【作者】 王坤；

【导师】 陈军亚；

【作者基本信息】 华中师范大学 ， 农村发展， 2022， 硕士

【摘要】 农民的身体健康不仅与个人幸福有关,也与国家的建设息息相关。随着2022年的“一号文件”出台,“三农”依旧是当前关注的重点。其中重点提及了农村的医疗保障问题,通过医疗保障帮扶、推动县域医疗卫生共同体建设等方式在加强医疗保障监管的同时,有序推动农村医疗制度改革,全面提升农村居民的医疗待遇水平。农村医疗保障制度的改革、发展与完善,不仅有助于满足农村地区农民的医疗需求,切实有力的对农民身体健康起到一定作用,也展现了现代国家政治权威的逐步提升,体现其社会性的同时体现政治性。我国农村医疗改革是一个时间跨度长、覆盖范围广、影响较深远的农村改革,其复杂变迁一直以来备受学界关注。有关农村医疗保障制度的研究,均侧重于研究一个阶段内制度变革的具体过程,且偏向于从静态单维视角研究变革的逻辑,未对改革过程和其背后逻辑进行长时期、连续性的研究。本文通过安徽省H镇S村的调研为基础,将我国农村医疗保障制度变革过程划分为三个阶段,系统地梳理中国农村医疗保障制度的演变历程,通过国家化理论的视角,研究我国农村医疗保障制度变革过程中,国家与农民之间的互动关系以及国家职能转变,探究我国农村医疗保障制度变革的特征,以及其变迁过程的深层逻辑。在医疗领域中,国家与农民互动关系增强,国家实现从“统治型国家”向“服务型国家”的转变,国家职能由统治职能转向服务职能,体现了国家职能的根本性变化。国家化视角为理解我国农村医疗保障制度的复杂变迁提供了一个广阔视角,为未来农村医疗保障制度变革指明方向、提供路径。本文的研究内容分为如下五章。第一章,重点介绍了本文的研究缘起、文献综述、国家化的分析视角,及研究框架和方法;第二章,传统时期农村医疗制度的内外在困境、农民自我救治的三种形式,以及农民获得的外部保障;第三章,合作化时期国家将医疗卫生重点向农村倾斜,并且实施赤脚医生政策与改革合作医疗制度,试图以国家、集体与农民三方共担的方式介入农村医疗领域,但对于农民做出的就医行为回应没有得到妥善的处理。第四章,新时期实施新型农村合作医疗制度和整合全国城乡居民医疗保障制度,以国家主担的农村医疗保障制度得到增强。在制度运行过程中,国家不断根据农民的就医行为转变来完善政策措施,又促使农民就医行为积极转变。第五章,主要讨论两个问题,一是医疗变迁过程——从自我负担到国家主担;二十国家职能转变得内在逻辑——从“统治职能”转变为“服务职能”,并进一步思考。更多还原

【Abstract】 The health of farmers is not only related to personal happiness,but also closely related to the construction of the country.With the release of the "No.1 Document" in 2022,agriculture,rural areas and farmers are still the focus of current attention.Among them,the medical security in rural areas is emphasized.While strengthening the supervision of medical security by means of medical security assistance and promoting the construction of medical and health communities in counties,the reform of rural medical system is promoted orderly and the medical treatment level of rural residents is comprehensively improved.The reform,development and improvement of the rural medical security system not only helps to meet the medical needs of rural farmers,but also plays a certain role in the health of farmers.It also shows the gradual improvement of the political authority of the modern country,reflecting its sociality and political nature.China’s rural medical reform is a long time span,wide coverage,far-reaching impact of rural reform,its complex changes have been concerned by the academic community.The research on rural medical security system focuses on the specific process of institutional reform within a stage,and tends to study the logic of reform from a static one-dimensional perspective,without a long-term and continuous study on the reform process and the logic behind it.Based on the H town S village in anhui province,on the basis of the research to our country rural medical security system reform process is divided into three stages,systematically combs the evolution course of China’s rural medical security system,from the Angle of nationalization theory,research in the process of rural medical security system reform in China,the interaction between government and peasants as well as the change of state function,Explore the characteristics of the reform of rural medical security system in China and the deep logic of its process.In the medical field,the interaction between the state and farmers is strengthened,the state has realized the transformation from "ruling state" to "service state",and the state function has changed from ruling to service function,which reflects the fundamental change of state function.The perspective of nationalization provides a broad perspective for understanding the complex changes of China’s rural medical security system,pointing out the direction and providing a path for the future reform of rural medical security system.The research content of this paper is divided into five chapters as follows.Chapter one mainly introduces the research origin,literature review,national analysis perspective,research framework and methods of this paper.Chapter two,the internal and external difficulties of the rural medical system in the traditional period,the three forms of self-treatment of farmers,and the external security of farmers;Chapter three:During the cooperative period,the state tilted its medical and health focus to the countryside,implemented the policy of barefoot doctors and reformed the cooperative medical system,and attempted to intervene in the rural medical field by sharing the responsibilities of the state,the collective and the farmers.However,the response to the farmers’ medical behavior was not properly handled.Chapter four:The implementation of the new rural cooperative medical system and the integration of the national medical security system for urban and rural residents in the new period,the rural medical security system is strengthened by the state.In the process of system operation,the state constantly improves policies and measures according to the change of farmers’ medical treatment behavior,and promotes the positive change of farmers’ medical treatment behavior.The fifth chapter mainly discusses two issues,one is the process of medical change--from self-burden to national burden;Second,the internal logic of the transformation of state functions--from "ruling function" to "service function",and further thinking.更多还原