The Changing Relationship between Chinese Urban Medical Profession and the State since the republican Period: From the perspective of the sociology of professions

职业与国家关系是职业社会学的中心议题。本文以法团自主性与临床自主性的分析框架，分三个阶段梳理了近代以来中国城市医生职业与国家关系的演变轨迹及其逻辑。民国时期，均处于新生阶段的医生职业和现代国家是“互构”关系；新中国成立后，通过将医生从自由职业者转化为单位人，国家“驯服”医生职业，使其成为国家机器的一部分；改革至今，医生对公立医疗机构的依附仍在延续，医生也由此获得对病患与医药厂商的“双向支配”，以此从市场中获取经济利益；但医生也因此成为患者与政府之间的“缓冲器”。本文认为，重构医生职业—国家关系应纳入新医改的议程当中。

The relationship between professions and the state is one of the most important issues in the sociology of professions. Using the analytical framework of corporateclinical autonomy dynamic relationship, this article delineates and analyzes the changing relationship between the (western) medical profession and the Chinese state since the Republican period. Before 1949, growing medical profession and the newborn state was in “interconstruction.” From 1949, the communist regime transformed medical professionals into the members of work unit successfully. The profession was tamed and became functionary of the state. Although China began the reform in 1978, public healthcare institutions still dominate the delivery of healthcare services. Therefore, the practitioners are still dependent upon work units. Meanwhile, they have the dominance over both patients and medical enterprises, through which the profession gain economic interests from the market. But the cost is that the practitioners have become the buffer between patients and the government. Therefore the further reform of healthcare system should reconstruct the relationship between the profession and the state.

姚泽麟

本文受2014年度教育部人文社会科学研究基金项目（14YJC840040）和2014年度上海市哲学社会科学规划课题项目（2014ESH001）的资助。

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