学习机制与适应能力:中国农村合作医疗体制变迁的启示

Learning and Adapting:The Case of Rural Healthcare Financing in China

适应能力对任何国家都十分重要,因为人类社会必须应对种种复杂局面、未知环境、不确定性、价值和利益冲突;而所有人,包括决策者、政策研究者和专家都只具备有限理性。适应能力的基础是学习。依据学习的推动者(决策者或政策倡导者)和学习源(实践或实验)两个向度可区分出四类学习模式。通过考察中国农村医疗融资体制过去60年的演变历史,发现我们的决策者和政策倡导者能够利用各种形式的实践和实验进行学习和获取必要的经验教训,进而调整政策目标和政策工具以回应不断变化的社会环境。此间高适应体制的"中国模式"逐渐成型,其活力来源于从不相信任何"放之四海而皆准"的标准。

Adaptive capacity is essential for any human social system,because human societies are full of unique circumstances,genuine uncertainty,novel complexity,conflicts of values and interests,and structural instabilities;and,more importantly,the environments under which the systems exist are always changing,while everyone,including policy makers and policy experts,operates under conditions of 'bounded rationality.' Learning is the base of adaptive capacity.This paper distinguishes four learning models by their location along two dimensions: the promoters of learning(policy makers or policy advocates) and the sources of learning(practical experiences or controlled experiments).By studying the evolution of healthcare financing in rural China in the last sixty years,this paper illustrates how policy makers react to newly emerging problems,imbalances,and difficulties by 'fine-tuning,' altering policy instruments,or adopting a new goal hierarchy according to lessons drawn from past and present experiences as well as deliberate policy experimentations.The study reveals that the resilience of the Chinese system lies in its deep-seated one-size-does-not-fit-all pragmatism.