地方政府医药价格改革的时空演进机理——以政策创新扩散为视角

The Space-Time Evolution Mechanism of Local Government’s Reform of Medicine Price from the Perspective of Diffusion of Policy Innovations

在我国单一制政体和复杂的府际关系下,社会政策的创新与扩散是一个涉面广泛、多元博弈的复杂政治过程。基于政策创新扩散理论,对中央、23个省级政府和4个直辖市的医药价格改革制度进行了案例追踪和文本比较分析。研究发现,地方医药价格改革政策扩散效应显著,随时间进程扩散呈现全国互动模型下的"S"型曲线;空间维度上,整体表现为由经济发达的东部沿海地区先行,逐步向中部、西部等其他地区推进;区域扩散和邻近效应显著,扩散存在势能差且具有一定的梯度性,沿动力源向周围政策势能低的省份扩散,呈现等级制模型;垂直影响和层级效应明显,体现政策变迁的互动性、动态性与复杂性;扩散内容以跟风模仿为主,学习性与创新能力不足。为提高地方政府政策持续创新力,中央政府应完善顶层设计并适当放权,拓展地方政府创新空间;地方政府应审时度势,积极提升再创新能力,发挥垂直影响的积极作用,加快政策扩散进程。

Under China’s unitary system of government and complicated inter-governmental relations, the in-novation and diffusion of social policy is a complicated political process involving a wide range of fields andmultiple games. On the basis of the theory of diffusion of policy innovations, this article conducts case trackingand text comparative analysis of the system of the reform of medicine price of the central government, 23 provin-cial governments, and 4 municipalities directly under the central government. It is found that the effect of thepolicy diffusion of local government’s reform of medicine price is significant, and over time presents an S-shaped curve under the model of nationwide interaction;in terms of spatial dimension, the overall performanceis that the economically developed eastern coastal areas take the lead and gradually advance to the central, thewestern, and other areas;regional diffusion and neighborhood effect are significant, the diffusion has potentialenergy difference and has certain degree of gradient, and it diffuses along the power source to the surroundingprovinces with low policy potential energy, presenting a hierarchical model;the vertical influence and hierarchi-cal effect are obvious, reflecting the interaction, dynamics, and complexity of policy changes;the content of dif-fusion is mainly a copycat, but lack learning ability and the innovation ability. In order to improve the substain-able innovation ability of local government policies, the central government should improve the top-level designand delegate power to expand the innovation space of local government;the local government should considerthe situation, enhance the re-innovation ability actively, play a positive role of vertical influence, and acceleratethe process of policy diffusion.