试验性治理与试点嵌套——中国公立医院改革的政策逻辑

Experimentalist Governance and Nested Policy Experimentation:The Policy Logic of Public Hospital Reform in China

经常性的政策试验是中国公共政策过程的典型特征,也是试验性治理进行政策创新、解决难题的主要载体。已有政策试点研究多以单项目试点为研究对象,然而对于长时期、跨部门、多目标的超大规模试点尚缺乏系统总结,在社会政策领域的探讨则更少。本研究以中国公立医院改革为例,通过对新医改11年间公立医院改革试点过程壮阔画卷的分析,结合内容分析和主题建模等方法,总结中国公立医院改革、乃至医疗保障体系建设的政策逻辑。研究发现,试点嵌套是在高度不确定性和利益格局高度复杂性约束下推进社会政策领域改革的有效模式。试点嵌套整合了试点空间、内容和过程等多重要素,有效提升了试点主体的学习能力、整合能力、兼容能力,促进了社会政策的创新扩散。

Frequent policy experiments are a hallmark of China’s public policy process,through which experimentalist governance generates policy innovations and solves thorny problems.The existing literature predominantly focuses on single pilot programs,and there is a paucity of scholarly knowledge on long-term,cross-sectoral,multi-objective,and large-scale policy experimentation.Focusing on the case of public hospital reform in China,this paper analyzes the dynamics of this eleven-year grand reform program.The underlying policy logic of the public hospital reform and the broad health-care security reform is elucidated through content analysis and topic modelling.This paper reveals that nested policy experimentation serves as an ef fective approach for undertaking policy reforms in the social welfare sphere under extraordinary uncertainties as well as intertwined vested interest.The nested approach integrates geographic,substantive,and processual elements of policy experiment,and signifi cantly improves policy learning capacity,coherence of policy design,and policy compatibility,eventually accelerating social policy innovations.