摘要：本文基于对山东、吉林、浙江、安徽和四川5个省份11个县（市）农业农村局相关业务部门及农户的实地调研，系统考察了基层政府推进玉米、水稻和小麦三类粮食作物“大面积单产提升行动”的具体举措、现实约束及其成因。调研发现，各地政府普遍采用对达到一定规模的新型农业经营主体进行补贴的方式，引导其优化生产经营与田间管理，并期待其发挥示范效应带动其他农户增产。配套措施包括规模主体人力资本提升、先进技术融合与扩散以及农业基础设施完善。然而，各地采取的大面积单产提升措施仍然存在四大问题：政策工具未作出针对性调整更新、规模主体对普通农户的示范效应传导不畅、基础设施建设与运行维护仍不完善，以及上级政府的试点配置逻辑与地方实际增产潜力的识别逻辑之间存在偏离。本文进一步从政策模糊性、部门协同机制、“自上而下”的政府工作机制、激励与问责及地方财政约束等五个维度讨论了产生上述问题的原因。最后，基于上述分析，本文分别从中央与地方两个层面提出政策建议，以期完善政策设计与执行机制，提升政策实施成效，切实推进粮食作物大面积单产提升，增强中国农业综合生产能力和质量效益。 关键词:粮食作物；大面积单产提升；政策工具；规模主体；治理约束

With a goal of improving health system quality and efficiency, reforms of China's health system over the past decade have sought to strengthen primary healthcare in lower-level clinics and health centers. Despite these wide-ranging reforms and initiatives, population-based studies have documented dramatic declines in patients' use of primary care facilities during this period. In this paper, we explore the determinants of this trend in China's rural areas using detailed longitudinal data following a nationally-representative sample of rural households and village clinics from 2011 to 2018. We estimate that between 2011 and 2018, the probability that individuals sought care at village clinics when ill dropped by 44%. At the same time, the utilization of outpatient services in county hospitals increased by 56% and patient self-treatment increased by 20%. Detailed Kitagawa-Oaxaca-Blinder decompositions suggest four primary drivers of this trend: the shifting burden of disease in rural areas, changes in how patients choose to seek care given different disease conditions, declining drug inventory in village clinics, and the decreasing importance of remoteness as a determinant of healthcare seeking behavior. Our results highlight the deteriorating role of village clinics in the rural healthcare system and the increasing importance of self-treatment and higher-tier primary care services.