【作者】 程毅；

【导师】 徐永祥；

【作者基本信息】 华东理工大学 ， 社会学， 2012， 博士

【副题名】基于上海金山、安徽阜阳、宁夏银川三地的实证研究

【摘要】 农村合作医疗是我国农村医疗保障的基本形式,是对广大农民实行医疗保障与卫生服务合二为一的一项基本制度。总体来看,十六大以来在建设社会主义和谐社会和社会主义新农村的时代背景下,农村合作医疗制度研究越来越深入和系统,理论框架愈益走向整合,学科范围愈益趋于多元。但毋庸置疑的是,当前农村合作医疗制度研究上仍然存在着研究领域泛化、研究理念理想化与研究视角单一化问题。所以,农村合作医疗制度的研究必须重视基本理论建设,关注现实中国的农村合作医疗制度的实践,实现研究的理论品质和实践品质的共同提升。本文力图对已有农村合作医疗制度的研究成果进行深入整理,从农村合作医疗制度变迁与重构的研究视角出发,借鉴和整合农村社会学、社会保障学,制度经济学和公共政策学等学科相关理论,将农村合作医疗制度置于中国经济社会发展历史进程的不同阶段加以整体考量,运用历史研究方法和比较研究方法,从纵横两条线清晰地勾勒出传统农村合作医疗制度兴盛与衰落的演变轨迹,以及新型农村合作医疗制度断裂与重构的建构进程,深刻分析我国非均衡发展现状与新型农村合作医疗制度统一性实践的内在矛盾,并在此基础上通过比较实证研究,系统指出三种新型农村合作医疗制度实践模式之比较共同性差异性成就与问题。新型农村合作医疗制度经过多年的试点,目前已覆盖全国绝大部分地区。但是,由于经济社会发展很不平衡,本文提出新型农村作医疗制度的实施一定要因地制宜,政策制度要符合当地实际,以此推动新型农村作医疗制度的可持续发展。本文研究的主要内容包括：第一,传统农村合作医疗制度兴盛与衰落的演变轨迹。通过历史文献研究,重点考察人民公社时期传统农村合作医疗制度产生和兴盛的体制原因,着重分析传统农村合作医疗制度的主要特征与社会功能,深入探讨家庭经营时期传统农村合作医疗制度衰落的原因及其社会后果。第二,新型农村合作医疗制度断裂与重构的建构进程。首先深刻指出农村合作医疗制度的艰难恢复和断裂代价,重点梳理了新型农村合作医疗制度框架与政策演化的重构理路,同时指出当前我国新型农村合作医疗制度建构实践的基本经验以及面临的主要困境。第三,非均衡发展条件下的新型农村合作医疗制度建构实践与运行机制实证和比较研究。从区域横向的角度比较研究当下我国经济社会非均衡发展条件下东中西部三地新型农村合作医疗制度建构实践、特点及其运行机制(包括资金筹集、分配补偿、监督管理等),重点考察区域经济社会发展水平与新型农村合作医疗制度的关系,对东中西部新型农村合作医疗制度供给进行客观评价。第四,非均衡条件下新型农村合作医疗制度可持续发展的政策建议。重点探讨非均衡发展现状与新农合制度统一性实践的矛盾,并提出非均衡发展条件下新型农村合作医疗制度可持续发展的非均衡模式选择,深入分析新型农村合作医疗制度可持续发展的主体框架及行为优化的方式和路径,创新新型农村合作医疗制度可持续发展的运行机制,主要包括新型农村合作医疗制度筹资机制创新、补偿机制创新、监管机制创新、评价机制创新。本文的创新之处在于：第一,本文认为,推进新型农村合作医疗制度的可持续发展是我国推进基本公共服务均等化的题中应有之义,而且必须放在突出的位置予以优先解决,因此必须明确新型农村合作医疗制度可持续发展的政府承担主导责任的必然性及对政府主体行为进行优化的基本政策路径。第二,本文认为,非均衡发展是经济发展的必然结果和空间变迁的表现形式,从多元学科和多维理论出发,将农村合作医疗制度置于中国经济社会历史进程的不同阶段加以整体考量,运用历史研究方法和比较研究方法,从纵横两条线可以清晰地勾勒出农村合作医疗制度的历史变迁和兴衰之道。农村合作医疗制度的兴盛与衰落、断裂与重构的背后推手是城乡二元社会结构的形成与发展、强化与固化、松动与挑战。当前新型农村合作医疗制度表现出较大的制度性优势,并正在改变我国二元制社会结构、建立和谐社会的进程中发挥着重要的作用。第三,本文认为,在横向区域非均衡发展的现实国情下,我国新型农村合作医疗制度可持续发展必须选择非均衡模式,具体表现在：在经济社会发展水平较高的东部农村地区发展福利-风险型合作医疗模式,在经济社会发展水平居中的中部农村地区发展风险型合作医疗模式,在经济社会发展水平较低的西部农村地区发展福利型合作医疗模式,同时要创新新型农村合作医疗制度可持续发展的筹资机制、补偿机制、监管机制与评价机制。更多还原

【Abstract】 Rural cooperative medical care is a basic form of medical insurance in rural areas in China and is also a fundamental system to implement health insurance and health services to farmers. Generally, under the current situation of constructing socialism, harmonious society and the new socialist countryside since 16th National People’s Congress, studies of rural cooperative medical care system are becoming more thorough and systematic, with the theoretical framework moving towards consolidation and subject ranges towards diversity. But areas of research of rural cooperative medical care system are undoubtedly generalized and concepts of research are idealized and perspectives of research are unified. Therefore, the study of rural cooperative medical care system must focus on the construction of basic theory, paying attention to the reality of China’s rural cooperative medical system in practice so as to enhance the significance of theory and practice.This article has been designed to deeply integrate researches of the rural cooperative medical system, with study perspectives from the rural sociology, social security science, institutional economics and public policy studies and other multi-disciplinary perspectives. Departure will be placed on the rural cooperative medical system in the historical process of urbanization in China to be a whole different stage of consideration, utilizing the historical research methods and comparative research methods with the vertical and horizontal lines to clearly outline the history changes of rural cooperative medical care system as well as the fracture and reconstruction of the rural cooperative medical system. This paper also has a comprehensive analysis of the unbalanced development in China and of the internal contradiction of the uniformed practices of the rural cooperative medical system. Through comparison of empirical studies, this essay puts forward achievements and problems with regards to the similarities and differences of three rural cooperative medical system practical models. After New-type rural cooperative medical care system being carried out for trials for six years, it is about to be promoted through the whole nation. However, because of the different levels of urbanization, economic development is very uneven in the society, I propose that the implementation of the health care system in rural areas should be adapted to local circumstances and the policies should be adapted to local realities in order to push forward the sustainable development of the new-typed rural cooperative medical systemThis essay studies from the following four perspectives. First refers to the history changes of rural cooperative medical care system. Through a comparative study, making major investigation on the historical process and the general characteristics of rural medical security system in developed countries and construction process and the main features and social functions of the rural cooperative medical care system, analyzing deeply into the reasons of the decline of the rural cooperative medical care system and the corresponding consequences during the period of household business. The second perspective is the fracture and reconstruction of the rural cooperative medical care system. It is firstly discussed the difficulty to restore the the rural cooperative medical care system and the expense of fracture. Then the next is the strategy to construct the new-typed rural cooperative medical care system, pointing out the basic experience and main difficulties of new-typed rural cooperative medical care system. Third are comparative studies of new rural cooperative medical system in practice and operation mechanism under different urbanization levels in central, western and eastern part of China. Conducting a comparative study on the new rural cooperative medical system in practice, characteristics and operation mechanism (including capital raising, the allocation of compensation, supervision and management) under current urbanization level of China in central, western and eastern regions from a regional point of view in horizontal, focusing on the relationship between the respective urbanization level and new rural cooperative medical systems and the evaluation of the new rural cooperative medical systems in central, western and eastern regions. Fourth are policy recommendations for the sustainable development of new rural cooperative medical system under no equalizing development conditions. Focusing on the selection of no equalizing models in the sustainable development of new rural cooperative medical system under different levels of urbanization, profoundly analyzing the new rural cooperative medical system in the main framework of sustainable development and means and path of behavior optimization, and innovating operating mechanism of new rural cooperative medical system, including financing mechanisms of new rural cooperative medical system, compensation mechanism, regulatory mechanism, and protection mechanism.The innovative points of this article are as follows:First, to promote the new rural cooperative medical system in China is to promote the sustainable development of equalization of basic public services, the proper meaning of the title, and must be prioritized and therefore it is clear that the government is mainly responsible for the sustainable development of the rural cooperative medical care system and is the body to optimize the behavior of these subjects. Second, urbanization is the inevitable result of economic development and spatial changes in the performance of forms, ranging from multi-disciplinary and multi-dimensional theoretical perspective. And the rural cooperative medical care system is placed in the historical process of urbanization in China to be at different stages of the overall consideration, using historical research methods and comparative research methods from the vertical and horizontal two lines to clearly outline the historical changes of rural cooperative medical care system as well as the rise and fall. The rise and fall, fracture and reconstruction of the rural cooperative medical care system are attributed to the occurrence and development, consolidation and solidification, ease up and challenge of the binary social structure. The current rural cooperative medical care system is of great advantages and plays a crucial role in the development of the rural cooperative medical care system. Third, under the process of urbanization and non-balanced vision of development, the sustainable development of China’s new rural cooperative medical system also needs to be in a non-equilibrium model, specifically manifesting in the following points:promoting Welfare- Risk-based cooperative medical model in the eastern areas of higher level of urbanization, promoting risk-type cooperative medical model in the rural areas of medium level of urbanization, promoting welfare-type cooperative medical model in the western rural areas of low level of urbanization. At the same time, the development of the western of. At the same time, we need to update the mechanism to raise money, compensate, regulate and appraise the sustainable development of the new type of rural cooperative medical system. (Innovations)更多还原