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