当代社会科学中方兴未艾的新制度主义揭示, 任何制度的正常运转都嵌入在更大的制度、结构甚至文化因素之 中。如果对制度嵌入性缺乏深入细致的研究 ,单纯就合作医疗研究合作医疗,我们就无法对国家如何适当干预提供学理上的指导 。本文依据新制度主义中制度嵌入性的思路,利用相关历史文献、统计数据和已有的调查研究 ,对合作医疗可持续性发展的制度结构和支持条件进行全面综合的分析 。

This is a study of cooperative medical schemes (CMSs)operating in rural China from the perspective of institutional embeddedness .As a kind of community-based health micro-insurance scheme , CMSs often suffer from financial vulnerability due to its small scale of risk pooling .CMSs operated relatively successfully during the pre-reform era as the institutional environment in which they were embedded were favorable .Under the planned economy and tough social control , adverse selection and provider-induced over-provision of healthcare were non-existent .During the market transition , CMSs encounter with so severe problem of adverse selection that they lose attractiveness to most of rural residents, and they are further sabotaged by bad governance .At the same time , healthcare providers, driven by marketization , have no longer had incentive to curtail cost increase .Chinese CMSs are at a crossroad, either developing towards a state-run voluntary health insurance scheme or maintaining its community -based nature but receiving strong support from the government .

顾昕,方黎明

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