The Action Logic Of Primary Medical Organization

Although the results of social transformation and health care reform in China have been impressive,there has been a phenomenon of mismatch between organizational operations and formal systems.The grass-roots health organization village clinics are a typical example.The operation of village clinics was affected by institutional reforms and social transformation.Although the country has issued relevant policies on rural health care,the function of the village clinics is limited and it is in a difficult position in reforms.Therefore,it is important to explore the reasons for this.Practically speaking,the purpose of this study is to explore the logic of village clinics in the process of institutional practice.Based on the theory of new-institutionalism and its legitimacy mechanism,Coleman's theory of corporate action,this article considers the village clinic as an actor to analyze its actions,and considers the external environment factors that restricts and influences its actions as well.At the same time,the "institution-field-action " is applied to analyze better.Through an empirical investigation of eleven village clinics in three townships in Yunnan Province,the micro-actions of the village clinics were analyzed in a macro context,and the probable institutional environment and social environment that may affect the village clinics were analyzed likewise.By discussesing the action of village clinic in rural area,the paper try to reveals the logical action regulations of rural medical organization.It is concluded that the actions of the village clinics are influenced by the external environment and the rational actions of the members of the organization.The formal system regulates and constrains the village clinics through incentives and restraints.The informal system shapes the actions of village clinics.The changes in the rural social environment also affect the survival and development of the village clinics.The village clinics adjust organizational behavior according to the external environment to gain legitimacy.The gaining of benefits as a rational actor is another important goal of the organization.The village clinics will choose the actions that are most beneficial to their own interests on the basis of maintaining the legitimacy of the organization.In the actual operation of the village field,the village clinic must interact with multiple entities,and it needs to make a trade-off between self-interest and organizational legitimacy,including taking different responses to different actors.The village clinics are not only organizations that are constrained by the external environment,but also rational actors.The actions of grass-roots medical organizations are the best choices between satisfying legitimacy and obtaining organizational benefits.In order that the function of the village clinic can be better utilized,the formal system should consider the medical needs of rural residents for the village clinics,and also consider the internal resources of the village clinics and the interests of the village doctors' acting as agents.