话语建构与“不决策”:对改革开放初期合作医疗解体的一个理论解释

Discursive Construction and “Nondecision-making ”: A Theoretical Explanation of Disintegration of the CMS in the Early Years of Reform and Opening Up

改革开放初期导致合作医疗解体的直接动因是政府决策者的"不决策"行为。"不决策"作为政策选择的一种隐蔽形式,它的合理性论证是在特定话语的建构作用下实现的。具体而言,在改革开放初期的"现代化"话语中,合作医疗被建构为文革"左"倾的产物、"非生产性开支"和落后的初级健康保障制度,从而遭到了质疑乃至"否定"。话语总是与权力关联在一起,话语建构本身就是一种隐蔽的权力运作方式。在农村医疗领域中,话语权的缺失是农民群体长期处于弱势地位的根本原因。

The direct reason of the disintegration of the cooperative medical scheme( CMS) in the early years of reform and opening up is national policy- makers' choice of'nondecision- making '. As a concealed form of policy choice,the rationales of'nondecision- making ' were achieved through specific discursive construction.Specifically,in the 'modernization'discourse in the early years,the CMS was regarded as the outcome of the 'Left ' line of the 'Cultural Revolution', 'unproductive expenditure' and the uncultured primary health care system. As a result, it was'denied'or doubted. Discourse is always associated with the exercise of power,and the'discursive construction'process itself,is a process of power exercises. In the domain of rural health,the absence of discourse- power is the fundamental reason why the peasants have been disadvantaged for so long.