4.3.3. Detailed Description of PMC-Index
In general, the quantitative results of the PMC-Index for the ten representative policies are all above 4, with two policies rated Optimal, six policies rated Good and the remaining two all rated Acceptable (see
Table 6). This indicates that the current PHERP follow the principles of science, reasonableness and operability, that the policies are adjusted in a timely manner according to the needs of public health protection at different times and that the synergy between policies is at a high level.
In order to visualize the scores of each main indicator, we have created a mean radar chart (see
Figure 6) which is irregularly shaped, with the highest score for policy nature (X
1), the lowest score for policy time (X
3) and policy release agency (X
6) among the ten main indicators. It can be seen that the scores of various indicators of the policy are still unbalanced, which reflects that there are still some weaknesses in the PHERP and provides an objective basis for the formulation and revision of policies in the future. The specific discussion is as follows:
As shown in
Figure 6, policy nature scores perfectly, which indicates that policies are able to balance the nature of prediction, regulation, advice and guidance.
The average scores of X2, X5, X7 and X9 are all above 0.7. This result means that the design and resource allocation of PHERP is relatively balanced in terms of policy instruments, policy fields, policy functions, policy action modes and policy evaluation. Policies comprehensively use supply-based, demand-based and environment-based policy tools in a broader manner. The policy takes into account eight functions, such as medical treatment guidance, popular science publicity and education, prevention points before the event, recovery and reconstruction after the event, and is able to flexibly use three modes of action, such as coercion, service and motivation. In the design of text content, the goal is clear, the basis is sufficient, the scheme is reasonably designed, the planning is detailed and the rules of responsibility and power exercise are clearly explained. Therefore, the score of policy function and evaluation is high.
The policy time X3 and policy release agency X6 ranks tenth, with 0.33. The shortcoming of this item come from the lack of clarity in the content of the policy text regarding the effective time frame of the policy. Most of the texts lack a time-bound planning of the policy objectives and generally show a single period of planning and assessment, which is not conducive to the efficient achievement of the policy objectives.
The quantitative result of the policy releasing agency matches the number of joint issuances in the data description. The linkage between the various issuing bodies at all levels is not yet close, with a single body accounting for 82% of issuances, and this result has the potential to lead to a separation of institutional responsibilities in the policy implementation process, thus affecting the effectiveness of policy implementation.
The top three quantitatively rated policies are P
10, P
3 and P
4 (see
Table 6). The first two policies were both issued by the State Council, P
3 and P
4 are both contingency plans and P
10 is the National Health Plan, just released in 2022.
As the policy with the highest score among the ten policies, P
10 obtained full marks in all other indicators except X
3 and X
6, which are generally not high in average scores. From its title, we can see that this is a comprehensive policy at the macro level, integrating the prevention, control and response of health emergencies into the national health plan. The policy covers economy, politics, education, social services, social environment and other aspects. In addition to the supply-based policy instruments such as fund guarantee and public health talent team building, the policy also proposes to strengthen international cooperation in the field of public health and the construction of a public health rule of law system. In addition, compared with the other nine policies, the reason for the highest score of P
10 is that the policy text clearly proposes to innovate the social mobilization mechanism and include enterprises, non-profit organizations and all citizens in the prevention, control and disposal of public health emergencies. On the one hand, enterprises, social groups, non-governmental organizations and other organizations can help prevent and control diseases. On the other hand, by joining in the prevention and control activities organized by government departments, the above-mentioned subjects can participate in the process of social governance, which can not only practice the concept of multi-body common governance but also deepen national identity and promote social unity [
65].
The shortcoming of the policy lies in the failure to specify in the text the phased assessment time frame for the realisation of the plan. The achievement of the policy effect not only relies on the scientific design of the policy text but also requires the effective cooperation of the policy implementation. Therefore, the stipulation of policy time should not be limited to the length of the policy effectiveness but should also pay attention to the design of the phased implementation assessment scheme for policies.
P3 and P4 are emergency plans for public health emergencies. The former is the “National emergency plan for public health emergencies” issued by the State Council in 2006, and the latter is the “National health emergency plan for natural disasters” issued by the Ministry of Health in 2009.
From the perspective of policy jurisdiction, P3 is the emergency reserve for all types of public health emergencies nationwide, and P4 is the emergency plan for health emergencies after natural disasters. In terms of effectiveness level, P3 is the superior law of P4.
From the quantitative evaluation results, the scores of X
1, X
2, X
3, X
5, X
6, X
7 and X
9 of the two policies are the same, and the differences are mainly reflected in the scores of X
4, X
5 and X
8. In terms of the X
4 policy field, the score of P
3 is lower than the average score of the main indicators. The policy contents of P
3 and P
4 involve economic, political and social environments. However, there is little mention of the emergency plan in the field of education and no detailed plan for the handling of public health events within educational institutions and the emergency response of educational institutions after the outbreak of public health emergencies; at the same time, the administrative department of education is not included in the coordination mechanism. P
4’s performance in X
5 policy function is inferior to P3’s, and the main gap comes from the vacancy of the policy’s function of stabilizing social order. Public health emergencies will have a certain impact on market supply, price level, social security, etc., so it is very necessary to embed order maintenance clauses in the policy content. The practice of fighting against COVID-19 shows that the basic living guarantee of the masses during the epidemic is equally important. Therefore, in 2022, the Ministry of Agriculture and Rural Affairs, the National Development and Reform Commission, the Ministry of Finance and other ministries and commissions jointly issued the work guide for coordinating the prevention and control of COVID-19 epidemic and ensuring the supply and price stability of “vegetable basket” products to maintain citizens’ living order. P
3 and P
4 policy texts are rich in guiding the work and life of government departments and people, however, the common shortcoming is that there is no mention of the code of conduct and policy safeguards that social groups, such as non-profit organisations, should have in response to emergencies. In fact, volunteer organizations and rescue organizations have played an important role in every emergency. Policy is not only the practical guide to prevent and respond to emergencies, but also the embodiment of social values. Therefore, the formulation of public policy should not only be problem-oriented but also take into account value orientation [
66].
The three policies at the bottom of the list are P9, P7 and P8, which are professional classification policies issued by various ministries and commissions, focusing on emergency response team building, public health prevention and treatment capacity building, and food safety risk detection. They scored the same on the four primary indicators X1, X2, X3 and X6. Among them, the score of X2 is lower than the average. The use of demand-based policy instruments is zero in P9 and P7, while the use of supply-based instruments is missing in P8; overall, there is some bias in the proportion of policy instrument use. Otherwise, all three policies performed poorly in terms of policy field, policy function, policy mode of action and policy target group. On the one hand, these shortcomings are limited by the professionalism and non-comprehensive nature of the policy content, but at the same time, there is still room for improvement in the design of the policy content. Taking the scores of X4, X5 and X7 of P8 as an example, although the policy objective is to risk testing for food safety, the content of the policy still needs to consider the work arrangements in economy, education, social services, social environment and other aspects. The restricted nature of the policy content leads to a limited policy function. The policy function of P8 is only manifested in three aspects: prevention in advance, event monitoring and reporting and emergency system construction. However, in fact, interspersing the policy content with science education and regular food safety risk prevention and control measures will not conflict with the achievement of the policy objectives; otherwise, issuing policies to achieve a single objective will inevitably lead to policy redundancy. Furthermore, the traditional Chinese policy implementation method relies on the vertical mechanism of administrative power, which can ensure the effective implementation of policies and prevent the occurrence of “executive vacancy”, however, this mode may also lead to the policy action mode being trapped in the “mandatory type”, which obviously runs counter to the concept of “multi-agent collaborative governance”, and is not conducive to the mobilization and use of social resources during the sudden crisis.
4.3.4. PMC-Surface of Four Policies
The PMC-Index results for the six policies, P3, P4, P7, P8, P9 and P10, have been discussed in detail in the previous section, and the following paper will analyse P1, P2, P5 and P6 in three dimensions by means of constructing a PMC-Surface.
P
1 is the implementation measures of the law on the prevention and control of infectious diseases issued by the State Council of China in 1989, which ranks sixth in PMC-Index. From the title, it can be seen that it is a supporting implementation measure of the law on the prevention and control of infectious diseases, and its policy objective is to implement the law with the highest effectiveness. From the surface chart (
Figure 7), we can see that there is a large imbalance in the indicators at all levels of the policy. The concave part in the figure is mainly concentrated in the upper and lower corners, which reflects the low scores of X
3, X
6 and X
8 in the PMC-Index results. In addition to the common low scores of X
3 and X
6 of all policies, the policy target groups of P
1 are limited to government departments and the public. At the same time, the scores of X
4 and X
7 are lower than the average value because the policy does not involve the economic and social services field, and the implementation of the policy is limited to coercion and incentives.
P
2 is the notice on printing and distributing the outline of the Tenth Five Year Plan for national prevention and control work issued by the general office of the Ministry of Health in 2001. Its policy objective is to actively prevent and control major and key infectious diseases endangering public health through reform, establishment and improvement of the disease prevention and control system and improve the emergency response and handling capacity of public health emergencies. Compared with the above figure, the curved surface of P
2 (
Figure 8) has less undulation, and the concave part is mainly concentrated in the lower right corner, that is, the policy time and the policy issuing institution. P
2 is an outline for the construction of health prevention and control over the next five years. In the text, policy makers detailed the specific objectives of future work from six aspects: system reform, infectious disease prevention and control, vaccine preventable infectious disease control, endemic disease and parasite prevention and control, chronic non-infectious disease prevention and control and rural health construction, however, in contrast to the clear work objectives, the policy text does not include a phased assessment plan for the achievement of the work objectives, so that there is a lack of effective supervision and guidance for the achievement of the policy objectives. In addition, there are many aspects of the policy that exceed the authority of the Ministry of Health, such as intergovernmental cooperation and patriotic health campaign, which are not equal to the powers and obligations of the policy issuing agencies, resulting in the phenomenon of ultra virus issuance and scheduling failure in the process of policy implementation.
P
5 is “Regulation on emergency response to public health emergencies” issued in 2011 by the State Council, and is the only policy in China with a high level of legal force that directly addresses emergency response to public health emergencies. The curved surface chart (
Figure 9) suggests that X
1 to X
3 show a straight-line downward trend, and the scores decrease in turn; in addition, there is an obvious depression between X
7 and X
9. P
5’s X
3, X
4, X
6 and X
8 do not score well for similar reasons as the other policies. In addition to this, as a comprehensive emergency response policy, P
5 focuses only on guidance for government departments and the public, neglecting the mobilisation and guidance of enterprises and non-profit organisations.
P
6 is the law of the People’s Republic of China on the prevention and control of infectious diseases revised in 2013, and is also the most effective policy text in the field of infectious disease prevention and control. For the prevention and control of infectious diseases, the policy establishes a set of strict standard systems for prevention, reporting, control, medical treatment, supervision and management, and safeguard measures, defines the responsibilities of governments at all levels and provides effective operational guidance for grass-roots departments. Looking at
Figure 10, it can be seen that there is a limited range of concavity in the surface plot of P
6, excluding the common problem of X
3 and X
6, the other level indicators of P
6 are generally relatively balanced, with only X
7 scoring below average for the policy mode of action. This is mainly due to the lack of incentive measures for the prevention and control of infectious diseases, excessive reliance on mandatory and service measures, long-length description of legal liability and incentive provisions such as granting incentives and allowances are only briefly covered in Chapter VII safeguards.