地方政府对中央政策响应差异化的影响因素及机制分析——基于医保支付方式改革的多案例比较  

Analysis of the Influencing Factors and Mechanism of Local Government's Response to Central Policy Differentiation——Comparison of Multiple Cases Based on the Reform of Medical Insurance Payment Methods

作　　者：李乐乐 张雨晴 古德彬 Li Lele;Zhang Yuqing;Gu Debin(School of Labor and Human Resources,Renmin University of China,Beijing,100872,China;School of Public Policy&Management,Tsinghua University,Beijing,100084,China;Sun Yat-sen University Cancer Center,Guangzhou,510060,China)

机构地区：[1]中国人民大学劳动人事学院,北京100872 [2]清华大学公共管理学院,北京100084 [3]中山大学肿瘤防治中心,广州510060

出　　处：《公共管理学报》2024年第2期153-165,176,共14页Journal of Public Management

基　　金：国家自然科学基金项目(72204251)。

摘　　要：在国家治理体系与治理能力现代化背景下,地方政府对中央政策响应表现出差异化的行为。本文立足于政策执行的经典理论,从央地关系和地方政府角色的视角构建地方政府政策响应行为差异化的理论解释框架。本文认为,地方政府的政策响应行为受到其扮演的“国家代理人”、“理性人”和“社会代理人”这三重角色的影响。以医保支付方式改革政策为例,本文采用多案例比较分析的方法,对地方政府政策响应差异化的影响因素及机制进行分析。研究发现,地方政府的三重角色会影响其政策执行的主观意愿,地方政府可支配资源会对政策执行形成客观约束,最终所产生的地方政府的整体政策目标序列是解释其政策响应差异的重要机制。本文的研究发现为理解地方政府的政策执行提供了新的视角,为地方政府更好地推动医保支付方式改革和改善民生保障提供了新的思路。In the context of modernization of national governance system and governance capacity,local governments show differentiated behaviors in response to policies of the central government.This paper constructs a theoretical framework for the different policy responses based on the per-spective of central-local relations and the role of local governments.Taking the health insurance payment reform policy as an example,the influ-encing factors of different policy responses are analyzed by adopting a multi-case comparative analysis.It is found that subjective willingness to implement policies influenced by the triple roles of local governments,objective constraints to implement policies limited by the resources at the disposal of local governments,and the overall sequence of policy goals of local governments are important mechanisms and logics that generate dif-ferences in policy responses.The findings of this paper provide a new perspective for understanding the policy implementation of local government politics and new ideas for local governments to better promote health insurance payment reform and improve people's livelihood.

关 键 词：央地关系 地方政府角色 政策响应 政策目标序列 医保支付方式 

分 类 号：D035[政治法律—政治学]