政策制定中多源流因素交互作用机制及其动态不稳定性——美国新一轮医疗卫生改革的经验  

The Interaction Mechanism of the Multiple Streams of Factors in Policy-Making and Its Dynamic Instability Experiences from the New Round of Health Care Reform in the USA

作　　者：赵德余[1] 

机构地区：[1]复旦大学社会发展与公共政策学院

出　　处：《经济社会体制比较》2012年第4期44-55,共12页Comparative Economic & Social Systems

基　　金：2011年上海市浦江人才项目("公共政策实施研究");复旦大学国家建设"985三期"整体推进社会科学研究项目

摘　　要："医改"对于一些国家而言既是对公民权利问题的回应,又是治理社会危机问题的一种政治努力。就权利而言,那些缺乏医疗卫生保险的公民是否应该得到政府的帮助而享有一定的社会保障权?从危机的视角来看,社会医疗卫生总费用的不断膨胀,无论是个人、社会保险机构,还是政府都已面临严重的支出负担压力。一旦个人无法支付医疗卫生费用,医疗保险机构与政府由此造成的入不敷出以及财务赤字严重到一定程度之后,社会性的医疗危机就爆发了。因此,医改就其性质而言,可以被视为如何通过政策制定的政治过程,以实现医疗卫生总费用的控制和公民权利保障的双重目标。Health care reforms are not only a response to the issues of civil rights for some countries, but also a political effort to control the problem of a social crisis. With regard to civil rights, should citizens who lack health insurance get help from the government and enjoy certain social security rights？ With regard to the social crisis, due to increases in total health costs, individuals, social insurance agencies and governments all face in- creased pressure to take on greater expenses. Once individuals can no longer afford health care and social insurance agencies and governments can not make ends meet and their financial deficits reach a certain level, a social health care crisis will ensue. Therefore, in terms of health care reforms, the question is how to use the political process of policy making to achieve the goals of controlling health care costs and protecting civil rights.

关 键 词：政策制定 多源流 动态不稳定性 美国医改 

分 类 号：R197[医药卫生—卫生事业管理]