本文综合已有制度变迁理论的研究成果,构建了一个融合诱致性制度变迁与强制性制度变迁两种路径的理论分析框架,在此基础上以厦门市分级诊疗制度创新为例,提出一个两阶段的制度变迁模式。基于成本—收益视角,本文对厦门市分级诊疗改革的制度变迁路径和参与主体进行具体分析。厦门的经验表明,激励地方政府制度创新需要建立“容错”机制,以发挥其“平衡器”作用。同时,制度创新关键是人,地方政府制度创新宜采取诱致性变迁路径,实现多方共赢。当然,在鼓励和激发地方政府制度创新的同时,也要强化统筹和“一盘棋”方略,以克服分割推进、分散试点对制度整合带来的不利影响。 Based on the research results of the theory of institutional change, this paper constructs a theoretical analysis framework that integrates the changes of the induced system and the compulsory system. Based on this, taking the innovation of the hierarchical medical system in Xiamen as an example, this paper proposes a two-stage The system of change patterns. Based on the cost-income perspective, this paper makes a detailed analysis of the institutional changes and participators in the reform of the classification and treatment of Xiamen City. Experience from Xiamen shows that to stimulate institutional innovation in local governments, it is necessary to establish a “fault-tolerant” mechanism to play its role as a “balancer.” At the same time, the key to system innovation is human beings. Institutional innovation of local governments should take the path of induced change and achieve multi-win-win situation. Of course, while encouraging and stimulating the innovation of the local government system, we must also strengthen the co-ordination and “one game” strategy so as to overcome the adverse impact of the split-promotion and the diversified pilot programs on system integration.