福利体制理论在医疗卫生体系研究中的应用:中国城市医疗卫生体制模式分析

Welfare Regime Theory in Health Care System Study:Analysis on the Health Care Regime in Urban China

源于福利国家模式划分研究的福利体制理论已经被广泛应用于国际或区域性社会福利模式以及单项或多项社会政策的比较研究中。但是医疗卫生体系却一直被这种研究忽略。本文以福利体制理论为依托,立足于医疗卫生的商品化和去商品化以及卫生服务公平性和不公平性两个维度,构建医疗卫生体制研究范式,进而尝试对中国城市医疗卫生体系的三个发展阶段进行模式划分。进行此种模式划分的风险性很大,但其价值在于能够抽离出中国城市医疗卫生服务体系筹资、供给和管理背后的政治经济学理念,对新一轮医疗卫生改革具有积极的理论启示和借鉴意义,同时也丰富了比较医疗政策研究理论。

Based on the study of welfare states,Welfare Regime Theory has been widely adapted in international and regional welfare regime studies or in specific-policy comparative studies.However,the health care system has often been neglected.Enlightened by the welfare regime theory,this study formulates the Health Care Regime Approach based on the analysis of health care commodification and de-commodification,and analysis of health equity and inequality.Through this approach,three types of health care regime were identified in the development of health care system in urban China,namely the State Welfare Model,the Selective Welfare Model,and the Selective+Residual Welfare Model.There is a great risk to make generalized categorizations on health care regimes,but it is valuable in terms of capturing the political economy behind the finance,provision and regulation of health care system.The approach can provide useful policy implications for the new health care reform in China.In addition,theories on comparative health policy studies are to be enriched.