政策话语建构政策认同:门诊共济改革中的利益、价值与自我观念Policy Discourse and Policy Identification: Interests, Values, and Self-concepts in China's Outpatient Mutual-aid Health Insurance Reform
邱玉慧
摘要(Abstract):
政策话语建构政策认同有赖于主体的利益诉求、价值匹配及其差异化定位。本文基于门诊共济改革的新浪微博数据,采用OLS、Logit模型和倾向值匹配方法,分析了在政策话语调整前后主体认同的显著差异及话语类型间的复杂性。研究运用扎根理论方法,识别出价值导向与具象认知两种自我阐释逻辑、五种认同路径及“话语-情境-自我”循环互构过程,并发现,价值自我对具象自我呈有条件统合,取决于价值自我的明晰性、具象自我的情境敏感性及二者方向的一致性,进而呈现出差异化认同路径;自我观念既源于政策话语及实践建构,也具有情境建构性。本文为分析利益与价值认同的复杂机理提供了新的场景和更细致的经验证据。
关键词(KeyWords): 门诊共济;政策话语;政策认同;自我观念;扎根理论
基金项目(Foundation): 教育部人文社科规划项目“重大民生改革的政策话语建构及其网络舆情引导效果评估研究”(项目批准号:23YJAZH112)的资助
作者(Author): 邱玉慧
参考文献(References):
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- (1)职工医保由单位和个人共同缴费,单位缴费一部分进入统筹账户、一部分划转个人账户,比例因地而异;个人缴费进入个人账户,比例一般为本人月缴费工资额的2%。居民医保由个人缴费和政府补贴构成,资金主要划入统筹账户;部分地区曾设立个人或家庭账户,但多数已于2019年以前取消。 (2)截至2019年年末,职工医保个人账户累计结存8276.50亿元。参见国家医保局.2019.全国医疗保障事业发展统计公报,北京.国家医保局. (3)所谓“共济”,既指一种价值理念,也指一种利益保障机制,不同语境下含义不同。一是作为制度理念和改革价值目标的“互助共济”,包括保险的风险共济和再分配的社会共济。二是用作改革正式名称的“门诊共济”,指“互助共济”的利益保障机制。三是作为个账资金使用规则的“家庭共济”,指“资金共用”。微博场域中对“互助共济”和“门诊共济”的宣传与这一概念存在一定混淆。 (4)分组过程中同时尝试了三分类方法:只含个账、同时含个账和共济、只含共济。但只含共济的样本比较少,且三分类也会使讨论更加复杂和分散,因此采用二分类。家庭共济解读归入个账话语。 (5)根据各省职工医保政策整理获得,截至2019年6月,部分地区已开展慢特病、社区首诊、门急诊、家庭病床等形式的门诊统筹;北京、河北、天津、浙江、福建、广东等地还开展了普通门诊统筹试点。 (6)“自立”原指依靠劳动挣得社会保险权益的价值假定。它与保险风险共济并不冲突,但常与产权私有、多缴多得相一致,与社会共济和再分配存在张力。资料中,多缴多得的认知甚至否定了保险共济,且未见其与“互助”兼容的表达。 (7)根据1998年《国务院关于建立城镇职工基本医疗保险制度的决定》,“个人帐户的本金和利息归个人所有,可以结转使用和继承”。但这里仅指个账内已有资金,并未排除个账存入比例调整的合理性。文件原文使用“帐户”,今规范用法为“账户”。