實驗主義與政策試點：中國大陸的公立醫院改革

Policy Experimentation and Test Sites: China's Public Hospital Reforms

本文以中國大陸公立醫院改革為例，探討中國大陸政策試點的運作邏輯。長期以來，「實驗主義」被許多學者歸納為中國大陸政策改革的基本模式，在最近的文獻發展裡，中國研究學者對由下而上所發展的地方創新已有相當多面向的研究成果，但關於由上而下所發布的政策試點的研究則嫌不足。為了完整瞭解中國大陸政策改革的模式，本文聚焦於政策試點，探究中央政府將特定地區列為試點的原則。本文透過迴歸分析與案例研究，發現中央政府所選擇的地方試點，多出現在經濟發展欠佳的地區。這是因為，在公立醫院改革的情況裡，經濟發展較差的地區，醫療問題也多較為嚴重，改革的迫切性較高，阻力也較小。因此，試點的挑選與該政策在當地已成功展現初步成果、以及可以繼續成功執行的預期性相關，當前試點的邏輯因而多屬於確認哪些地方可以作為示範地區。 This paper explores the logic of China's policy experimentation through an examination of public hospital reforms. For a long time, ＂experimentalism＂ has been summarized by many China scholars as the basic model of policy reform in China. In recent development, many researchers focus on bottom-up local innovations, and the study on top-down policy experimentation with local test sites is relatively insufficient. To have a better grasp of China's gradual style of reform, this paper focuses on top-down policy experimentation and examines how the Chinese central government selected local test sites in public hospital reforms. The results show that the prefectures and counties with lower levels of economic development were more likely to be selected as test sites. This is because medical problems were more serious in poor areas, and implementing the reform in these places would meet less resistance. This paper provides large-N evidence and case study research to this argument. In order to have positive feedback of experimentation, the central government tended to choose the localities with a higher probability for the reform to be successful. In other words, the logic of choosing local test sites is to demonstrate the merits of reform.