一劳非永逸:基层医疗卫生体系科层化的效果及其限度  

Once but Not for All:The Effects of Bureaucratization of the Primary Health Care System in Rural China and Its Limits

作　　者：何雪吟 HE Xueyin

机构地区：[1]清华大学社会学系

出　　处：《社会学评论》2025年第1期145-171,共27页Sociological Review of China

摘　　要：基本公共卫生服务均等化的目标需要借助大量项目资金的输入来实现,而资金运用方式和转化效率与基层卫生组织结构密切相关。通过案例比较,本文分析了我国两个县域的乡镇、村两级医疗卫生机构的关系模式与工作流程,归纳出项目式关联与准科层化两种类型。前者充分利用了本土资源,却由于难以控制政策执行者而面临低效率困境;后者充分适应了乡村一体化的政策导向,却由于资源高度集中,只能将医疗服务化约为卫生行政,难以回应民众需求。结合制度变革的历史维度,本文考察了科层化作为一种组织机制调整策略所能发挥的效果及其限度,在基层组织的理性化趋势之下,医疗卫生体制改革依然不是一劳永逸的。China’s current governance goal of“equalizing basic public health services”relies on the input of substantial project funds,and the efficiency of their use is related to the organizational structure of the rural bureaucracy.Through a case comparison of two counties,this paper analyses how the different patterns of rela⁃tionship between township-level and village-level health institutions affect policy implementation.The two models are constructed as“project-based linkage”and“quasi-bureaucratization”.The former is localized but malfunctions due to the uncontrollability of policy implementers.The latter is subject to the policy orientation of rural health system integration;still,it can only reduce services to administration due to the concentration of resources,failing to respond to the public.This paper adopts the historical view of institutional transformation,examines the effects and limits of bureaucratization as a historical strategy,and suggests that health system reform will not be“once and for all”,even under the trend of rationalizing grassroots governance.

关 键 词：基层治理科层化 乡村医疗 公共卫生 乡村一体化 

分 类 号：F83[经济管理—金融学]