Hierarchical medical system is the first of the five basic medical systems and is also the ultimate goal to be achieved by the “strong grassroots” of the new medical reform. The implementation of the hierarchical medical system needs the guidance of the scientific and perfect policy system. The research on hierarchical medical system policy is conducive to analyzing the value orientation and evolutionary logic of the existing policies and ensuring that the top-level design cooperates with the social process. Taking the policy of hierarchical medical system published by the central and provincial governments as the study object, the paper establishes a three-dimensional analysis framework of policy instrument, policy objectives, and policy intensity, and explores the internal collaboration of the policy system of hierarchical medical system in China. The results show that the cooperativity of policy tools “supply-demand-environment” is poor, with strong supply, light environment, and weak demand. The cooperativity of “scale – efficiency” of policy objectives is lacking, and the radiation scale of policy objectives at each stage first expands and then decreases. The cooperativity of the policy intensity “administrative effectiveness - content effectiveness” is good, and there is a large space for coordination among the formulation subjects. The cooperativity of the three elements of “instrument-objectives-intensity” is insufficient, and there is a deviation from reality. Especially in the promotion period and breakthrough period, instrument and intensity may not provide strong support for realizing the objectives value. The text of hierarchical medical system policy clarifies the principal-agent relationship between the parties in the medical benefit transmission chain and restricts and guides policy implementation. Therefore, it is necessary to optimize the structure of policy instrument, rationally grasp the policy intensity, coordinate the three elements, and adjust policies closely with the changes in the real situation. The research has important reference value for improving hierarchical medical system policy, promoting the equalization of basic medical services in China, and realizing double breakthroughs in theory and practice.

分级诊疗既是五项基本医疗制度之首,又是新医改 “强基层”最终要实现的目标,分级诊疗制度落地离不开科学完善的政策体系指引,分级诊疗政策研究有利于剖析现有政策的价值导向和演进逻辑,确保顶层设计与社会进程有效衔接。文章以中央和省级层面出台的分级诊疗政策为研究对象,建立政策工具—政策目标—政策力度的三维分析框架,探究我国分级诊疗政策体系的内部协同性。研究发现,政策工具 “供给—需求—环境”协同性较差,强供给、轻环境、弱需求;政策目标 “规模 效率”协同性有所欠缺,各阶段政策目标的辐射规模先扩大后减小;政策力度 “行政效力 内容效力”协同性较好,制定主体间有较大协同空间;“工具—目标—力度”三要素协同性不足,与现实存在偏差,尤其在推广期和突破期,工具、力度可能无法为实现目标价值提供有力支持。分级诊疗政策文本厘清了医疗利益传输链条中各方主体之间委托代理关系,约束并指导现实实践。因此,要优化政策工具结构、合理把握政策力度、协调工具目标价值、紧随现实调适政策。研究对完善分级诊疗政策体系、推进我国基本医疗服务均等化、实现理论与实践双重突破有重要参考价值。