鄂西新型农村合作医疗制度研究
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摘要
本研究利用文献法、访谈法以及问卷调查获得的资料,对湖北省长阳土家族自治县合作医疗改革的发展历程及其新型合作医疗实施的现状进行了研究,旨在挖掘其中的一些问题,并提出一些建设性意见。
第一部分交代了研究问题的背景,回顾了相关研究的文献,阐明了本研究的对象选择、基本思路和意义,对相关概念进行了阐释,并介绍了所采用的主要研究方法。
第二部分回顾了长阳县农村合作医疗的发展历程,包括长阳县农村合作医疗的起源、普及、滑坡、振兴以及长阳县新型农村合作医疗的建立五个发展阶段。
第三部分概括了全国新型农村合作医疗的现状,长阳县新型农村合作医疗的基本制度规定,并在制度的框架内对新型农村合作医疗进行了评价。同时,描述了我国农民社会的基本特征,通过对长阳县200名农民的问卷调查和访谈,了解了农民对新型农村合作医疗的基本评价,分析了农民参与新型农村合作医疗的吸引因素和排斥因素。其次,从宏观社会的角度对新型农村合作医疗进行了评价,指出基础设施薄弱、医疗卫生领域的混乱、受市场经济冲击等诸多问题。最后,针对今年“两会”期间国家对新型农村合作医疗的相关政策进行了分析并提出了相应见解。
第四部分概述了本研究的基本结论,提出了办好新型农村合作医疗的建设性意见,指出要从制度、管理、基础设施、法律等四个方面着手,完善农村合作医疗,为农民创造最大化福利。并指出了本研究存在的不足之处。
With the data and documents observed by literatures、interviews and survey, the essay research the course of Collaboration Medical Reforming and the present condition of New-style Collaboration Medical System in Rural Areas in Changyang. The purpose of this research is to find some problems about it, even to give some suggestions.
The first part introduces the background of this study, reviews relevant study, clarifies researchable object, the study purpose, significance and basic concepts, and offers main study methods.
The second part describes process of Collaboration Medical System in Changyang, including five developing stages: the origin of traditional Collaboration Medical System, the universal of traditional Collaboration Medical System, the declining of traditional Collaboration Medical System, the promotion of traditional Collaboration Medical System and the establishment of new-style Collaboration Medical System in Changyang.
The third part illustrates the current situation of the national new-style Collaboration Medical System and the basic institution of new-style Collaboration Medical System in Changyang, appraises to the new-style Collaboration Medical System in the frame of the institution. Meanwhile, describes the essential feature of China peasant society. Based on 200 questionnaire investigation and interviews, finds out about peasant’s appraisal on the new-style Collaboration Medical System, analyzes the attraction factor and rejection factor of participating in new-style Collaboration Medical System. Then, appraises to new-style Collaboration Medical System in the term of macroscopical society, points out a great deal of problems, such as weakness of the infrastructure, confusion in the health care field, striking by market economy, etc. Finally, analyzes and proposes the relative opinion about the relevant policy of the new-style Collaboration Medical System to the country during“Two Conferences”.
The fourth part offers a conclusion, gives some suggestions to create new-style Collaboration Medical System, points out that set about from four respects, such as institution, management, infrastructure, law, etc. to perfect New-style Collaboration Medical System, and creates the maximizing welfare for peasants. Even indicates the shortages of this research.
第一部分交代了研究问题的背景,回顾了相关研究的文献,阐明了本研究的对象选择、基本思路和意义,对相关概念进行了阐释,并介绍了所采用的主要研究方法。
第二部分回顾了长阳县农村合作医疗的发展历程,包括长阳县农村合作医疗的起源、普及、滑坡、振兴以及长阳县新型农村合作医疗的建立五个发展阶段。
第三部分概括了全国新型农村合作医疗的现状,长阳县新型农村合作医疗的基本制度规定,并在制度的框架内对新型农村合作医疗进行了评价。同时,描述了我国农民社会的基本特征,通过对长阳县200名农民的问卷调查和访谈,了解了农民对新型农村合作医疗的基本评价,分析了农民参与新型农村合作医疗的吸引因素和排斥因素。其次,从宏观社会的角度对新型农村合作医疗进行了评价,指出基础设施薄弱、医疗卫生领域的混乱、受市场经济冲击等诸多问题。最后,针对今年“两会”期间国家对新型农村合作医疗的相关政策进行了分析并提出了相应见解。
第四部分概述了本研究的基本结论,提出了办好新型农村合作医疗的建设性意见,指出要从制度、管理、基础设施、法律等四个方面着手,完善农村合作医疗,为农民创造最大化福利。并指出了本研究存在的不足之处。
With the data and documents observed by literatures、interviews and survey, the essay research the course of Collaboration Medical Reforming and the present condition of New-style Collaboration Medical System in Rural Areas in Changyang. The purpose of this research is to find some problems about it, even to give some suggestions.
The first part introduces the background of this study, reviews relevant study, clarifies researchable object, the study purpose, significance and basic concepts, and offers main study methods.
The second part describes process of Collaboration Medical System in Changyang, including five developing stages: the origin of traditional Collaboration Medical System, the universal of traditional Collaboration Medical System, the declining of traditional Collaboration Medical System, the promotion of traditional Collaboration Medical System and the establishment of new-style Collaboration Medical System in Changyang.
The third part illustrates the current situation of the national new-style Collaboration Medical System and the basic institution of new-style Collaboration Medical System in Changyang, appraises to the new-style Collaboration Medical System in the frame of the institution. Meanwhile, describes the essential feature of China peasant society. Based on 200 questionnaire investigation and interviews, finds out about peasant’s appraisal on the new-style Collaboration Medical System, analyzes the attraction factor and rejection factor of participating in new-style Collaboration Medical System. Then, appraises to new-style Collaboration Medical System in the term of macroscopical society, points out a great deal of problems, such as weakness of the infrastructure, confusion in the health care field, striking by market economy, etc. Finally, analyzes and proposes the relative opinion about the relevant policy of the new-style Collaboration Medical System to the country during“Two Conferences”.
The fourth part offers a conclusion, gives some suggestions to create new-style Collaboration Medical System, points out that set about from four respects, such as institution, management, infrastructure, law, etc. to perfect New-style Collaboration Medical System, and creates the maximizing welfare for peasants. Even indicates the shortages of this research.
引文
[1]中共长阳县委员会,《长阳合作医疗起源》,1972.3
[2]倪兵万、朱本正,《深受贫下中农欢迎的合作医疗制度》(原载《人民日报》1968.12.5)
[3]《长阳县关于改革农村医疗卫生制度的初步总结》,(原载《人民日报》、《情况汇编》第2090期1972.3.15)
[4]《光明日报》1976.9.10
[5]张效武、郭美松,《解决农民看病难问题长阳村村实行合作医疗》(原载《人民日报》1992.4.29)
[6]长阳县合管办,2004
[7]长阳县卫生局,2005
[8]《长阳土家族自治县开展新型农村合作医疗报告》,2004
[9]长阳县人民医院合作医疗办公室内部资料,2005
[10]《全国新型农村合作医疗试点工作进展顺利》,卫生部网站,2006-1-10
[11]《努力实践“三个代表”办好新型合作医疗--长阳新型农村合作医疗试点工作情况汇报》,长阳土家族自治县卫生局,2005年)
[12]《农村合作医疗住院病人转诊规定》,长阳县人民医院,2005
[13]《经济日报》,2004年01月11日
[14]《农村合作医疗医药费报销办法》,长阳县人民医院,2005
[15]《经济日报》,钟华林,2004年01月11日
[16]卫生部,2006
[17]国办发[1991]4号
[18]国办发[2003]3号
[1]张立荣,李海华.中国农村社会保障:现状分析与对策构想.社会保障制度,2001(3)20～25
[2]孙爱琳.中国农村医疗保险:现状分析于对策构想.江西财经大学学报2003(2)16～19
[3]朱俊生等.论建立多层次农村医疗保障体系.人口与经济.2002(2) 66～71
[4]梁鸿.讨论中国农村社会保障及其特殊性.社会保障制度.2000(1)20～22
[5]葛强.推行农村合作医疗可行性调查分析.江苏卫生保健.2002(3)26～31
[6]周寿祺等.吴县农村大病统筹合作医疗实施9年的调查.中国农村卫生事业管理.2003(5)13～17
[7]张子平等.发展和完善农村合作医疗制度面临的主要问题与对策.国际医药卫生导报.2000(1022～25)
[8]左和详等.经济欠发达地区推行农村合作医疗制度的思考.中国卫生事业管理.1998(8)438～440
[9]沈文虎等.农村合作医疗管理模式的应用.广西预防医学.1999(3)170～173
[10]王书城,李雪生.关于改革与完善农村合作医疗保健制度的基本构想.中国农村卫生事业管理.1994(9)5～8
[11]陶国斌.从根本上扭转重城市轻农村的医疗保障现状.瞭望新闻周刊.2001(43)12～19
[12]王东兵.风风雨雨三十年.健康报. 1996.6.28.第3版
[13]张效武,郭美松.解决农民看病难问题—长阳村村实行合作医疗.人民日报.1992.4.29第5版
[14]张德元.中国农村医疗卫生事业发展历程回顾与分析.湖南科技学院学报.2005 (5)15～22
[15]吴新慧.鄂西农村医疗保障供给的困境与出路.华中科技大学硕士学位论文.2004:22～24
[16]韩留富.农村医疗保障制度的变革、创新及政府调控.中国矿业大学学报.2003(1)23～27
[17]殷绛.民族地区新型农村合作医疗制度建设的思考.中南民族大学学报(人文社会科学版)第25卷第4期
[18]袁日华.社会学视野下的新型农村合作医疗及其发展.华中科技大学硕士学位论文.2005:23～24
[19]郭于华.“道义经济”还是“理性小农”.读书.2002(5)11～13
[20] J.米格代尔,李玉琪,袁宁(译).农民、政治与革命——第三世界政治与社会变革的压力.中央编译出版社,1996
[21]林闽钢等.走向全球化的中国社会保障制度改革.中国商业出版社,2001
[22]陆学艺.社会学要重视研究当今农民问题.中国社会学年鉴1979-1989.中国大百科全书出版社,1989
[23]费孝通.乡土中国.北京出版社,1998
[24]风笑天.社会学导论.华中理工大学出版社,1997
[25]鲁思?本尼迪克特.菊与刀——日本文化的类型.商务印书馆出版社,1990
[26]国家统计局.中国统计年鉴.中国统计出版社,1999
[27] Cui Lili. Rebuilding rural cooperative medical system. Beijing Review. Beijing: Vol.40(1997):22~25
[28] Keith McClellan. A primer on rural medical politics. 2: Federal Provincial jurisdictions. Canadian Journal of Medicine. Ottawa, Vol.6.2001:282~285
[29] Sokin, Alan L. Health Economics: An Introduction. Lexington Books (1883)
[30] Simon Szreter. Economics growth, Disruption, Deprivation, Disease, and Death: On the Importance of the Politics of Public Health for Development. Population and develop review, Vol.23.1997:11~14
[31] Gerald Boom. Primary health care meets the market in China and Vietnam. Health Policy, Vol. 44.1998:1~5
[32] Christopher J.Smith. Modernization and health care in contemporary China. Health and place, Vol. 4.1998:1~5
[33] WEEKENDER, Health Economics: An update on cooperative hospitals. Business World. Manila: Feb 5, 1999:1
[34] Liu Yuanli. Development of the rural health insurance system in China. Health Policy and Planning. Oxford, Vol.19(2004):159
[35] Scott, James C., Domination and the Arts of Resistance: Hidden Transcripts, Yale University Press, 1990
[36] Scott, James C., Weapons of the Weak: Everyday From of Peasant Resistance. Yale University Press, 1985
[37] Hearn, Wayne. Rural cooperatives. American Medical News. Chicago, Vol.38, 1995:12
[38] Guy Carrin, Aviva Ron, Yang Hui. The reform of the rural cooperative medical system in the People’s Republic of China: interim experience in 14 pilot Counties. Social Science and Medicine, Vol,48.1999:125~129
[39] Rothschild, Michael and Stiglitz, Joseph E. Equilibrium in Competitive Insurance Markets. Quarterly Journal of Economics, November,1976:165~166
[40] Stiglitz, J.E. Monopoly, non-linear pricing and imperfect information: The insurance market. Review of Economic Studies, Vol.44.1977:12~15
[41] White, Elizaberth C. Rural Hospitals Band Together to Regain Local Market Shares. Modern Health care. Chicago, Vol.15(1985):172~174
[42] WHO. Macro economics and Health: Investing in health for Economic Development. Report of the Commission on Macroeconomics and Health, 20 December, 2001:101~105
[2]倪兵万、朱本正,《深受贫下中农欢迎的合作医疗制度》(原载《人民日报》1968.12.5)
[3]《长阳县关于改革农村医疗卫生制度的初步总结》,(原载《人民日报》、《情况汇编》第2090期1972.3.15)
[4]《光明日报》1976.9.10
[5]张效武、郭美松,《解决农民看病难问题长阳村村实行合作医疗》(原载《人民日报》1992.4.29)
[6]长阳县合管办,2004
[7]长阳县卫生局,2005
[8]《长阳土家族自治县开展新型农村合作医疗报告》,2004
[9]长阳县人民医院合作医疗办公室内部资料,2005
[10]《全国新型农村合作医疗试点工作进展顺利》,卫生部网站,2006-1-10
[11]《努力实践“三个代表”办好新型合作医疗--长阳新型农村合作医疗试点工作情况汇报》,长阳土家族自治县卫生局,2005年)
[12]《农村合作医疗住院病人转诊规定》,长阳县人民医院,2005
[13]《经济日报》,2004年01月11日
[14]《农村合作医疗医药费报销办法》,长阳县人民医院,2005
[15]《经济日报》,钟华林,2004年01月11日
[16]卫生部,2006
[17]国办发[1991]4号
[18]国办发[2003]3号
[1]张立荣,李海华.中国农村社会保障:现状分析与对策构想.社会保障制度,2001(3)20～25
[2]孙爱琳.中国农村医疗保险:现状分析于对策构想.江西财经大学学报2003(2)16～19
[3]朱俊生等.论建立多层次农村医疗保障体系.人口与经济.2002(2) 66～71
[4]梁鸿.讨论中国农村社会保障及其特殊性.社会保障制度.2000(1)20～22
[5]葛强.推行农村合作医疗可行性调查分析.江苏卫生保健.2002(3)26～31
[6]周寿祺等.吴县农村大病统筹合作医疗实施9年的调查.中国农村卫生事业管理.2003(5)13～17
[7]张子平等.发展和完善农村合作医疗制度面临的主要问题与对策.国际医药卫生导报.2000(1022～25)
[8]左和详等.经济欠发达地区推行农村合作医疗制度的思考.中国卫生事业管理.1998(8)438～440
[9]沈文虎等.农村合作医疗管理模式的应用.广西预防医学.1999(3)170～173
[10]王书城,李雪生.关于改革与完善农村合作医疗保健制度的基本构想.中国农村卫生事业管理.1994(9)5～8
[11]陶国斌.从根本上扭转重城市轻农村的医疗保障现状.瞭望新闻周刊.2001(43)12～19
[12]王东兵.风风雨雨三十年.健康报. 1996.6.28.第3版
[13]张效武,郭美松.解决农民看病难问题—长阳村村实行合作医疗.人民日报.1992.4.29第5版
[14]张德元.中国农村医疗卫生事业发展历程回顾与分析.湖南科技学院学报.2005 (5)15～22
[15]吴新慧.鄂西农村医疗保障供给的困境与出路.华中科技大学硕士学位论文.2004:22～24
[16]韩留富.农村医疗保障制度的变革、创新及政府调控.中国矿业大学学报.2003(1)23～27
[17]殷绛.民族地区新型农村合作医疗制度建设的思考.中南民族大学学报(人文社会科学版)第25卷第4期
[18]袁日华.社会学视野下的新型农村合作医疗及其发展.华中科技大学硕士学位论文.2005:23～24
[19]郭于华.“道义经济”还是“理性小农”.读书.2002(5)11～13
[20] J.米格代尔,李玉琪,袁宁(译).农民、政治与革命——第三世界政治与社会变革的压力.中央编译出版社,1996
[21]林闽钢等.走向全球化的中国社会保障制度改革.中国商业出版社,2001
[22]陆学艺.社会学要重视研究当今农民问题.中国社会学年鉴1979-1989.中国大百科全书出版社,1989
[23]费孝通.乡土中国.北京出版社,1998
[24]风笑天.社会学导论.华中理工大学出版社,1997
[25]鲁思?本尼迪克特.菊与刀——日本文化的类型.商务印书馆出版社,1990
[26]国家统计局.中国统计年鉴.中国统计出版社,1999
[27] Cui Lili. Rebuilding rural cooperative medical system. Beijing Review. Beijing: Vol.40(1997):22~25
[28] Keith McClellan. A primer on rural medical politics. 2: Federal Provincial jurisdictions. Canadian Journal of Medicine. Ottawa, Vol.6.2001:282~285
[29] Sokin, Alan L. Health Economics: An Introduction. Lexington Books (1883)
[30] Simon Szreter. Economics growth, Disruption, Deprivation, Disease, and Death: On the Importance of the Politics of Public Health for Development. Population and develop review, Vol.23.1997:11~14
[31] Gerald Boom. Primary health care meets the market in China and Vietnam. Health Policy, Vol. 44.1998:1~5
[32] Christopher J.Smith. Modernization and health care in contemporary China. Health and place, Vol. 4.1998:1~5
[33] WEEKENDER, Health Economics: An update on cooperative hospitals. Business World. Manila: Feb 5, 1999:1
[34] Liu Yuanli. Development of the rural health insurance system in China. Health Policy and Planning. Oxford, Vol.19(2004):159
[35] Scott, James C., Domination and the Arts of Resistance: Hidden Transcripts, Yale University Press, 1990
[36] Scott, James C., Weapons of the Weak: Everyday From of Peasant Resistance. Yale University Press, 1985
[37] Hearn, Wayne. Rural cooperatives. American Medical News. Chicago, Vol.38, 1995:12
[38] Guy Carrin, Aviva Ron, Yang Hui. The reform of the rural cooperative medical system in the People’s Republic of China: interim experience in 14 pilot Counties. Social Science and Medicine, Vol,48.1999:125~129
[39] Rothschild, Michael and Stiglitz, Joseph E. Equilibrium in Competitive Insurance Markets. Quarterly Journal of Economics, November,1976:165~166
[40] Stiglitz, J.E. Monopoly, non-linear pricing and imperfect information: The insurance market. Review of Economic Studies, Vol.44.1977:12~15
[41] White, Elizaberth C. Rural Hospitals Band Together to Regain Local Market Shares. Modern Health care. Chicago, Vol.15(1985):172~174
[42] WHO. Macro economics and Health: Investing in health for Economic Development. Report of the Commission on Macroeconomics and Health, 20 December, 2001:101~105