改革背景下医疗科室的运行与变迁
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摘要
近年来,医疗领域备受社会关注。医疗制度、医院、医生常常成为公众与媒体指摘的对象。当下,虽然“看病难”和“看病贵”的问题已经通过新的医疗改革政策得到了一定程度的缓解,但医患关系紧张的问题却依然存在,甚至愈发严重。对当前医疗组织所出现的种种问题进行合理的解释必须要解决以下两个问题。一是在过去几十年的改革过程中,医院组织发生了怎样的变迁过程,是什么力量和原因导致了它的具体变迁?第二是当下医院的日常运行现状是怎样的?
本文通过参与观察、深入访谈等方法,以一个二级医院的E科为例,从医疗职业、组织结构、分配制度与医患关系等四个方面探讨了基层医院科室日常运行与变迁的过程和机制。
通过研究我们发现,基层医疗科室处在在一个广泛、动态的组织场域之中。科室与政府、医药市场、患者、外院同类科室、医院管理层、本院科室同处在这个场域。场域中各种力量之间的变动不断地推动着基层医疗科室自身的变迁。
由于医院具有“双重权威”的属性,医院管理层并不具备评价专业科室的能力,因此往往放权给科室,使科室获得了一定的独立性；另一方面,医院管理层掌握着整个医院各种资源分配的权力,这又使得科室要按照医院的安排进行运作。
同时,政府对于卫生工作的安排逐层通过卫生部门、医院管理层传达给一线科室。国家的各种卫生政策往往是科室变革的最大驱动。国家对于卫生系统投入方式的改变使得科室的运行逻辑由公益性向营利性转变。
在科室争取自身资源的过程中依然面临着激烈的竞争。这种竞争包括与医院不同科室争夺组织场域内有限的经济资源,同时还与外院相关科室争夺本地区有限的病人资源。E科作为一个二级医院的科室,近年来在竞争中已开始逐渐处于劣势,这一方面由于其主要竞争对手皆为市级医疗机构科同类科室,无论从人员还是从资金上较E科都更具优势。同时,由于上级对“逐级转诊”的强调,E科也越来越难以留住危重病号,这在实践中限制了医务人员的职业发展。另外,在整个组织环境中C院也被设定为低于市级医疗单位的医院。在此情况下,E科领导不断地寻求各种方式以抵御这种组织环境的结构化,从而使科室在医疗组织场域中能够维持自身的地位。
同样处于这个场域中的还包括市场的力量。市场经济影响着科室医务人员的工作心态,也影响着科室内部结构中的各种关系,尤其是医护之间的关系。医院通过获取药材采购的权利而与市场接轨；同时通过各种制度安排,科室中出现了“以药养医”的现象。
患者、媒体等社会力量是推动科室改革的有效外部动力。近年来媒体对于医疗行业的广泛报道使得社会对于医疗保障的关注度不断增加,尤其是对医院在市场化运行过程中的种种负面现象的报道影响力极大。医患关系从和谐的“同志间”关系激变为一种紧张的市场性供求关系。医患关系的紧张也使得科室人员不得不花费大量精力关注与患者的沟通,同时他们一方面通过提高自身的技术标准,防止工作中的各种疏漏的发生,另一方面则在与患者交流过程中更加谨慎,从而规避各种风险。
组织场域中的各种行动者通过以上的方式影响着科室的运行与变迁。同时,我们也可以看到,在科室内部也存在着具有韧性的既有结构。组织内的个体在各种政策的开放与强制下,调整着自己的行动。另一方面,科室成员也利用自己在组织结构内的地位与权力采取各种策略维护着自身的利益。
In recent years, the medical field attracts much social concern. The health care system, including hospitals、doctors and nurses is often criticized. Nowadays,"difficult" and "expensive" medical service has been resolved to some extent. New medical reform policy has been published, but the tension between doctors and patients is even more serious. To explain the problems of the current medical organizations, we must solve two problems:In the past decades, along the process of reform, what change has been taken into the hospital and what caused its changes?
With observation, in-depth interviews and other methods, this article examines the process and mechanism of a medical unit of a secondary hospital——Medical Unit E. We explore4facets of the running and changing of the Medical Unit:the medical profession, the structure, the distribution system and the doctor-patient relationship.
Through the research, we found that medical unit is not a separate organization in the hospital, it is in the in a wide range of dynamic organization field. The government, the pharmaceutical market, the patient, similar medical units in other hospitals, all of them in the organizational field promotes the transformation of the Medical Unit E.
As a subordinate organization of the hospital, the medical unit must accept the management of the hospital, but the hospital has a "dual authority" attributes. The manager does not have the ability to evaluate the professional unit and often distribute the power to the units. So the units get their own independence. The hospital management department controls the entire hospital distribution of power and manages the finance of the hospital, which makes the medical units works in accordance with the arrangements of the hospital most of the time.
Meanwhile, the state government for health work arrangements drill through the health sector, the hospital management communicated to the units. Many national health policies are often the biggest motivation for change. National sections from a change in the way the health system inputs funding by the superior survival of functional organization, and become willing to seek their own interests with profit-making organization.
The medical unit is facing fierce competition in the units in the process of fighting for their own resources. This competition including organizational field within the limited economic resources to compete with the different units of the hospital, and compete for patients with limited resources in the region as well as with the relevant sections of the outer court. Medical Unit E, As a secondary hospital units,whose main competitors are the municipal medical institutions. At the same time, due to the "step by step" to cure the patients,the Medical Unit E increasingly difficult to retain the critically ill patient, in practice restrict the establishmet of a doctor's experience, while located in the entire organizational environment in Medical Unit E, as below the municipal medical units of the hospital. The leaders of the Medical Unit E seek ways to resist the structured environment of this organization in the Field of medical organizations to determine their status.
Also in this field, there are market forces. Widespread market economy on the social impact of the department volunteers staff working mentality. Narrow sense in the medical field, including medicine, medical equipment, has achieved the market and supply hospitals with the market by the right to get into the drug, and then in some units in medicine to support medical phenomenon.
Patients, the media and other social forces prompted the department to run the external forces. Media widely reported for the medical industry in recent years makes the increase of social concern for the medical security, is also concerned about the hospital in the process of market-oriented operation, all the negative signs. The tension in the doctor-patient relationship, but also makes the department personnel had to take some effort to appease the patient suffering from anxiety and distrust. Begin to address the shortcomings of their own work, to improve their own technical standards to prevent omissions in the work.
The various actors of the organizational field by more than one way to influence units run and change. At the same lime, we can also see that internally in the department, there is an existing structure with toughnes Individuals within the organization under the various policies of openness and forced to adjust their own behavior. Meanwhile, department members use their status and power within the organizational structure to adopt various strategies to safeguard their own interests.
本文通过参与观察、深入访谈等方法,以一个二级医院的E科为例,从医疗职业、组织结构、分配制度与医患关系等四个方面探讨了基层医院科室日常运行与变迁的过程和机制。
通过研究我们发现,基层医疗科室处在在一个广泛、动态的组织场域之中。科室与政府、医药市场、患者、外院同类科室、医院管理层、本院科室同处在这个场域。场域中各种力量之间的变动不断地推动着基层医疗科室自身的变迁。
由于医院具有“双重权威”的属性,医院管理层并不具备评价专业科室的能力,因此往往放权给科室,使科室获得了一定的独立性；另一方面,医院管理层掌握着整个医院各种资源分配的权力,这又使得科室要按照医院的安排进行运作。
同时,政府对于卫生工作的安排逐层通过卫生部门、医院管理层传达给一线科室。国家的各种卫生政策往往是科室变革的最大驱动。国家对于卫生系统投入方式的改变使得科室的运行逻辑由公益性向营利性转变。
在科室争取自身资源的过程中依然面临着激烈的竞争。这种竞争包括与医院不同科室争夺组织场域内有限的经济资源,同时还与外院相关科室争夺本地区有限的病人资源。E科作为一个二级医院的科室,近年来在竞争中已开始逐渐处于劣势,这一方面由于其主要竞争对手皆为市级医疗机构科同类科室,无论从人员还是从资金上较E科都更具优势。同时,由于上级对“逐级转诊”的强调,E科也越来越难以留住危重病号,这在实践中限制了医务人员的职业发展。另外,在整个组织环境中C院也被设定为低于市级医疗单位的医院。在此情况下,E科领导不断地寻求各种方式以抵御这种组织环境的结构化,从而使科室在医疗组织场域中能够维持自身的地位。
同样处于这个场域中的还包括市场的力量。市场经济影响着科室医务人员的工作心态,也影响着科室内部结构中的各种关系,尤其是医护之间的关系。医院通过获取药材采购的权利而与市场接轨；同时通过各种制度安排,科室中出现了“以药养医”的现象。
患者、媒体等社会力量是推动科室改革的有效外部动力。近年来媒体对于医疗行业的广泛报道使得社会对于医疗保障的关注度不断增加,尤其是对医院在市场化运行过程中的种种负面现象的报道影响力极大。医患关系从和谐的“同志间”关系激变为一种紧张的市场性供求关系。医患关系的紧张也使得科室人员不得不花费大量精力关注与患者的沟通,同时他们一方面通过提高自身的技术标准,防止工作中的各种疏漏的发生,另一方面则在与患者交流过程中更加谨慎,从而规避各种风险。
组织场域中的各种行动者通过以上的方式影响着科室的运行与变迁。同时,我们也可以看到,在科室内部也存在着具有韧性的既有结构。组织内的个体在各种政策的开放与强制下,调整着自己的行动。另一方面,科室成员也利用自己在组织结构内的地位与权力采取各种策略维护着自身的利益。
In recent years, the medical field attracts much social concern. The health care system, including hospitals、doctors and nurses is often criticized. Nowadays,"difficult" and "expensive" medical service has been resolved to some extent. New medical reform policy has been published, but the tension between doctors and patients is even more serious. To explain the problems of the current medical organizations, we must solve two problems:In the past decades, along the process of reform, what change has been taken into the hospital and what caused its changes?
With observation, in-depth interviews and other methods, this article examines the process and mechanism of a medical unit of a secondary hospital——Medical Unit E. We explore4facets of the running and changing of the Medical Unit:the medical profession, the structure, the distribution system and the doctor-patient relationship.
Through the research, we found that medical unit is not a separate organization in the hospital, it is in the in a wide range of dynamic organization field. The government, the pharmaceutical market, the patient, similar medical units in other hospitals, all of them in the organizational field promotes the transformation of the Medical Unit E.
As a subordinate organization of the hospital, the medical unit must accept the management of the hospital, but the hospital has a "dual authority" attributes. The manager does not have the ability to evaluate the professional unit and often distribute the power to the units. So the units get their own independence. The hospital management department controls the entire hospital distribution of power and manages the finance of the hospital, which makes the medical units works in accordance with the arrangements of the hospital most of the time.
Meanwhile, the state government for health work arrangements drill through the health sector, the hospital management communicated to the units. Many national health policies are often the biggest motivation for change. National sections from a change in the way the health system inputs funding by the superior survival of functional organization, and become willing to seek their own interests with profit-making organization.
The medical unit is facing fierce competition in the units in the process of fighting for their own resources. This competition including organizational field within the limited economic resources to compete with the different units of the hospital, and compete for patients with limited resources in the region as well as with the relevant sections of the outer court. Medical Unit E, As a secondary hospital units,whose main competitors are the municipal medical institutions. At the same time, due to the "step by step" to cure the patients,the Medical Unit E increasingly difficult to retain the critically ill patient, in practice restrict the establishmet of a doctor's experience, while located in the entire organizational environment in Medical Unit E, as below the municipal medical units of the hospital. The leaders of the Medical Unit E seek ways to resist the structured environment of this organization in the Field of medical organizations to determine their status.
Also in this field, there are market forces. Widespread market economy on the social impact of the department volunteers staff working mentality. Narrow sense in the medical field, including medicine, medical equipment, has achieved the market and supply hospitals with the market by the right to get into the drug, and then in some units in medicine to support medical phenomenon.
Patients, the media and other social forces prompted the department to run the external forces. Media widely reported for the medical industry in recent years makes the increase of social concern for the medical security, is also concerned about the hospital in the process of market-oriented operation, all the negative signs. The tension in the doctor-patient relationship, but also makes the department personnel had to take some effort to appease the patient suffering from anxiety and distrust. Begin to address the shortcomings of their own work, to improve their own technical standards to prevent omissions in the work.
The various actors of the organizational field by more than one way to influence units run and change. At the same lime, we can also see that internally in the department, there is an existing structure with toughnes Individuals within the organization under the various policies of openness and forced to adjust their own behavior. Meanwhile, department members use their status and power within the organizational structure to adopt various strategies to safeguard their own interests.
引文
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[13][德]柯武刚,史漫飞,2000,《制度经济学》,韩朝华译,北京：商务印书馆.
[14][美]W·理查德·斯格特,2002,《组织理论：理性、自然和开放系统》黄样等译,北京：华夏出版社.
[15][美]W·理查德·斯科特,杰拉尔德·F·戴维斯,《组织理论：理性、自然与开放系统的视角》,高俊山译,2010年,北京：中国人民大学出版社,第294页.
[16][美]W·理查德·斯科特,2010,《制度与组织：思想观念与物质刊益(第3版)》,姚伟、王黎芳译,北京：中国人民大学出版社.
[17][美]林南,2005,《社会资本——关于社会结构与行动的理论》,张磊译,上海：上海人民出版社
[18][法]米歇尔·克罗齐耶,埃哈尔·费埃德伯格,2007.《行动者与系统：集体行动的政治学》,张月等译,上海：上海人民出版社.
[19][美]欧文·戈夫曼,2008,《日常生活中的自我呈现》,冯钢译,浙江浙江大学出版社.
[20][法]皮埃尔·布迪厄,2003,《实践感》,蒋兹骅译,南京：译林出版社
[21][美]威廉·科克汉姆,2000,《医学社会学》,杨辉,张拓红等译,北京华夏出版社.
[22][美]沃尔特·W.鲍威尔、保罗j通马吉奥,2008,《组织分析的新制度主义》,姚伟译,上海：上海人民出版社.
[23][美]伊万·塞勒尼等,2010,《新古典社会学的想象力》,吕鹏等译,北京：社会科学文献出版社.
[24]周雪光,2003,《组织社会学十讲》,北京：社会科学文献出版社.
[25]Charles C. Ragin, Howard Saul Becker.1992, What is a case?: exploring the foundations of social inquiry. Cambridge University.
[26]Galbraith, Jay R. 1973. Designing complex organizations. Reading, MA: Addison-Weslev
[27]Herderson.,G.E.,& Cohen,M.S., !984, The Chinese hospital: A socialist work unit. New Haven, CT:Yale University Press.
[28]Lawrence, Paul R., and Jay W. Lorsch J 967,Organization and Environment: Managing Differentiation and Integration. Boston: Graduate School of Business Administration. Harvard t. nivcrsitv.
[29]Lu, Xiaoho and Elizabeth Perry[eds.] ,1997, Danwei: The Changing Chinese Workplace in Historical and Comparative Perspective. Vrmonk, NY: M. E. Sharp
[30]Norman K. Denzin and Yvonna S. Lincoln (eds.),2005,The Sage Handbook of Qualitative Research, Sage Publications.
[31]W alder Andrew G. 1986.Communist Neo-Traditionalism: Work and Authority in Chinese Industry.Berkeley: University of California Press.
[32]边燕志、约翰·罗根、卢汉龙,et al.“单位制”与住房商品化[J].社会学研究,1996(1)：28-35.
[33]曹志勇.市场与政府之间—乡镇卫生院转型过程中的制度回应.清华大学硕士论文,2007年.
[34]甘阳,新时代的“通三统”——三种传统的融会与中华文明的复兴.书城,2005(7).
[35]何水红,医疗收费制度变迁中的利益博弈分析——以安徽省台肥市为例,华中师范大学硕士论文,2007年
[36]胡伟,李汉林,单位作为—种制度——关于单位研究的种,视角,江苏社会科学,2003(6)：68-76.
[37]揭爱花,单位：一种特殊的生活空间,浙江大学学报(人文社会科学版)2010(10).
[38]李汉林.变迁中的中国单位制度回顾中的思考 社会2008(3):31-40.
[39]李猛.周飞舟.李康.单位：制度化组织的内部机制.中国社会科学季刊(香港)1996年总第16期.
[40]孙立平、王汉生、王思斌、林彬、杨善华.改革以来中国社会结构的变迁.中国社会科学,1994(2)：47-62.
[41]魏兰菊,乔镇卫生室的生存空间：一种国家与社会关系的视角,中南大硕士论文,2007年.
[42]吴晓刚.从人身依附到利益依赖.北京大学社会学系硕士学位论文,1994
[43]谢新华,活着：困境中生存的乡镇卫生院——对湘中古镇卫生院的人类学研究,华中科技大学硕士论文,2007年。
[44]张静.阶级政治与单位政治——城市社会的利益组织化结构与社会参与.开放时代,2003(2)：109-119.
[45]C Oi.Commercializing China's Rural Cadres. Problems of Communism 35(September-October):1-15, 1986.
[46]JC Oi. State and Peasant in Contemporary China.. Berkeley and Los Angeles: University of California Press, 1989.
[47]John W. Meyer and Brian Rowan. Institutionalized Organizations: Formal Structure as Myth and Ceremony American Journal of Sociology Vol. 83, No. 2 (Sep., 1977). pp. 340-363
[48]Martin Ruef and W. Richard Scott.A Multidimensional Model of Organizational Legitimacy: Hospital Survival in Changing Institutional Environment.Administrative Science Quarterly, Vol. 43, No. 4 (Dec., 1998), pp. 877-904
[49]Paul J. DiMaggio and Walter W. Powell. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields American Sociological Review Vol. 48, No. 2 (Apr., 1983). pp. 147-160
[50]Thomas D'Aunno, Melissa Succi and Jetrrey A. Alexander.The Role of Institutional and Market Forces in Divergent Organizational Change. Administrative Science Quarterly,Vol.45, No.4 (Dec.,2000), pp. 679-703
[51]Vucror Nce.A Tbcory of M(?)rker Trensrtion:From Redisorbution to Morkers in State Socinlism.American Socioionucal Review.Vol.54.No.5(Oct,1989),pp. 663-681
[52]湖南批准首家民营二级专科医院http://news.xinhuanet.com/health/2010-11/19/c_12793912.htm
2周雪光,组织社会学十讲,2003,北京：社会科学文献出版社,第75页。
3 Martin Ruef and W. Richard Scott.A Multidimensional Model of Organizational Legitimacy:Hospital Survival in Changing Institutional Environments Administrative Science Quarterly, Vol.43, No.4 (Dec.,1998), pp.877-904.
4 Thomas D'Aunno, Melissa Succi and Jeffrey A. Alexander.The Role of Institutional and Market Forces in Divergent Organizational Change. Administrative Science Quarterly, Vol.45, No.4 (Dec.,2000), pp.679-703.
5 Galbraith, Jay R.1973. Designing complex organizations. Reading, MA: Addison-Wesley. pp.2.
6 Lawrence, Paul R., and Jay W. Lorsch,1967, Organization and Environment: Managing Differentiation and Integration. Boston:Graduate School of Business Administration, Harvard University.
7[法]米歇尔·克罗齐耶,埃哈尔·费埃德伯格,《行动者与系统：集体行动的政治学》.张月等译,2007.上海：上海人民出版社.第136页。
8 Victor Nee. A Theory of Market Transition:From Redistribution to Markets in State Socialism. American Soc iological Review, Vol.54, No.5 (Oct.,1989), pp.663-681
9胡伟,李汉林,《单位作为一种制度——关于单位研究的一种视角》,江苏社会科学.2003年第6期,68-76.
10路风,中国单位体制的起源和形成,中国社会科学季刊(香港),1993年第4期,66-87。
11 JC Oi.Commercializing China's Rural Cadres. Problems of Communism 35(September-October):1-15,1986. JC Oi. State and Peasant in Contemporary China.,. Berkeley and Los Angeles University of California Press,1989.
12 Walder Andrew G..Communist Neo-Traditionalism:Work and Authority in Chinese Industry.Berkeley:University of California Press,1986.
13周雪光,西方社会学关于中国组织与制度变迁研究状况述评,社会学研究,1999年第4期,26-43.
14揭爱花,单位：一种特殊的生活空间,浙江大学学报(人文社会科学版)2010年第10期,76.
15李猛.周飞舟.李康.单位：制度化组织的内部机制.中国社会科学季刊(香港)1996年总第16期,。
16孙立平、王汉生、王思斌et al.改革以来中国社会结构的变迁.中国社会科学1994(2),47-62。
17吴晓刚,从人身依附到利益依赖,北京大学社会学系硕十学位论文,1994.
18边燕杰、约翰。罗根、卢汉龙et。al。 “单位制”与住房商品化.社会学研究1994(1) 28-35。
19 Naughton, Barry.1997. "Danwei:The Economic Foundations of a Unique Institution." in Danwei:The Changing Chinese Workplace in Histoncaland Comparative Perspective, edited by Xiaobo Lu & Elizabeth J.Perry. Armonk, NY.
20李汉林.变迁中的中国单位制度：回顾中的思考《社会》,2008(3),31-40。
21张静.阶级政治与单位政治——城市社会的利益组织化结构与社会参与.开放时代,2003(2)109-119.
22谢新华,活着：困境中生存的乡镇卫生院——对湘中古镇卫生院的入类学研究,华中科 技大学硕士论文,2007.
23曹志勇,市场与政府之间—乡镇卫生院转型过程中的制度回应,清华大学硕士论文,2007
24魏兰菊,乔镇卫生室的生存空间：一种国家与社会关系的视角,中南大学硕士论文,2007
25何水红.医疗收费制度变迁中的利益博弈分析——以安徽省合肥市为例,华中师范大学硕士论文,2007
26郝天军,社会资本对医院发展的影响研究,华中科技大学博士论文,2007
27甘阳,新时代的“通三统”——三种传统的融会与中华文明的复兴,书城,2005年第7期。
28 W·理查德·斯科特,杰拉尔德·F·戴维斯,《组织理论：理性、自然与开放系统的视角》高俊山译,2010年,北京：中国人民大学出版社,第294页。
29 W·理查德·斯科特,《制度与组织——思想观念与物质利益》,姚伟,王黎芳译,北京：中国人民大学出版社,第190页。
30我们认为医患纠纷的过程,包括“医闹”现象,都不是无序的,而是建立在文化与制度之上。
54维克多 特纳,《仪式过程：结构与反结构》,北京：中国人民大学出版社,2010.
83明廷强.邢曾勇.我国医患纠纷的成因及其对策,齐鲁学刊2008(5),107-110.
84张孙彪,林楠,“果报观”与中国传统医学论理道德医学与哲学(人文社会医学版)2009年9月第30卷第9期：20-22,
85孙思邈.备急千金要方：卷一[M].鲁兆麟点校.沈阳：辽宁科学技术出版社,1997：1.
86马建石,杨自裳.大清律例通考校注.卷二十六,刑律.人命.中国政法大学出版社,1992
87从明清笑话看明清时期医患关系 湖北中医药大学 本科毕业论文 2011
88 Vogel, Ezra.1965. "From Friendship to Comradeship:The Change in Personal Relations in Communist China. " The China Quarterly 21:46-60.
103[美]沃尔特·W.鲍威尔、保罗J迪马吉奥,2008,《组织分析的新制度主义》,姚伟译,上海：上海人民出版社,第185页。
[1]边燕杰主编,2002,《市场转型与社会分层——美国社会学者分析中国》北京：生活·读书·新知三联书店.
[2]边燕杰,吴晓刚,李路路主编,2008,《社会分层与流动——国外学者对中国研究的新进展》,北京：中国人民大学出版社.
[3]费孝通, 1985,《乡土中国》,北京：生活·读书·新知三联书店。
[4]费孝通,2001,《江村经济》,北京：商务印书馆
[5]李友梅、周雪光,2007,《组织社会学实证研究文选》,上海：上海人民出版社.
[6]张永宏,2007, 《组织社会学的新制度主义学派》,上海：上海人民出版社.
[7][美]艾尔·巴比,2009,《社会研究方法(第十一版)》邱泽奇译,北京华夏出版社.
[8][法]埃哈德·费埃德伯格,2007,《权利与规则——组织行动的动力》,上海：上海人民出版社.
[9][美]彼得·布劳,马歇尔·悔耶, 2001,现代社会中的科层制》,马戎,时宪民,邱泽奇译,北京：学林出版社.
[10][美]詹姆斯·马奇,赫伯特·西蒙,2008,《组织》,邵冲译,北京：机械工业出版社.
[11][美]詹姆斯·汤普森,2003,《行动中的组织——行政理论的社会科学基础》,敬又嘉译,上海：上海人民出版社.
[12][美]吉尔·伊·亚尔,伊万·塞勒尼,艾莉诺·汤斯利,2008,《无需资本家打造资本主义——后共产主义中欧的阶级形成和精英斗争》,吕鹏,吕佳龄译,北京：社会科学文献出版社.
[13][德]柯武刚,史漫飞,2000,《制度经济学》,韩朝华译,北京：商务印书馆.
[14][美]W·理查德·斯格特,2002,《组织理论：理性、自然和开放系统》黄样等译,北京：华夏出版社.
[15][美]W·理查德·斯科特,杰拉尔德·F·戴维斯,《组织理论：理性、自然与开放系统的视角》,高俊山译,2010年,北京：中国人民大学出版社,第294页.
[16][美]W·理查德·斯科特,2010,《制度与组织：思想观念与物质刊益(第3版)》,姚伟、王黎芳译,北京：中国人民大学出版社.
[17][美]林南,2005,《社会资本——关于社会结构与行动的理论》,张磊译,上海：上海人民出版社
[18][法]米歇尔·克罗齐耶,埃哈尔·费埃德伯格,2007.《行动者与系统：集体行动的政治学》,张月等译,上海：上海人民出版社.
[19][美]欧文·戈夫曼,2008,《日常生活中的自我呈现》,冯钢译,浙江浙江大学出版社.
[20][法]皮埃尔·布迪厄,2003,《实践感》,蒋兹骅译,南京：译林出版社
[21][美]威廉·科克汉姆,2000,《医学社会学》,杨辉,张拓红等译,北京华夏出版社.
[22][美]沃尔特·W.鲍威尔、保罗j通马吉奥,2008,《组织分析的新制度主义》,姚伟译,上海：上海人民出版社.
[23][美]伊万·塞勒尼等,2010,《新古典社会学的想象力》,吕鹏等译,北京：社会科学文献出版社.
[24]周雪光,2003,《组织社会学十讲》,北京：社会科学文献出版社.
[25]Charles C. Ragin, Howard Saul Becker.1992, What is a case?: exploring the foundations of social inquiry. Cambridge University.
[26]Galbraith, Jay R. 1973. Designing complex organizations. Reading, MA: Addison-Weslev
[27]Herderson.,G.E.,& Cohen,M.S., !984, The Chinese hospital: A socialist work unit. New Haven, CT:Yale University Press.
[28]Lawrence, Paul R., and Jay W. Lorsch J 967,Organization and Environment: Managing Differentiation and Integration. Boston: Graduate School of Business Administration. Harvard t. nivcrsitv.
[29]Lu, Xiaoho and Elizabeth Perry[eds.] ,1997, Danwei: The Changing Chinese Workplace in Historical and Comparative Perspective. Vrmonk, NY: M. E. Sharp
[30]Norman K. Denzin and Yvonna S. Lincoln (eds.),2005,The Sage Handbook of Qualitative Research, Sage Publications.
[31]W alder Andrew G. 1986.Communist Neo-Traditionalism: Work and Authority in Chinese Industry.Berkeley: University of California Press.
[32]边燕志、约翰·罗根、卢汉龙,et al.“单位制”与住房商品化[J].社会学研究,1996(1)：28-35.
[33]曹志勇.市场与政府之间—乡镇卫生院转型过程中的制度回应.清华大学硕士论文,2007年.
[34]甘阳,新时代的“通三统”——三种传统的融会与中华文明的复兴.书城,2005(7).
[35]何水红,医疗收费制度变迁中的利益博弈分析——以安徽省台肥市为例,华中师范大学硕士论文,2007年
[36]胡伟,李汉林,单位作为—种制度——关于单位研究的种,视角,江苏社会科学,2003(6)：68-76.
[37]揭爱花,单位：一种特殊的生活空间,浙江大学学报(人文社会科学版)2010(10).
[38]李汉林.变迁中的中国单位制度回顾中的思考 社会2008(3):31-40.
[39]李猛.周飞舟.李康.单位：制度化组织的内部机制.中国社会科学季刊(香港)1996年总第16期.
[40]孙立平、王汉生、王思斌、林彬、杨善华.改革以来中国社会结构的变迁.中国社会科学,1994(2)：47-62.
[41]魏兰菊,乔镇卫生室的生存空间：一种国家与社会关系的视角,中南大硕士论文,2007年.
[42]吴晓刚.从人身依附到利益依赖.北京大学社会学系硕士学位论文,1994
[43]谢新华,活着：困境中生存的乡镇卫生院——对湘中古镇卫生院的人类学研究,华中科技大学硕士论文,2007年。
[44]张静.阶级政治与单位政治——城市社会的利益组织化结构与社会参与.开放时代,2003(2)：109-119.
[45]C Oi.Commercializing China's Rural Cadres. Problems of Communism 35(September-October):1-15, 1986.
[46]JC Oi. State and Peasant in Contemporary China.. Berkeley and Los Angeles: University of California Press, 1989.
[47]John W. Meyer and Brian Rowan. Institutionalized Organizations: Formal Structure as Myth and Ceremony American Journal of Sociology Vol. 83, No. 2 (Sep., 1977). pp. 340-363
[48]Martin Ruef and W. Richard Scott.A Multidimensional Model of Organizational Legitimacy: Hospital Survival in Changing Institutional Environment.Administrative Science Quarterly, Vol. 43, No. 4 (Dec., 1998), pp. 877-904
[49]Paul J. DiMaggio and Walter W. Powell. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields American Sociological Review Vol. 48, No. 2 (Apr., 1983). pp. 147-160
[50]Thomas D'Aunno, Melissa Succi and Jetrrey A. Alexander.The Role of Institutional and Market Forces in Divergent Organizational Change. Administrative Science Quarterly,Vol.45, No.4 (Dec.,2000), pp. 679-703
[51]Vucror Nce.A Tbcory of M(?)rker Trensrtion:From Redisorbution to Morkers in State Socinlism.American Socioionucal Review.Vol.54.No.5(Oct,1989),pp. 663-681
[52]湖南批准首家民营二级专科医院http://news.xinhuanet.com/health/2010-11/19/c_12793912.htm
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