試驗性治理與試點嵌套：中國公立醫院改革的政策邏輯

經常性的政策試驗是中國公共政策過程的典型特徵，也是試驗性治理進行政策創新、解決難題的主要載體。已有政策試點研究多以單項目試點為研究對象，然而對於長時期、跨部門、多目標的超大規模試點尚缺乏系統總結，在社會政策領域的探討則更少。本研究以中國公立醫院改革為例，通過對新醫改11年間公立醫院改革試點過程壯闊畫卷的分析，結合內容分析和主題建模等方法，總結中國公立醫院改革、乃至醫療保障體系建設的政策邏輯。研究發現，試點嵌套是在高度不確定性和利益格局高度複雜性約束下推進社會政策領域改革的有效模式。試點嵌套整合了試點空間、內容和過程等多重要素，有效提升了試點主體的學習能力、整合能力、相容能力，促進了社會政策的創新擴散。
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 effective 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 significantly improves policy learning capacity, coherence of policy design, and policy compatibility, eventually accelerating social policy innovations. Copyright © 2021 中國社會保障學會;《中國民政》雜誌社有限責任公司.