近年來，醫療政策與社會政策學界探討中國經濟轉型對於健康照護體系影響 的研究方興未艾，特別是中國在改革開放之後，對於中國城市與鄉村原有健康保 障體系將產生哪些衝擊與因應對策，乃成為重要的議題。1980 前中國的醫療保 障制度主要是公費醫療與勞保醫療制度。1980 年代中期之後，在市場化經濟政 策的導引下，嘗試以引進市場競爭策略來強化醫療供給者的服務誘因。然而，隨 著醫療供給者之間的惡性競爭與醫療市場中所謂供給創造需求的扭曲結構，相應 地也必須在醫療體系私有化策略上進行配套性的改革。中國國務院的社會發展中 心就對於十五年來的醫療體系改革過度向供給者傾斜給予相當負面的評價，並且 在社會各界引起廣泛的迴響。其次，許多統計數據顯示，在私有化策略的衝擊之 下，一般城市居民的醫療不平等條件與進入醫療體系障礙確實有日趨不穩定的趨 勢。本研究將以江蘇省的公立醫院改革為例，分析各地方政府採取不同改革策略 的原因、過程與後果。在田野研究中將分析宿遷（私有化）、鎮江（整合式社會 保險）與無錫（管辦分離）三個不同的改革模式，我們將聚焦於地方政府與醫院 間的策略互動，分析影響地方政府採取不同改革策略的路徑、因素與後果。最後， 我們希望與「地方組合主義」的觀點進行對話 From Marketization, Commodification to Egalitarianism? the controversy analysis of Chinese Health Care System Reform Recently, the impact of market transition on Chinese health care system has caught wide attention among the scholars of health and social policy studies. Particularly after the economic reform era, how the health care system in urban and rural areas has been transformed by the marketization process is especially crucial. Before 1980, the Chinese health care system was mainly dominated by the government-financed and labor insurance system. After 1980, the marketization strategy has been adopted by the policy-maker to improve the economic incentives of medical provider. However, the malicious competition between providers and the information asymmetry within medical market results in accessibility and inequality problems for the low-income households. The structural reform of Chinese health care system has therefore sparked wide debate among the Chinese society. This research aims to evaluate these reform options, particularly focus on their impacts on the health inequality. The three model in Jiansu Province during the hospital reform will be examined in the field study. The Suchen (privatization model), Chen-Qian (integrated social insurance) and Wu-Shi (autonomization model) seems to demonstrate the three typical models in Chinese health care and hospital reform. The path, process and consequences of the reform will be examined in terms of local cooporationism.
