
texts were analyzed. RESULTS & CONCLUSIONS The study indicated that the effective implementation of this policy faces four
dimensions of impediments： first， the policy itself suffered from systemic design problems and insufficient coordination， leading to
source-based constraints； second， there was a lack of effective synergy mechanisms among implementing agencies， resulting in
fragmented service and supervision capabilities， and their behaviors were distorted by interest-driven motives； third， there were
cognitive biases regarding the policy among the target group， and their behaviors were distorted by interest-driven motives； fourth，
environmental factors such as pressure on medical insurance funds and traditional medical-seeking concepts overlapped to restrict
the space for policy implementation. Therefore， the following optimization strategies are proposed： strengthening top-level design to
eliminate rule ambiguity and implementation deviation； improving multi-party synergy mechanisms to enhance policy operational
efficiency； deepening policy interpretation and interest coordination to guide rational behavior among the target group； and breaking
environmental barriers to build an external ecosystem adaptable to policy development， thereby promoting the high quality
development of incorporating retail pharmacies into the outpatient pooling system.
KEYWORDS retail pharmacies； outpatient pooling； Smith policy implementation process model； policy implementation
efficiency

Δ 基金项目 国家社会科学基金重点项目（No.24AZD029）；国家
自然科学基金面上项目（No.72274059）；湖南省医疗保障研究会 2024 医保制度是减轻群众就医负担、增进民生福祉、维
年度课题（No.2024A07）；2024 年湖南农业大学研究生科研创新项目 [1]
护社会和谐稳定的重要制度安排 。零售药店作为医疗
（No.2024XKCB047）
卫生服务体系的重要组成部分，其纳入门诊统筹管理是
＊第一作者 教授，博士生导师。研究方向：卫生政策与医疗保障。
E-mail：Liliqing1136@163.com 拓展医保服务渠道、提升参保人就医购药便利性的重要

中国药房 2026年第37卷第5期 China Pharmacy 2026 Vol. 37 No. 5 · 571 ·