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国家发展战略与政策选择受中央政策共同体的认知取向影响。特定时期内国家合作医疗政策的选择与变迁,既受到国家建设取向转变的影响,也是决策者为了论证国家建设路径合理性、获得政治合法性所作的策略选择。新中国成立至今我国的国家建设取向经历了理想主义、发展主义到科学发展观的转换。相应的,合作医疗政策定位也经历了从社会主义“人民福利”、“营利性”政策到“国民福利”的转变。在该过程中,农民群体的社会身份实现了“人民”向“国民”的转变。但是政治参与等积极权利的缺失表明农民群体尚未获得真正的公民资格,合作医疗也需实现由国家主导的自上而下的福利赋予行为向基本公民权利的转变。
The choice of national development strategy and policy is influenced by the cognitive orientation of the Central Policy Community. The choice and change of the national cooperative medical policy in a specific period are not only affected by the transformation of the national construction orientation but also the policy choices made by the policy makers in order to demonstrate the rationality of the national construction path and obtain the political legitimacy. Since the founding of New China, the orientation of our country’s construction has undergone a transformation from idealism and developmentism to the concept of scientific development. Correspondingly, the positioning of the cooperative medical policy has also undergone a change from the socialist “people’s welfare” and “profit-making” policies to “national welfare.” In the course of this process, the social identity of the peasantry changed from “people” to “national”. However, the lack of positive rights such as political participation indicates that the peasants’ groups have not yet acquired true citizenship and that the cooperative medical care needs to realize the transformation from a state-led top-down welfare grant to a basic civil rights.