通过研究南非和赞比亚两国卫生保健筹资改革的政策制定过程 ,揭示政治和行政现实形成的政策变化模式及其影响。显示政治因素及参与者对卫生筹资政策的实施有很大影响。政治变革给政治领导 ,特别是卫生部领导提供了实行新政策的机遇 ,也创造了约束改革设计进程和实施的环境 ,并限制了政策的公平性和持续收益。而技术分析家的影响是变化的和有限的 ,且他们首选的政策常常只得到很少的政治支持。处于一线的卫生工作者、中层管理者和公众对政策有重要影响。提示政治和技术分析相结合支持政策变革 By examining the policy development process of health care financing reforms in South Africa and Zambia, we reveal the patterns of change in policy and their implications as a result of the political and administrative realities. It shows that political factors and participants have a great influence on the implementation of health financing policies. Political change has given political leaders, especially the leaders of the Ministry of Health, the opportunity to implement new policies, create an environment that will constrain the process of reform and implementation of the design and limit the fairness and continuing benefits of the policies. The impact of technology analysts is both variable and limited, and their preferred policies often receive little political support. The front-line health workers, middle managers and the general public have a major impact on policy. Suggesting a combination of political and technical analysis to support policy change