The Logic and Trend of Urban Community Health Service Policies in China

Background Urban community health services are key to promoting the high-quality development of community health. However, previous studies have seldom explored the evolutionary logic and development trend of community health service policies. It is difficult to provide a comprehensive answer to the questions of the generation, evolution and trend of community health service policies in China. Objective To understand the current status, evolutionary logic and trend of community health service policies, in order to provide intellectual reference for promoting the high-quality development of community health services and implementing the hierarchical diagnosis and treatment system. Methods The Central People's Government website, National Health Commission, relevant official provincial websites, CNKI, China Community Health Association and other platforms were searched from December 2019 to March 2022 for community health service reform related policies published at national level (n=98) from January 1997 to March 2022. The included policies were analyzed with the help of the policy orientation analysis model. Results The policy changes in urban community health services of China have gone through four stages since 1997, including initial exploration centered on the transformation and frame construction (from 1997 to 2002), normative construction focusing on the bottom of the public health network (from 2003 to 2008), prosperous development focusing on the mechanism reform (from 2009 to 2016), and deepening reform centered on quality improvement and empowerment (from 2017 to 2022). The changes in community health service policies in China follows the following evolutionary logic, including the dynamic mechanism from marketization to professionalization and social community linkage governance, target orientation from scale expansion to internal quality improvement, policy discourse changing from predominantly economics-based discourse to multiple tools coordination. Conclusion Community health service policies should promote the innovation of the dual collaborative governance framework and mechanism, strengthen the coordination among professional systems and their effective synergistic linkage with the social community governance systems; promote community value-based health care and trust-based health care with health as the core, establish and improve evaluation standards for the capacity and quality of specialized primary care; promote the diversified application and matching of policy tools to adapt to the diversified needs of community health and wellness interests.