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已发表论文
家庭医生作为基层公务员：基于访谈的关于中国上海公共卫生突发事件期间服务供应挑战的研究
Authors Wang G , Tang M, Zhang T, Luo L
Received 21 July 2025
Accepted for publication 7 October 2025
Published 15 October 2025 Volume 2025:18 Pages 3343—3357
DOI https://doi.org/10.2147/RMHP.S555229
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Mecit Can Emre Simsekler
Gan Wang,1,2 Man Tang,3 Tiantian Zhang,1,2 Li Luo1,2
1Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, 200032, People’s Republic of China; 2School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China; 3School of Government, Peking University, Beijing, 100871, People’s Republic of China
Correspondence: Li Luo, Email liluo@fudan.edu.cn
Objective: This study aims to analyze the service supply challenges for Family Physicians during public health emergencies through the lens of street-level bureaucracy.
Methods: Guided by street-level bureaucracy theory within a three-tier analytical framework (micro-, meso-, and macro-levels), this qualitative study employed semi-structured interviews with 36 Family Physicians in Shanghai regarding their responses to a public health emergency. Interviews were recorded, transcribed verbatim using “iFlytek Hearing” software, manually reviewed, and analyzed thematically using NVivo 10.
Results: The analysis revealed multi-level challenges. At the micro-level, Family Physicians faced dual role pressures as “state agents” and “public agents”, leading to reduced discretionary power and a tendency for prosocial deviant behavior; their understanding of policies and effectiveness of communication with the public directly impacted policy implementation outcomes. At the meso-level, resource scarcity created supply-demand contradictions, triggering adaptive policy implementation, where Family Physicians innovatively met service needs under constraints and participated in community collaborative governance. At the macro-level, policy ambiguity was prominent, essential medicine supply chains faced difficulties, and training and career development pathways in general practice remained underdeveloped.
Conclusion: This study provides a deep understanding of the service supply challenges faced by Family Physicians during public health emergencies, offering a scientific basis for optimizing service supply strategies, and this theoretical framework can be extended to the analysis of other street-level bureaucrats.
Keywords: street-level bureaucracy, family physician, public health emergencies, primary health care, health policy
1Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, 200032, People’s Republic of China; 2School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China; 3School of Government, Peking University, Beijing, 100871, People’s Republic of China
Correspondence: Li Luo, Email liluo@fudan.edu.cn
Objective: This study aims to analyze the service supply challenges for Family Physicians during public health emergencies through the lens of street-level bureaucracy.
Methods: Guided by street-level bureaucracy theory within a three-tier analytical framework (micro-, meso-, and macro-levels), this qualitative study employed semi-structured interviews with 36 Family Physicians in Shanghai regarding their responses to a public health emergency. Interviews were recorded, transcribed verbatim using “iFlytek Hearing” software, manually reviewed, and analyzed thematically using NVivo 10.
Results: The analysis revealed multi-level challenges. At the micro-level, Family Physicians faced dual role pressures as “state agents” and “public agents”, leading to reduced discretionary power and a tendency for prosocial deviant behavior; their understanding of policies and effectiveness of communication with the public directly impacted policy implementation outcomes. At the meso-level, resource scarcity created supply-demand contradictions, triggering adaptive policy implementation, where Family Physicians innovatively met service needs under constraints and participated in community collaborative governance. At the macro-level, policy ambiguity was prominent, essential medicine supply chains faced difficulties, and training and career development pathways in general practice remained underdeveloped.
Conclusion: This study provides a deep understanding of the service supply challenges faced by Family Physicians during public health emergencies, offering a scientific basis for optimizing service supply strategies, and this theoretical framework can be extended to the analysis of other street-level bureaucrats.
Keywords: street-level bureaucracy, family physician, public health emergencies, primary health care, health policy