制度化能力与民生绩效——基于中美两国“新医改”的比较研究

Institutionalization Capacity and People’s Livelihood Performance:A Comparative Study of the“New Medical Reform”Between China and the United States

“制度化能力”是国家能力的重要组成部分,是推进国家治理体系和治理能力现代化的重要议题,对于促进和改善民生事业的绩效具有十分重要的意义。医疗卫生事业是重大民生事业,中美两国几乎同时启动的“新医改”为揭示制度化能力与民生绩效的关系提供了历史契机。基于对两国“新医改”历程的考察,运用比较研究方法,揭示制度化能力对于医疗卫生事业发展及其绩效提升具有重要的作用。其中,在医疗卫生政策的过程绩效方面,美国的“新医改”因为深度嵌入在了该国独特的政党政治结构之中而不断处于制定制度和废止制度的循环往复之中;中国的“新医改”过程则在经历了早期的“政治化”之后迅速转入“制度化”阶段,表现出了明确的制度化目标和较强的制度化能力。在医疗卫生政策的结果绩效方面,与各自十年前的情况相比,中国在医疗卫生制度建设的水平、国民健康素质的提升和卫生健康事业的经济绩效等方面的进步都要更为明显,进一步彰显了制度化能力与民生绩效的紧密关系。中美“新医改”历程及其绩效的差异集中反映两国在国家制度和国家治理体系的差别,其核心是制度化能力的差异。文章从制度化能力的角度探讨民生绩效,深化了对于坚持和完善中国特色社会主义制度、推进国家治理体系和治理能力现代化的认知。

“Institutionalization capacity”is an important part of national capacity,which is an important issue to promote the modernization of national governance system and governance capacity and of great significance to promote and improve the performance of people’s livelihood.The health care is a major cause of people’s livelihood.The“new health care reform”launched by China and the United States simultaneously provides a historical opportunity to reveal the relationship between the institutionalization capacity and the people’s livelihood performance.Based on the investigation of the process of the“new medical reform”in the two countries,I use the comparative research method to reveal the important role of institutionalization capacity in the development and performance improvement of medical and health services.Among them,in terms of the process performance of health care policy,the“new health care reform”in the United States is constantly in the cycle of formulating and abolishing the system because it is deeply embedded in the unique political structure of the country,while the“new health care reform”in China is rapidly turning into the“institutionalization”stage after the early“politicization”,which shows clear institutionalization goal and strong institutionalization capacity.In terms of the results and performance of medical and health policies,compared with the situation ten years ago,China has made more obvious progress in the level of medical and health system construction,the improvement of national health quality and the economic performance of health services,which further demonstrates the close relationship between the institutionalization capacity and the people’s livelihood performance.The differences in the course and performance of the“new health care reform”between China and the United States are the concentrated reflection of the differences in national systems and national governance systems between the two countries,and the core is the differences in institutionalization capacity.I discusse the people’s livelihood performance from the perspective of institutional capacity,which deepens the cognition of adhering to and improving the socialist system with Chinese characteristics and promoting the modernization of national governance system and governance capacity.