Abstract: Objective To analyze the issues encountered during the implementation of the "Two Permissions" policy,aiming to provide references for better implementation of the "Two Permissions" policy. Methods Based on prior research,convenience sampling method was adopted to conduct a questionnaire survey on 233 personnel from over 20 primary medical and health institutions in several administrative districts of Tianjin,and the data were analyzed. Results The average score of the respondents' understanding of the "Two Permissions" policy was （2.90±1.40）points,among which personnel with higher professional titles,higher positions,and longer working years demonstrated a greater understanding of the "Two Permissions" policy（all P<0.05）. The primary factors impeding policy implementation included "the need for enhanced publicity and implementation of the 'Two Permissions'" "insufficient financial support and the necessity to adjust the financial investment structure" "the ambiguity in determining income costs and the extraction ratio of surplus funds",and "the absence of actionable guiding documents" Conclusion The implementation of the "Two Permissions" policy in primary medical and health institutions in Tianjin demands a multi-faceted policy environment. Feasible research considerations and suggestions are proposed from both the government and institutional levels to facilitate better policy implementation.

Key words: "Two Permissions" policy, Primary medical and health institutions, Performance appraisa, Policy recommendations