中国农村传统合作医疗制度研究

【作者】 钟雪生；

【导师】 柳建辉；

【作者基本信息】 中共中央党校 ， 中共党史， 2008， 博士

【摘要】 中华人民共和国成立以来,中国政府一直力图为广大农村居民构建有效的医疗保障制度。从20世纪50年代中期至80年代初,覆盖面最广、受益人群最多的就是农村传统合作医疗制度。作为中国农村卫生保健工作的一项大胆探索和有益尝试,这项制度大大缓解了广大农村缺医少药的局面,提高了农村居民对基本医疗保健服务的可及性和可得性,显著改善了农村人口的健康水平,并被国际社会公认为发展中国家农村卫生工作的宝贵经验。本文由绪论、正文(五章)和结束语三部分组成。绪论部分着重介绍选题缘由及研究意义、国内外研究现状、选题的重点、难点和创新点、主要研究方法和论文的基本框架等,使读者能够了解本文的学术价值、历史和现实意义。第一章主要介绍农村传统合作医疗制度的兴起。建国初期,整个国家卫生状况十分糟糕,缺医少药,农村更甚。中央人民政府面对农村地区十分落后的卫生状况,采取了积极的措施来应对。首先是提出了卫生工作“四大方针”,为新中国卫生事业的发展指明了方向。接着以危害人民健康最大的20种传染病作为防治目标,以天花、鼠疫、霍乱作为防治重点,大力开展防疫工作,为此后新中国的防疫工作打下了牢固的基础。农业合作化运动的兴起,为农村基层卫生组织——“联合诊所”的产生提供了组织基础,在农业合作化高潮中“农业社保健站”应运而生。这标志着农村传统合作医疗制度的兴起。第二章主要阐述农村传统合作医疗制度的发展。毛泽东对农村卫生工作的重视,“二元结构”社会下的农民医疗保健的无奈选择,“大跃进”和人民公社化运动的推动,使得推广和扩大合作医疗制度成为各地人民公社建设的一项重要内容。此外,“三级预防保健网”在人民公社化运动中快速发展,使广大农村缺医少药的状况得到明显改善。“三级医疗保健网”与农村合作医疗制度关系密切,前者是后者的支持体系和实施平台,并为后者提供制度实施的组织保障,后者是其网底和基础。另外,60年代中期农村卫生人员培训力度的加快为合作医疗制度的发展提供了丰富的人力资源。第三章主要介绍农村传统合作医疗制度的高潮。组织卫生资源大力开展农村巡回医疗,对农村合作医疗制度的完善和发展起了积极的推进作用;毛泽东“六·二六指示”激起了全国上下对农村医疗卫生工作的极大重视,使得医疗卫生工作的重点切实向农村转移;毛泽东对“乐园公社”合作医疗的批示折射出其心中的“理想社会”模式;大众传媒与政治运动的交互作用使合作医疗制度在农村得到迅猛推广,遍地开花。最后,本部分对合作医疗制度的管理和特点作了介绍。第四章主要阐述农村传统合作医疗制度下的“赤脚医生”。本章首先对“赤脚医生”产生和发展的背景进行了分析,对“赤脚医生”现象演进的历史进行了阐述。接着,对“赤脚医生”的管理、待遇,合作医疗制度下的“医患关系”及其成因进行了探讨。最后,对合作医疗及“赤脚医生”的历史作用进行了深入地分析。第五章介绍农村传统合作医疗制度的衰落。本章对农村传统合作医疗制度走向衰落、“赤脚医生”现象的终结的过程进行了阐述,对合作医疗制度衰落的消极影响进行了分析。最后,对这一制度衰落的原因进行了深入地探讨。结语部分首先客观评价了中国农村传统合作医疗制度的兴衰及绩效,接着对农村传统合作医疗制度和新型合作医疗制度进行了一番比较,最后总结了农村传统合作医疗制度的历史经验,以图对当下正进行的如火如荼的新型农村合作医疗制度的实施和完善有所启示和借鉴。更多还原

【Abstract】 Chinese government has strived to establish effective medical care system since the establishing of People’s Republic of China. From mid 1950s to early 1980s, rural traditional cooperative medical system was one of which involved in the widest areas and benefited most people. As a bold and wholesome attempt of the Chinese rural medical care, this system has helped ease the situation of lack in both doctors and medicine, increase the accessibility and availability of the farmers’ demanding basic medical care service, and also improve the health level of rural population. It’s acknowledged as valuable experiences of rural medical care for the developing countries by the international community.Three sections are includes: Introduction, Body (composed of five chapters) and Conclusion.Section 1 is Introduction which introduces the origin of this thesis’ title, the significance of the research, the up-to-now related research both at home and abroad, focal points, difficult points, some innovations, main methods and the structure of this dissertation. It enables the readers to understand the academic value, historical and realistic significance of this research.Chapter 1 introduced the origin and rise of Chinese rural traditional cooperative medical system. At the very founding of the People’s Republic of China, the medical conditions of the whole country were terrible, lacking in doctors and medicines everywhere, especially in the rural areas. Thus Central People’s Government adopted a series of positive measures to deal with the extremely backward medical conditions in rural areas. "Four Guidelines" for medical care was put forward for the first time, pointing out the direction of New China’s medical care undertaking. Then with 20 kinds of infectious disease that endangered the people’s health most aimed at as goal, smallpox, pest infestation, cholera that endangered national defense and economy aimed at as the focal point, New China carried out epidemic prevention vigorously which laid the first stone for the future. The rise of agricultural cooperation movement constituted the organizational foundation for the primary form of rural cooperativemedical service——polyclinic. In the height of agricultural cooperation movement,agricultural health centers were founded, which marked the start of Chinese rural traditional cooperative medical system.Chapter 2 discussed the development of rural traditional cooperative medical system. Mao Zedong’s weighing on rural medical care, the compulsory choice of the farmers’medical care in a dualistic structure society and "the Great Leap Forward" Movement and the People’s Commune Movement altogether made popularizing and expanding cooperative medical system one of the important parts in the construction of people’s commune in every region. Three-level network of health services developed rapidly in the People’s Commune and improved the rural conditions of lacking in doctors and medicines significantly. Three-level network of health services correlated closely to rural cooperative medical system. The former was the latter’s supporting system and execution platform providing the latter with organizational guarantee to carry out its program, while the latter was the former’s tulle background and foundation. What’s more, the speeding up of the training of Chinese rural health officers in mid 1960s provided human resources for the development of the cooperative system.Chapter 3 depicts the prosperity of the traditional rural cooperative medical care system. Through carrying out itinerant medical service with health resources in rural areas, it plays an important role in improving and developing the rural cooperative medical treatment system. In Mao Zedong’s "Instructions of June 26"made the whole country value the rural medical health work, and it made the focus of medical health work be shifted to rural area. Mao Zedong’s instructions of "Paradise Commune" cooperative medical treatment reflected the ideal society in his heart. It was the interaction of mass media and political campaign that made the cooperative medical system spread in rural areas. Finally, the sector introduced the management and features of the cooperative medical system.Chapter 4 continues to describe barefoot doctor of the traditional rural cooperative medical treatment system. The chapter analyses the developmental background of the barefoot doctors and elaborates the evolutional history of the barefoot doctor. Then it discusses the ` salaries, the doctor-patient relationship and its reasons of the barefoot doctors under the cooperative medical system. Finally, the article analyses the historical role of the barefoot doctors and the cooperative medical system deeply.Chapter 5 is about the decline of the traditional rural cooperative medical system in. This chapter expounds the enervation of the traditional rural cooperative medical system and disappearance of barefoot doctors, and it analyses the negative impact of the decline of the cooperative medical system. Lastly, the article discusses the reasons of the decline of the system.In the last part of article, it compares the traditional rural cooperative medical system with the new cooperative medical treatment system. On summarizing the historical experience of the traditional rural cooperative medical care system, the article further sums up some current problems that should be concerned in the development of the new cooperative medical treatment system.更多还原