【作者】 胡宏伟；

【导师】 郭席四；

【作者基本信息】 武汉科技大学 ， 社会保障， 2006， 硕士

【摘要】 农村合作医疗是我国农村最基本的医疗保障形式,但是,伴随农村经济体制改革,传统农村合作医疗供给遭到削弱,我国农民失去了最基本的医疗保障,几乎完全沦为自费医疗,农村医疗卫生状况恶化,因病致贫、因病返贫问题严重。为改善农村医疗卫生状况,减轻疾病对农户家庭的冲击,从20世纪90年代起,我国政府积极在全国范围内开始探索、重建农村合作医疗制度,恢复农村合作医疗供给。2003年初,我国政府开始试点推行新型农村合作医疗。自此,我国农村合作医疗建设步入了一个新的阶段。必须说明的是,重建期至今(20世纪90年代以来)的农村合作医疗不同于传统的合作医疗:传统合作医疗是建立在集体经济基础之上的福利制度;而重建期至今的农村合作医疗(尤其是新型农村合作医疗)引入了保险机制,要求县(乡)级为统筹单位建立基金,对抗疾病风险1,具有保险性质,基本是一种合作性质的医疗保险。根据医疗保险理论,农村合作医疗的需求方是农户,农村合作医疗的供给方是政府,而医疗服务的供给方是定点医疗机构。本文研究的是具有保险性质的农村合作医疗的需求与供给,不是医疗服务的需求与供给,所以,本文中合作医疗的需求方为农户,供给方为政府,而不是定点医疗机构2。当然,本文也分析了定点医疗机构医疗服务的质量和价格将影响政府供给农村合作医疗。但是,重建期至今(20世纪90年代以来)我国农村合作医疗的有效需求与供给始终处于较低水平,即农村合作医疗的供求仅实现了低水平均衡,而社会全面发展需要农村合作医疗的有效需求和供给均达到较高水平,实现高水平均衡。可见,重建期至今农村合作医疗的有效需求水平与供给水平相对于社会发展要求其达到的有效需求水平和供给水平而言是相对不足的、滞后的,其均衡水平也是相对不足的、滞后的3。本文旨在分析和解决这一问题,分析重建期至今农村合作医疗有效需求与供给均相对不足、供求低水平均衡的原因并提出对策,以期为推进新型农村合作医疗建设提供决策参考。第一章即导论介绍了本文的研究背景和研究现状,阐述了本文的研究目的、思路、方法和文章框架,说明了本文的研究意义和创新,并阐明了本文研究不足和下一步研究方向。第二章阐述了本文分析的理论构架(理论基础),主要包括医疗保险需求与供给基本理论、博弈论和新制度经济学的基本思想。更多还原

【Abstract】 Rural Cooperative Medical System (CMS) is the basic medical security form in Chinese rural area. However, with the reformation of rural economic system, traditional rural cooperative medical supply declined rapidly. The peasants in our country lost the basic medical security while rural medical and health condition deteriorated. The problem of poverty caused by illness become more and more serious.In order to improve the rural medical & health condition and relieve the burden that illness brought to the rural households, our government has actively begun to explore and rebuild the rural CMS, and reset the supply of CMS as well since 1990. In early 2003, our government began to carry out a new type of CMS. Since then, the construction of CMS has stepped into a new stage.However, since 1990, the effective demand & supply of our CMS still remained at a low level. The supply & demand of CMS only realized a low-level equilibrium, while the all-round social development requires that the effective demand & supply of CMS reaches a comparatively high level and realizes high-level equilibrium. Therefore, since 1990, the effective demand & supply of CMS is comparatively insufficient and behind the development when it compared to the required demand & supply level.This thesis aims at analyzing and solving this problem. It analyzes the reasons of comparatively insufficient demand and supply of CMS since 1990, and put forward some suggestions so as to give some references to promote the construction of CMS. In chapter 1, that is the introduction, it introduces the background and present situation of CMS, elaborates the purpose, ways of thinking, methods and framework, illustrates the significance and innovation and clarifies the shortcomings and following researched direction of this paper.In chapter 2, it elaborates the basic theory of this paper, including the basic theories of medical insurance demand and supply, game theory and new-institutional economics.In chapter 3, it introduces the basic concept and history of CMS, analyzes the characteristics of the new CMS, defines the origin of CMS and reviews the 7 stages of CMS.In chapter 4, it set up the peasants’demanding model for CMS based on the previous research, mainly including paying ability model and models of willingness to pay, which are used for analyzing and explaining the demanding behavior for CMS of rural households. On the basis of this, it put forward the problem of comparatively insufficient demand of CMS, and analyzes the reasons.In chapter 5, it reveals the supplier of CMS is government, but the realization & maintenance of supply is affected by rural households & specific medical organizations through the construction of three part participating system, including government, peasants & specific medical organization and lasting gamble. It is a consequence brought out by three parts. On the basis of this, it points out the comparatively insufficient supply of CMS, and analyzes the reasons.In chapter 6, it proposes the solution to the problem of low-level equilibrium of demand & supply of CMS, and gives some references to promote the new CMS and realize the high-level equilibrium of demand & supply of CMS on the basis of chapter 4&5.更多还原