健康权是公民的基本权利之一。医疗卫生服务作为实现公民健康权的必要手段，已成为现代政府一项重要的公共服务职能，并直接体现着一国政府对医疗卫生服务的价值定位、发展模式的选择、经济增长与公平的互动，以及政府、市场与公民的关系。特别是自第二次世界大战以来，围绕什么是公平的医疗卫生服务，如何恰当运用政府、市场和社会的手段，以及如何促进医疗卫生服务公平的可持续发展这三大问题，世界各国政府进行了持续的改革。在探索这些问题答案的过程中，中国医疗卫生服务的公平价值观和公平状况像钟摆一样运动，摆幅剧烈，代价惨重。相较而言，世界其他主要国家虽因体制和历史背景的不同，医疗卫生服务的管理体制、提供机制也各具特色，但改革却经历了几次共同的浪潮和趋势，医疗卫生服务公平都未发生过钟摆式的剧烈运动。

基于此，本研究试图回答三个问题：（1）新中国成立以来，中国医疗卫生服务历史沿革中，公平的波动轨迹是什么？（2）为什么不同于国际潮流，中国医疗卫生服务改革出现了“钟摆式”公平的特点？（3）“钟摆式”公平的动因及风险是什么？风险又该如何规避？为了回答这三个问题，本研究主要以历史制度主义和公平的相关理论为分析框架，通过比较研究、文献研究等方法，具体运用地理信息系统（Geographic Information System,GIS）等分析技术对新中国成立至今的中国医疗卫生服务改革中公平的波动轨迹进行分析。

本书的核心观点是：（1）中国医疗卫生服务改革过程中公平的价值基点先后经历了基于政治运动的“简单平等主义”、基于市场运动的“功利主义”的两次“钟摆式”摆动和基于基本权利的“校零”回调过程；这种“钟摆式”公平具有摆幅剧烈且反弹性大、基本保障体系不稳定且可持续性差等特点，体现了公平、效率与增长，政府、市场与社会两大关系的失衡，使社会付出了巨大代价。（2）中国正式制度因素和非正式制度因素的共同作用是“钟摆”摆动剧烈和频繁的重要驱动力；在正式制度和非正式制度因素的交互影响下，市场逻辑与医疗卫生服务特性的内在冲突，以及功利主义与公民健康权的内在悖论加剧了“钟摆”的摆动幅度，增加了改革的不可持续性。（3）为避免“钟摆式”的改革风险，需通过价值基点的权衡与定位，以及正式制度与非正式制度因素的平衡两大方面构建改革中公平的可持续发展模式。

本研究可能的贡献点是：第一，结合政治哲学中平等和公平的相关理论，通过对卫生领域历史改革的分析，首次提出了中国医疗卫生服务改革中“钟摆式”公平的历史运动轨迹。第二，尽可能地搜集整理了新中国成立以来医疗卫生服务公平相关的历史数据，为长时段分析研究医疗卫生公平的波动轨迹奠定了一定基础。第三，反思了医疗卫生服务公平的“钟摆式运动”及其动因，并为进一步研究如何规避“钟摆式运动”的风险、维护公平的可持续发展等问题奠定了基础。第四，在研究方法上，结合政治哲学和医疗卫生领域公平的相关理论，构建了较为系统、具体的公平分析框架，并首次尝试引入GIS分析技术，划分并评价了新中国成立以来三大历史阶段医疗卫生服务改革中的公平状况。

The right to health is one of the fundamental rights of citizens. As a necessary means to realize citizens' right to health, medical and health services have become an important public service function of modern government, and directly reflect the value proposition of a country's government on medical and health services, the choice of development model, the interaction between economic growth and fairness, and the relationship between government, market and citizens. Especially since the Second World War, governments around the world have carried out continuous reforms around the three major issues of what constitutes equitable health services, how to properly use government, market and social means, and how to promote equitable sustainable development of health services. In exploring the answers to these questions, the values of fairness and fairness in China's health services move like a pendulum, swinging violently and at great cost. In contrast, although other major countries in the world have different management systems and delivery mechanisms for medical and health services due to different systems and historical backgrounds, the reform has experienced several common waves and trends, and there has been no pendulum-like vigorous movement in the fairness of medical and health services. Based on this, this study attempts to answer three questions: (1) What is the fair fluctuation trajectory in the historical development of China's medical and health services since the founding of the People's Republic of China? (2) Why, unlike the international trend, is it that China's medical and health service reform has the characteristics of "pendulum" fairness? (3) What are the motives and risks of "pendulum" fairness? How can risks be avoided? In order to answer these three questions, this study mainly takes the relevant theories of historical institutionalism and fairness as the analysis framework, and uses analysis techniques such as Geographic Information System (GIS) to analyze the fluctuation trajectory of fairness in China's medical and health service reform since the founding of New China through comparative research and literature research. The core points of this book are: (1) the value base point of fairness in the process of China's medical and health service reform has successively experienced two "pendulum" swings based on "simple egalitarianism" based on political movements, "utilitarianism" based on market movements, and "zero" pullback process based on basic rights; This kind of "pendulum" fairness has the characteristics of sharp swing and large rebound, unstable basic security system and poor sustainability, reflecting fairness, efficiency and growth, and the imbalance of the relationship between government, market and society, which has cost society a huge price. (2) The combined effect of formal and informal institutional factors in China is an important driving force for the violent and frequent swing of the "pendulum"; Under the influence of the interaction of formal and informal institutional factors, the inherent conflict between market logic and the characteristics of medical and health services, and the inherent paradox between utilitarianism and citizens' right to health, have exacerbated the swing of the "pendulum" and increased the unsustainability of reform. (3) In order to avoid the risk of "pendulum" reform, it is necessary to build a fair sustainable development model in reform through two aspects: the weighing and positioning of value base points and the balance of formal and informal institutional factors. The possible contributions of this research are: first, combined with the relevant theories of equality and fairness in political philosophy, through the analysis of historical reform in the health field, the historical trajectory of "pendulum" fairness in China's medical and health service reform is proposed for the first time. Second, as much as possible, the historical data related to medical and health service fairness since the founding of New China were collected and sorted out, which laid a certain foundation for long-term analysis and study of the fluctuation trajectory of medical and health equity. Third, it reflects on the "pendulum movement" of health service equity and its motives, and lays a foundation for further research on how to avoid the risks of the "pendulum movement" and maintain equitable sustainable development. Fourth, in terms of research methods, combined with political philosophy and relevant theories of fairness in the field of medical and health care, a more systematic and specific fairness analysis framework was constructed, and GIS analysis technology was tried for the first time to divide and evaluate the fairness situation in the three historical stages of medical and health service reform since the founding of New China.（AI翻译）