Between The Market And Government: The Institutional Response Of The Township Hospital During The Transforming Process

This M.A. thesis is aimed to interpret the transforming history of the Chinese rural hospital by the theory of neo-institutionalism. The rural hospital who takes charge of medical administration and medical prevention is founded by county or town government. As the key position of the three tiers within China's rural health care system, the rural hospital makes contributions to the village basic medical health and public health. But because of the China's economic reform, the whole Chinese health field experiences tremendous changes, which influences the rural hospital. Because of this, when we talked about the transforming history of the Chinese rural hospital, the government and the media want to explain this bye the market competition. This research interprets this transformation in the other way, by introducing the two concepts (technical environment, institutional environment) of neo-institutionalism.Picking up a typical rural hospital in H county, Hubei province, this research takes the qualitative method, and does in-depth interview, participating observation with the related rural staff. After analyzing the interviewing documents, we get some interpretations: First, the foundation of the rural hospital is leaded by the government administration. And the process could be explained through the viewpoint of the institutional environment, neo-institutionalism. Second, during the end of 1970's and the beginning of 1980's, the rural hospital witnessed the Chinese social transformation from planned economy to market economy, and it declined gradually. At this time, Market factor did some influence to the rural hospital indeed, and this answered to the explanation of technical environment, neo-institutionalism. But this process could not be explained only by market factor, because the Chinese government never gave up the rural hospital, the village basic health organization. As the institutional environment told, the government policy and financial support at that time could both explain the rural hospital's changes. This analysis way also accords with the institutional environment explanation of neo-institutionalism. The transformation of the organization is never only influenced by the market. Sometimes the government policy takes the decisive position of the process; Third, as the New Cooperative Medical System (NCMS) starts, the rural hospital gets another opportunity to rebirth. And this proves the explanation of the government policy to the rural hospital's change again. At last, this thesis focuses on an interesting problem during the interview and does some explanation using the concept"legitimacy".As the special organization, the rural hospital's three stages prove the explanation logic of the neo-institutionalism. The birth and development of the organization is related to its environment. But the technical environment and institutional environment have their own different features. The organization of Chinese rural hospitals is better to be interpreted by the institutional environment concept.