模糊性政策执行模式的动态转换逻辑——以异地就医即时结算政策为例

目的：在高度复杂性和不确定性条件下，模糊性日益成为公共政策的显要属性。缘于模糊性，政策执行过程往往伴随执行模式的动态转换，而学界对该转换过程和机制缺乏足够探讨。方法：本研究基于修正的模糊—冲突模型和多源流模型，构建了一个解释模糊性政策执行模式动态转换的分析框架，并以异地就医即时结算政策为例对模式转换逻辑进行了阐释。结果：同一项模糊性政策在执行中会经历从试验性执行到象征性执行，再到政治性执行，最终进入常态化行政性执行的动态转换过程。促使执行模式转换的原因与对应阶段的主导动力源流密不可分。结论与建议：细化的执行手段、清晰的权责关系、自上而下的高位推动、充足的执行资源及数字化技术都有助于降低政策的模糊性和冲突性，提升政策执行效果。

The dynamic transformation logic of ambiguous policy implementation mode： A case of the immediate settlement of trans-regional treatment policy

Objective: Under the highly complex and uncertain social conditions, ambiguity has increasingly become an important attribute of public policy. The implementation process of ambiguous policy is often accompanied by the dynamic transformation of the implementation mode. However, the transformation process and specific mechanism are still lack of in-depth discussion. Methods: Based on the modified Ambiguous-Conflict Model and Multiple Streams Framework, this paper constructs an analytical framework to explain the dynamic transformation of ambiguous policy implementation mode in the context of China, and takes the immediate settlement of trans-regional treatment policy as an example to explore the mechanism of the transformation. Results: It is found that the implementation mode of an ambiguous policy will undergo a dynamic transformation path from experimental implementation to symbolic implementation, then to political implementation, and finally towards administrative implementation. Conclusions and Suggestions: Multiple measures such as refined means of implementation, clear relationship between powers and responsibilities, top-down high-level driving, sufficient resources and digital technology, can help reduce the ambiguity and conflict of the policy and improve the effect of policy implementation.