高势能政策执行偏差的困局及其秩序破解——基于医改政策执行的观察  

The Dilemma of Implementation Deviations for High Political Potential Energy Policy and Its Solution from Order Perspective——Based on an Observation on Typical Health Care Reform Policies

作　　者：曹琦[1] 严则金 Cao Qi;Yan Zejin(School of Public Administration and Policy,Renmin University of China,Beijing,100872,China;Beijing Hospitals Authority,Beijing,100053,China)

机构地区：[1]中国人民大学公共管理学院,北京100872 [2]北京市医院管理中心,北京100053

出　　处：《公共管理学报》2024年第2期141-152,175,176,共14页Journal of Public Management

基　　金：国家社会科学基金项目(23BGL298)。

摘　　要：医药卫生体制改革是我国推进健康中国建设的核心任务与体制基石。诸多医改政策具有较高的政治势能,但在实际执行中却产生偏差,政策执行结果与初衷偏离甚至相悖。现有研究对这一问题的理论机制解释力不足。本文从高势能政策的本质入手,提出秩序维度的思考,认为高势能政策普遍旨在重构秩序,而政策执行偏差就来自于“自发秩序”向“自觉秩序”转化过程中的秩序困境。本文首先从类型学意义上,界定政策执行偏差包括“逆执行”、“形式执行”和“弱执行”三种主要类型,相应选择公立医院规模控制、家庭医生签约服务、城市医疗集团建设三项代表性政策进行分析,并与“有效执行”的三项政策案例进行比较,提炼高势能政策执行偏差秩序视角的理论解释。认为高势能政策有效执行需要共享价值、结构功能与激励契约三项秩序要素的适配和共生,否则自觉秩序就不会生长,政策执行就会产生偏差。高势能政策不能只满足于制定环节的价值理性,还要关注执行环节中关键秩序要素能否统合支撑秩序范式转化。The health care reform is the core task and institutional cornerstone of China's efforts to promote "Healthy China Strategy".Many health care reform policies have high political potential energy,but in actual implementation,deviations have been observed,and the policy results even contradict with the original intention.Existing researches on the theoretical mechanism of this problem have insufficient explanatory power.In this paper,we approach our analysis based on the essence of high political potential energy policy,and put forward the thinking from order per-spective.We argue that high potential energy policies generally aim at reconstructing order,and the deviations of their implementations come from the dilemma in the process of transforming "spontaneous order" to "conscious order".We firstly define the three main types of policy implementa-tion deviations,including "reverse implementation","superficial implementation" and "weak implementation" in a typological sense.And accord-ingly,we select and analyze three representative cases of health care reform policies,namely Public Hospital Size Control,Family Doctor Contract-ing Service and Urban Hospital Group,which are in turn compared with cases of "effective implementation" to refine the theoretical explanation from order perspective.It is reasoned that effective implementation of high potential energy policies requires adaptation of the three order elements including value consensus,supportive structural-function and appropriate incentive contract.Otherwise,the conscious order will not grow and the policy implementation will be deviated.We advocate that high potential energy policy entails more deliberations to ensure synergy of the three or-der elements supporting the construction of a new order.

关 键 词：高势能政策 政策执行偏差 医改政策 自觉秩序 自发秩序 

分 类 号：D035[政治法律—政治学] R19[医药卫生—卫生事业管理]