【作者】 李立清；

【导师】 李明贤；

【作者基本信息】 湖南农业大学 ， 农业经济管理， 2008， 博士

【摘要】 兴起于2002年的中国新型农村合作医疗制度,是“由政府组织、引导、支持,农民自愿参加,个人、集体和政府多方筹资,以大病统筹为主的农民医疗互助共济制度。”与我国传统农村合作医疗制度具有本质上的不同,新型农村合作医疗制度是在政府政策引导和财政支持下,农民通过合作组织互助共济、提高农民自己医疗卫生服务需求实现能力和医疗卫生服务消费水平的准社会保障制度。新型农村合作医疗制度的政策出台背景、制度结构设计、制度实施过程及效果等问题,是农村发展经济学与卫生经济学交叉领域的新问题,是农村公共经济研究领域的新探索,是医疗卫生经济理论的新发展。开展新型农村合作医疗制度经济学研究,对于解决农民基本医疗和因病致贫返贫的现实困难、加快解决“三农”问题、构建和谐社会及推进社会主义新农村建设,具有十分重要的理论意义与现实价值。本文以我国农村新型合作医疗制度产生的历史背景、制度实施及农村医疗卫生现状、新农合制度实施成效及其困难、产生困难的经济学原因分析、改进新农合制度、提高制度运行效率等为基本研究内容,通过深入的农村社会调查研究,对农户参加新农合的实际情况及参合行为进行描述、对我国新农合制度建设现状进行客观评价,定性与定量地分析新农合制度绩效及其影响因素,探讨提高农户参合意愿、改进新农合制度绩效的基本路径,并有针对性地提出对策建议。本文共分八章。第一章为导论,包括问题的提出与选题的意义,国内外研究现状及其述评,研究的主要内容、基本框架、基本思路及主要方法等。第二章从农村发展经济学理论、农村公共产品理论、社会保障理论、卫生经济学理论、信息经济学理论等多视角,阐释新型农村合作医疗制度的理论基础。第三章为农村合作医疗制度国际模式比较,重点对免费医疗保障模式、社会医疗保险模式、商业医疗保险模式、社区合作医疗保障模式、储蓄医疗保障模式等几种保障模式的特点和典型国家的运行机制等进行了比较研究。第四章是我国农村合作医疗发展与制度变迁分析。第五章是新型农村合作医疗制度的理论分析,从制度设计、政策执行、农村经济社会发展环境的影响、制度配套措施、制度运行效果等方面,对新农合制度实施中存在的问题进行总结,并从道德风险、道德风险下的垄断均衡、医疗保险支付方式对医疗总费用的影响、“逆向选择”、政府规制等方面,对问题进行了理论剖析。第六章是新型农村合作医疗制度的实证分析。以湖南为例,运用Logistic模型、PSM(倾向得分匹配法)分析方法、农户对新农合“满意度”分析等多种计量经济分析模型,对新农合制度设计合理性、农村医疗卫生资源利用水平、农民医疗卫生费用与家庭卫生支出等进行了实证分析。第七章提出了中国农村合作医疗制度再创新目标构设、模式选择、路径设计和政策建议等。第八章归纳了本文研究的基本结论,提出了中国农村合作医疗保障制度再创新的研究展望。本文在对新农合政策出台背景、制度结构、政策实施过程和制度实施效果的理论与实证研究中,及对农村医疗卫生保障制度的国际比较与我国历史制度变迁观察中,得出了一系列重要的观点与结论。在国际模式比较研究方面的主要结论是发展中国家政府应承担农村医疗保障的主要责任、发展中国家政府高度关注穷人和低收入群体医疗保障、政府与市场混合提供医疗保险服务,相关法律体系较为完善。对我国农村合作医疗制度变迁分析得出的主要结论是,新农合与传统农村合作医疗制度都具有明显的制度补充性特点、新农合的最大成功在于实现了“合作供给”向“合作需求”转变。同时,还得出一系列新农合制度理论与实证研究的重要结论。就进一步完善改进新农合,推进农村合作医疗制度再创新问题,本文概括了新型农村合作医疗制度改革的四条基本经验,提出了中国农村合作医疗制度再创新目标构设,进行了中国农村合作医疗制度再创新的路径设计,提出了实现制度再创新的相关对策建议。本文在汲取和借鉴前人研究成果的基础上,紧密结合中国国情,对中国农村合作医疗保障制度问题进行经济学研究,自己认为,可能在以下三方面取得了一定的研究创新:一是用Logistic模型、PSM分析方法等多种计量分析方法研究了新农合制度实施效果及其影响因素;二是开展了新农合制度再创新研究,拓宽了“解决问题”的视野。本文跳出现行新农合制度本身的束缚,在充分肯定新农合四条基本经验的基础上,提出了内涵丰富的农村合作医疗制度再创新“四四十三”模式,并进行了“三扩两自愿,五化一统筹”的制度再创新路径设计,创新性地提出“再降低参合门槛”、“摊保入亩”、“农村卫生券”、“农民社会保障税”、“再提高农村医疗保障统筹层级”等一系列政策建议,具有原创性;三是本文采用的“校府合作研究”方法具有创新价值。研究过程中,作者与当地政府之间以项目合作研究为平台,开展了项目研究成果与新农合实践主体之间的多次信息互馈。更多还原

【Abstract】 In China, The new-type rural cooperative medical system rising in the year of 2002 is medical mutual redress scheme for rural people, which is organized, guided and supported by the government, participated voluntarily by rural residents, funded by multiple parties including the individual, the collective and the government, focused on compensating catastrophic diseases. In comparison with the traditional Chinese rural cooperative medical system, the new one has a fundamentally nature difference that the new rural cooperative medical system is organized, guided and supported by the government, and farmers could improve their own health needs and enjoy the health services by taking part in this co-operation fraternal order organization. In the context of new-type rural cooperative medical system, the background introduction of the policy, structure design, implementation and effectiveness of institution so on are brand new in the cross field of rural development economics and health economics, new exploration in rural areas of public economics and the development of economic theory. it is of great theoretical significance and practice value to carry out the study of new-type rural cooperative medical system economics, which is vital to solve the basic medical and practical difficulties due to health problems, expediting the settlement of the "three-rural" issue and building a harmonious society and push forward the building of new socialist rural areas.In this paper, the historical background and implementation of a new-type rural cooperative medical system were investigated as well as rural medical health status, implementation effectiveness of the new system of agricultural system, difficulties arising from implementation, the analysis of the economic reasons, the improvement of efficiency of the system and so on, via in-depth study of rural society, description of rural households participation in agricultural co-operation, assessing the status of agricultural co-operation, qualitatively and quantitatively analyzing the efficiency of agricultural co-operation system and its attributions, improving the activities of farmers and basic approach of the new system, making some suggestions. This article is divided into eight chapters: the first chapter, as introduction, includes the rise of problem, the significance of the research, the research statue and its commentary, main content, basic framework, basic idea and main methods. The second chapter includes the economic theory of rural development, rural public goods theory, theory of social security, health economics theory, information theory in economics and other perspectives, explaining the new rural cooperative medical system on the basis of the theory. The main content of the third chapter include the rural cooperative medical system for the international comparison model, which carries out a completely comparative study. emphasizing on free health care model, the social model of health insurance, medical insurance business model, community health care model, the features of health care savings of several security and the country running Mechanism ,The fourth chapter gives an analysis of rural cooperative medical system development and system evolution. Chapter V is an analysis of new-type rural cooperative medical system, it gives a theoretical analysis on system design, implementation of the policy, effect of rural economic and social development environmental, system measures, running of system, summarizing the problems: the risk of moral hazard, the monopoly balance under moral hazard, medical insurance payment and the total health care costs. Chapter VI is an empirical analysis of new-type rural cooperative medical system. Taking Hunan For example, by using Logistic model, PSM (tendency to score matching) analysis method, "Satisfaction" analysis model and the new agricultural co-operation and other measures analysis of the economic analysis model, the new agricultural co-operation system, the level of rural medical and health resources use, health care cost of farmers, and other expenses were empirically analyzed. Chapter VII proposed goal configuration of Chinese rural cooperative medical system, model selection, path design and policy recommendations and so on. Chapter VIII summed up the basic conclusions of the study, a Chinese rural cooperative medical care system innovation was prospected.In this paper, the background of new agricultural co-operation policy, structure of the system, policy implementation and effectiveness of the implementation were theoretically and empirically studied, and rural medical and health security system of international comparisons with the history of our country were observed, series of important views and conclusions were drawn. The main conclusions in the pattern of international comparative study include that the developing countries government should bear primary responsibility of health care, poor and low-income health care should be paid great attention to, the government and the market commonly provide health insurance services and the related legal system should be more perfect. the main conclusions of rural cooperative medical system analysis include that the new agricultural co-operation medical system have clear complementary, the great success of new agricultural is the transformation of "the supply of co-operation" to "demand for cooperation ". At the same time, a series of new agricultural system theory and empirical study of the important conclusions were drawn. To further improve the new agricultural co-operation medical system, this article summarizes four basic experiences of new rural cooperative medical system reform and a new goal configuration for rural cooperative medical system was proposed. The path of the new innovation of system was designed, the relevant counter measures and suggestions were made.In this paper, on the basis of proceeding research results, in close connection with China’s national conditions, China’s rural cooperative medical care system was studied, in the following three areas, some research innovation have been made. First, the use of Logistic model, PSM analysis and other methods of measurement analysis was adopted, the efficiency of new system of agricultural co-operation and their effects factors were investigated. Second, carrying out a new research of agricultural co-operation system, broadening the "solution of problem" vision. this paper jumps out of the new system of agricultural bound, in full recognition of four basic experience of new agricultural co-operation, a new "4413" mode was established, and the "three expansion, two Voluntary, five co-ordinate, one statistic "path was designed, and a series of policy recommendations, for instance, "the threshold of the Senate together"," share capital into the field ", " rural health vouchers ", " social security tax of farmers "and" a further increase in rural health care co-ordinate security level "were proposed originality; Third, this paper, "the common research between university and government" method is of the innovative value. During the research, the author and the local government carry out cooperative research project, exchanging the information and experience of project research and new-type agricultural co-operation practice.更多还原