关键词: 项目制, 公共服务, 医疗服务, 公立医院, 托管合作

Abstract: It is worth exploring how to solve unbalanced and inadequate supply of public services by project system. A research on the sinking policy of high-quality medical resources in Zhejiang Province shows that the problem of insufficient medical service capacity and resource shortage at the grass roots can be solved to a certain extent by means of the trust cooperation of public hospitals prized by project system. The implementation of such a project is not equal to the parallel two-way cooperation of commercial projects, but also goes beyond the policy logic of “multi-line mobilization” and “cross-level integration” of the traditional government project system. Through a series of mechanisms of “multi-dimensional mobilization”, “external integration” and “internal stratification”, especially the inputs of “bureaucratic variable” and “specialized variable” respectively in the “governance layer” and the “technical level” with the help of “embedded governance structure”, “bundled personnel policy”, it responds to the coordination dilemma and performance control problem of multiple “contract-awarding” relations. Of course, a performance of the project functions depends on the full response to the tension between bureaucracy, specialization and marketization logic, as well as the imbalance of power and responsibility within bureaucracy. This further leads to a deeper institutional change and creates conditions for the adjustment of local actors’ autonomy and the improvement of governance capacity.

Key words: project system, public service, medical service, public hospital, trusteeship