Page 144 - 《社会》2026年第4期

家国关系变迁中的就医秩序与行动伦理

Action Ethics and the Medical Order in the Evolution of
State鄄Family Relations: A Longitudinal Study of a North
China Village
SANG Kun GAO Yuan
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鄄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鄄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鄄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鄄thereby revitalizing the traditional“state鄄family
integration” in the process of modernization.
Keywords：hierarchical medical system， medical treatment order， state鄄peasantry
relationship， village doctors， village collective

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