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“话语”是政策过程中的普遍性因素,也是一个长期被忽视的因素。公共政策是话语建构下的产物。决策过程可以视为围绕特定议题的意义赋予、话语宣称与竞争的过程,竞争的“获胜者”将影响最终政策选择或变迁的方向。通过关注话语在“社会现象-社会问题-政策议题”转化过程中的作用,可以构建一个理解决策过程的解释模型。应用该模型考察1990—2003年中国农村合作医疗的国家决策过程,可以发现“地方互助”话语的长期主导为国家在不进行财政投入的情况下谋求重建传统合作医疗的政策取向赋予了“合理性”依据。而“新农合”政策的出台,是由于“国家投入”话语在众多政策倡导者的努力下,成功地与“扶贫”话语关联在一起,并取代“地方互助”话语而主导了合作医疗政策场域。
“Discourse ” is a universal factor in the policy process, but also a long-neglected factor. Public policy is the product of discourse construction. The process of decision-making can be seen as the process of asserting and disclaiming the discourse around the meaning of a particular issue. The “winner” of competition will influence the direction of the final policy choice or change. By focusing on the role of discourse in the transformation of social phenomena - social issues - policy issues, we can construct an interpretive model for understanding the decision-making process. Using this model to examine the national decision-making process of China’s rural CMS from 1990 to 2003, we can find that the long-term dominant position of “local mutual aid” is the policy orientation of seeking to rebuild the traditional cooperative medical care without the government’s financial investment. “Reasonableness” basis. The promulgation of the “NRCMS” policy is due to the fact that the discourse of “national input” has been successfully linked to the discourse of “helping the poor” with the efforts of many policy advocates and has replaced the " Discourse and dominated the cooperative medical policy field.