用QCA方法打开公共政策试点选择的“黑盒子”——中国城市公立医院改革试点的政策科学逻辑

Unpack the"Black Box"of Policy Pilot Sampling with the QCA Method:The Policy Logic of Urban Public Hospital Reform in China

目的:以我国公立医院改革试点为背景,分析大规模政策试验中的试点选择逻辑。方法:选取国内209个地级及以上城市(包括103个试点城市和106个非试点城市),采用清晰集定性比较分析方法(csQCA),结合案例进行阐释分析。结果:我国四批公立医院改革国家联系试点城市的选择呈现5种不同组态,分别为再接再厉型、取长补短型、一马当先型、背水一战型、以身作则型。每种组态代表了中央政府特定的试验目的。结论:在大国治理的复杂场景中,公共政策试点选择并非线性决策,多种逻辑在其中发挥作用。“正向抽样论”与“代表性论”均在本研究中得到部分印证。试点作为试验性治理的核心载体,发挥着治理的多重功能。

Objective:To explain the strategy for pilot selection in large policy experimentation programs through analyzing the logic of pilot sampling in China's public hospital reform program.Methods:A total of 209 cases(103 pilots and 106 non-pilots)were selected.Crisp-set QCA combined with illustrative case studies was employed as analytical methods.Results:Our analyses reveal five distinctive pathways of pilot sampling:piloting for challenge,piloting for advancement,piloting for innovation,piloting for action,and piloting for regional generalization.Each modality represents a specific experimental purpose.Conclusion:Pilot sampling is by no means a linear decision.This study found that multiple logics were at play in the pilot sampling process of China's public hospital reform.Both representativeness argument and positive sampling argument received certain level of endorsement.We reveal that piloting serves as a versatile governance tool that can fulfill multiple functions in complex reforms.