【作者】 张雪峰；

【导师】 屈锡华；

【作者基本信息】 四川大学 ， 行政管理， 2005， 硕士

【摘要】 健康之于人类,无论其贫富,无论进化到何种阶段,都是永恒的追求。中国改革开放前的“合作医疗”以其“低成本向大众提供卫生服务”而著称,随着农村经济改革的深入,这一系统逐渐瓦解。为解决农村基本卫生医疗保障,上世纪90年代以来开始“二次合作医疗”改革,但实施结果并不如人意。目前,农村医疗保障基本上是农民自我保障,农民因病致贫、因病返贫现象极为普遍。 经验证明,健康卫生发展并不自动跟随经济增长,中国的社会保障系统受到不公平性的困扰,尤其是农村医疗卫生保障筹资和组织出现了严峻的问题。健康水平的衰退、卫生部门的低生产力最终将使经济增长消失,影响经济的可持续发展,因此合适的卫生政策和有力的领导是卫生健康与经济同步发展、互相促进的必要条件,也是经济持续发展的要求。 本文从合作医疗的外部性和准公共产品特征入手,对合作医疗推行难问题进行公共政策分析,并借鉴现代保险的观点,运用经济学工具,考察卫生服务的内在特点并对合作医疗的运行机制进行分析,进而试图对合作医疗保险的制度和组织形式改革提出对策建议。 本文共分5个部分: 前言,从中国农村医疗保障的缺失以及医疗卫生中的城乡差别谈起,指出在中国农村加强医疗保障体系构建的必要性,并提出本文的研究视角和方法; 第一章,系统介绍了农村合作医疗发展的历史沿革以及国内在这一领域已有的研究成果; 第二章,首先提出了影响合作医疗推行的因素,然后对合作医疗自身的特点进行考察,着重分析了卫生保健的外部性和准公共产品特征以及卫生服务中更多还原

【Abstract】 Health is the eternal pursuit of human beings whenever evolution happens. Befor reform, China’s rural cooperative medical system was well-known for its low cost and high availability. With the deepening of rural reform, this medical system gradually came to the end. Since 1990s, China has launched the movement of rebuilding rural medical system, but the result is not satisfying. Now, in the rural area, people have almost no security except family security. Many rural people fall into or go back to poor conditions because of illness.Experience has proved that health care does not automatically develop with the economy. China’s social security system has been puzzled by the problem of unfairness. China’s rural security is now facing the serious problem of fund-raising and institition arrangement. The degrading of health care and the low productivity of sanitary sectors will eventually spoil the economic increase and sustainable development. Therefore, good sanitary policies and strong leadership are necessary for the synchronous development of health and economy and they are also the requirement of economic sustainable development.Beginning with the analysis of externalities and the characteristic of semi public product, the author made the policy analysis of cooperative medical system. Using the modern insurance and economics for reference, the author studied the internal characteristics of sanitary service and analysed the running mechanism of cooperative medical system. On this basis, the author tried to make some suggestionsfor the institution and organization arrangements of cooperative medical system.The essay is composed of 5 parts:The foreward beginned with the absence of rural health security and the difference of sanitary service in urban and rural areas. The author pointed out the necessity of establishing health security system and put foreward the studying methods and angles of this essay;The first chapter systematically introduced the history of rural cooperative medical system and the available study results in this area;The second chapter gave the factors which influence the running of rural cooperative medical system first, then studied the internal characteristics of rural cooperative medical system. It focused on the analysis of externalities and the characteristic of semi public product as well as the moral hazzard and adverse selection;The third chapter first analysed the factors which influence the running of rural cooperative medical system with the method of policy making. Then the author made the suggestions for solving moral hazzard and adverse selection;The fourth chapter made further analysis for the key point of rural cooperative medical system, that is fund-raising problem, and offered the choices for institution improvement.更多还原