| 引用本文：Daniel Béland, Philip Rocco, Alex Waddan.美国医改实施：政府间政治与制度设计困境[J].中国卫生政策研究,2014,7(7):1-8 |
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| 美国医改实施：政府间政治与制度设计困境 |
| 投稿时间：2014-05-10 修订日期：2014-06-10 PDF全文浏览 HTML全文浏览 |
| Daniel Béland1, Philip Rocco2, Alex Waddan3 |
1. 约翰逊—肖亚玛公共政策研究学院 加拿大萨斯喀彻温 S7N 5B8;
2. 加州大学伯克利分校查尔斯和路易斯·特拉弗斯政治系 美国伯克利 CA 94720-1950;
3. 莱斯特大学政治与国际关系系 英国莱斯特 LE1 7RH |
| 摘要:《可负担的医疗法案》是在美国两党政治对立的情况下颁布和实施的。本文认为，美国联邦和州政府角色权限的分配，加剧了该法案执行过程中的政治冲突。联邦和州层面的政治参与者（特别是州长和州立法机构）就该法案进行制度协调的不同途径，已经阻碍了医疗保险交易所的建立和医疗救助扩展计划。通过比较，本文认为制度设计时尽量减少政治冲突的医疗保险监管机制改革，在执行过程中大幅度减少了政治摩擦。此外，本文强调了多层次制度设计对实施一些重要改革所产生的政治影响。 |
| 关键词:可负担的医疗法案 医疗保险交易所 监管机制改革 制度设计 政策实施 |
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| Implementing health care reform in the United States：Intergovernmental politics and the dilemmas of institutional design |
| Daniel Béland1, Philip Rocco2, Alex Waddan3 |
1. Johnson-Shoyama Graduate School of Public Policy, Saskatchewan S7N 5B8, Canada;
2. Charles and Louise Travers Department of Political Science, University of California, Berkeley, Berkeley CA 94720-1950, United States;
3. Department of Politics and International Relations, University of Leicester, Leicester LE1 7RH, United Kingdom |
| Abstract:The Affordable Care Act (ACA) was enacted, and continues to operate, under conditions of political polarization.In this article, we argue that the law's intergovernmental structure has amplified political conflict over its implementation by distributing governing authority to political actors at both levels of the American federal system.We review the ways in which the law's demands for institutional coordination between federal and state governments (and especially the role it preserves for governors and state legislatures) have created difficulties for rolling out health-insurance exchanges and expanding the Medicaid program.By way of contrast, we show how the institutional design of the ACA's regulatory reforms of the insurance market, which diminish the reform's political salience, has allowed for considerably less friction during the implementation process.This article thus highlights the implications of multi-level institutional designs for the post-enactment politics of major reforms. |
| Key words:Affordable Care Act Health-insurance exchanges Regulatory reform Institutional design Policy implementation |
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