破解公共服务供给失衡困局的项目制路径--基于浙江城市优质医疗资源下沉政策的研究

The Project System Path to Solve the Imbalance of Public Service Supply--Research on the Sinking Policy of High Quality Medical Resources in Cities of Zhejiang Province

如何以项目制破解公共服务供给不平衡、不充分的问题仍值得探讨。对浙江省城市优质医疗资源下沉政策的研究表明,借助项目制撬动的公立医院托管合作,可以一定程度上解决基层医疗服务能力不足和资源紧缺的问题。该项目的实施既不等同于商业项目的平行双向合作,也超越了传统政府项目制“多线动员”“跨级整合”的政策逻辑,通过“多维动员”“外部统包”“内部分层”一系列机制,特别是借助“嵌入式的治理结构”“捆绑式的人事政策”,在组织的“治理层”“技术层”分别投入“科层化变量”“专业化变量”,回应了多重“发包—承包”关系的协调困境与绩效控制难题。当然,要实现项目功能的彻底释放,仍依赖于对科层化与专业化、市场化逻辑之间张力以及科层制内部权责关系失调等问题的充分回应。这可能导向一种更深层次的制度变革,为地方行动者自主性的调节和政府治理能力的提升创造条件。

It is worth exploring how to solve unbalanced and inadequate supply of public services by project system.A research on the sinking policy of high-quality medical resources in Zhejiang Province shows that the problem of insufficient medical service capacity and resource shortage at the grass roots can be solved to a certain extent by means of the trust cooperation of public hospitals prized by project system.The implementation of such a project is not equal to the parallel two-way cooperation of commercial projects,but also goes beyond the policy logic of“multi-line mobilization”and“cross-level integration”of the traditional government project system.Through a series of mechanisms of“multi-dimensional mobilization”,“external integration”and“internal stratification”,especially the inputs of“bureaucratic variable”and“specialized variable”respectively in the“governance layer”and the“technical level”with the help of“embedded governance structure”,“bundled personnel policy”,it responds to the coordination dilemma and performance control problem of multiple“contract-awarding”relations.Of course,a performance of the project functions depends on the full response to the tension between bureaucracy,specialization and marketization logic,as well as the imbalance of power and responsibility within bureaucracy.This further leads to a deeper institutional change and creates conditions for the adjustment of local actors’autonomy and the improvement of governance capacity.