社会杂志 ›› 2026, Vol. 46 ›› Issue (4): 136-175.

• 专题二：医疗与社会 • 上一篇    下一篇

家国关系变迁中的就医秩序与行动伦理——一个华北村庄的历时性研究

桑坤, 高远*()   

  • 出版日期:2026-07-20 发布日期:2026-09-18
  • 通讯作者: 高远
  • 作者简介:

    桑坤  中国农业大学人文与发展学院

    SANG Kun, College of Humanities and Development Studies, China Agricultural University

  • 基金资助:
    国家社科基金青年项目“乡村振兴背景下小农户融入现代农业经营体系的实践路径研究”(22CSH036); 国家社科基金重点项目“小农户生产与农业现代化有机衔接机制研究”(23ASH007)

Action Ethics and the Medical Order in the Evolution of State-Family Relations: A Longitudinal Study of a North China Village

Kun SANG, Yuan GAO*()   

  • Online:2026-07-20 Published:2026-09-18
  • Contact: Yuan GAO
  • Supported by:
    the National Social Science Foundation's Youth Project(22CSH036); the National Social Science Foundation's Key Project(23ASH007)

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摘要：

在进入21世纪后，伴随着国民健康需求的日益复杂化，农村分级诊疗体系建设逐步被纳入中央政府的议程。本文以“就医秩序”为分析对象，以国家—农民关系为分析框架，通过对1949年以来中国的政策文本与华北简村田野材料的历时性比较，揭示了国家—农民关系在医疗场域中的演变逻辑以及就医秩序的生成机制。研究发现，国家角色在经历了“间接下沉—抽离—直接下沉”的转型后，资源动员能力虽然在逐步增强，但当前的就医秩序仍面临行为失序的困境，其根源在于国家与农民之间缺失“具象化的国家”这一联结纽带——国家意志在基层可感知、可信任的人格化载体。作为其中关键行动者的乡村医生，他们经历了从受集体的支持到被市场塑造，再到受纵向分级诊疗体系的规约的过程，日益陷入既难以融入科层体制也无法嵌入乡土关系的结构性张力的困境，从而导致科层化供给与农村社会基础难以有效对接。本文认为，未来农村公共服务供给的关键不在于国家与集体间的简单责任划分，而在于构建能同时接纳国家资源与规范和激活乡土社会内生性力量的接点机制，使“家国一体”传统在现代化进程中焕发新的生命力。

关键词: 分级诊疗体系, 就医秩序, 国家与农民关系, 乡村医生, 村集体

Abstract:

Since the turn of the century, with the growing complexity of public health needs, the establishment of a rural hierarchical medical system has been progressively placed on the national agenda. Taking "medical order" as its analytical focus and employing the state-peasant relationship as its theoretical framework, this study conducts a longitudinal comparison of policy documents from 1949 to the present and ethnographic materials from Jian Village and its surrounding areas in North China, aiming to reveal the evolving logic of the state-peasant relationship in the healthcare domain and the generative mechanisms of medical order across different historical periods. The study finds that the state's role in rural healthcare governance has undergone a three-phase transformation—"mediated engagement, withdrawal and direct immersion". While its capacity to mobilize resources has gradually strengthened, the current medical order still faces the predicament of behavioral disorder. The root cause lies in the absence of a "concretized state" serving as a connecting link between the state and the peasants, that is, a personified embodiment of the state's will that is both perceptible and trustworthy at the grassroots level. As key actors, village doctors have seen their role evolve from being supported by the collective, to being shaped by market forces, and then to being constrained by the vertical tiered healthcare system. They are increasingly caught in a structural dilemma: neither integrated into the bureaucratic system nor embedded in local community relationships, resulting in a disconnect between the provision of bureaucratised healthcare services and the rural social fabric. This study argues that the key to the future rural public service delivery lies not in a simplistic division of responsibilities between the state and the collective, but in the construction of a connective mechanism that can simultaneously accommodate state resources and regulations while activating the endogenous forces of rural society-thereby revitalizing the traditional "state-family integration" in the process of modernization.

Key words: hierarchical medical system, medical treatment order, state-peasantry relationship, village doctors, village collective