摘要
既有研究时常观察、分析有组织的利益相关者与政府之间的治理互动过程,却相对忽略了政府内外部行动者的分散性及其对政策变迁产生的影响。聚焦广东省从药品零加成到医用耗材零加成的政策过程发现,分散化的行动者主要通过“碎片化”政策反馈机制来推动政策变迁。在广东省的医疗控费过程中,公立医院除了诉诸正式的行政沟通,主要根据差异化的资源效应和非正式关系来寻求利益和观点表达。而政府内部的不同行动者则根据部门立场和经验来对公立医院反馈的相关问题进行“碎片化”再解释。“碎片化”政策反馈确保了分散化行动者的多元目标、价值和利益能够嵌入政策变迁过程。但由于分散化行动者互动的“等级导向”以及改革的政绩考核要求,它只能构成一种“弱”修正机制,对地方卫生政策的目标和工具进行微调。文章从“以行动者为中心”的制度主义视角丰富了政策反馈的理论研究,并尝试结合中国的行政体制特征,解释医疗控费政策渐进式改革的形成和困境。
Existing studies have paid certain attention to policy interactions between organized stakeholders and the government, but relatively ignored the decentralization of actors inside and outside the government and their influence on policy change. Focusing on the Policy Feedback Theory(PFT) and the case study of Canceling of the Drug Price Addition Policy(CDPAP) in China’s Guangdong Province, this study reveals there is a fragmented policy feedback mechanism to ensure that diverse interests and concerns can be embedded in the administrative medical cost-containment. In our case, CDPAP shape differentiated resource effects and benefit compensations for public hospitals so that most public hospitals resort to the fragmented health administration system to seek interest and opinion expression, with several hospitals developing their respective policies. However, the perception and interpretation of policy outcomes also tend to be fragmented among different government departments and their officials. Therefore, policy change relies strongly on the hierarchical direction and coordination. Top-down political orders and performance assessments lock in the basic objectives and instruments for subsequent policies while the fragmented policy feedback only constitutes a weak revision mechanism of related medical cost-containment policies. This study enriches the theoretical discussion of policy feedback from the perspective of actor-centered institutionalism, and suggests the dilemma of administrative medical cost-containment in China.
作者
吴文强
岳经纶
Wu Wenqiang;Kinglun Ngok(Center for Political Development and Local Governance,Fujian Normal University,Fuzhou;School of Government,Sun Yat-sen University,Guangzhou)
出处
《经济社会体制比较》
CSSCI
北大核心
2022年第6期140-150,共11页
Comparative Economic & Social Systems
基金
国家社科基金青年项目“基于卫生健康共同体建设的政策整合机制研究”(项目编号:21CZZ026)。
关键词
公立医院
医疗控费
行动者
政策反馈
政策变迁
Public Hospital
Medical Cost Containment
Actor Policy Feedback
Policy Change
