集体化时期农村医疗卫生制度研究

【作者】 王胜；

【导师】 梁景和；

【作者基本信息】 首都师范大学 ， 专门史， 2009， 博士

【摘要】 集体化时期的农村医疗卫生制度,旨在满足社员的基本医疗卫生服务需求。这一制度体系以基层党支部为领导,以集体经济为依托,以社、队医疗组织为机构,以赤脚医生为主体,以防病治病为主要任务,以贫下中农协会为监督,具有鲜明的社会主义集体性质。集体化前期,即从1956年到1965年,农村医疗卫生制度经历了三个阶段。其一,农业合作化时期,集体性质的联合诊所、农业社保健站、个体行医并存:其二,大跃进和人民公社化运动时期,只有公社医疗机构及其派出机构;其三,调整时期,公社医疗机构下放,大队保健站与个体行医并存。与此相应,这十年间的农村医务人员的行医方式,由分散和较为随意的个人行为逐步转为集体医疗机构的制度化公共行为,便于组织、管理,有助于卫生防疫工作的普遍发展。然而,“大跃进”后,所有制形式不断变化,跃进、集中,调整、下放、精简,给农村医疗卫生事业发展造成了一定的混乱。基层卫生组织的频繁变动使卫生工作者协会名存实亡,农村医务人员的业务培训和提高工作陷于停顿,整体技术依然处于较低水平,少数名老中医后继无人。当时半数以上的大队仍然无医无药,农村卫生事业还远远不能适应农村新的形势和广大农民对医药的需求。1965年,毛泽东发出了“把医疗卫生工作的重点放到农村去”的指示。同年秋,大批城市医务人员组成农村卫生工作队,深入农村为当地培训半农半医,有效改善了农村缺医少药的困境。随后,大队卫生室普遍建立,农村三级保健网初步成型。1968年底,合作医疗制度因成效显著得到了毛泽东的肯定。在最高领导人的支持下,“文革”时期的合作医疗制度以“卫生革命”的形式得以推广普及。其举办形式先期以大队办为主,后期发展为社队联办和社办。合作医疗的资金大多为生产大队、生产队和个人三级筹款,并通过大量使用土医、土药、土方,自采、自种、自制、自用中草药解决资会和药品不足问题。合作医疗制度的普遍推行,基本满足了农民的治疗与保健需求。以县级医疗卫生机构为中心、与公社卫生院和大队卫生所组合而成的三级医疗卫生网,承担和参与农村基层各方面的卫生工作:动员群众开展爱国卫生运动,负责环境卫生和饮水卫生的技术指导,进行计划免疫、传染病管理,预防和治疗当地常见病、寄生虫病、地方病,宣传卫生科学知识,落实计划生育措施,指导妇幼保健,开展采种制用中成药等。同时,农村基层卫生工作也得到各有关部门的密切协作,具有鲜明的群众性和社会性。农村卫生事业作为农民“自己的事业”,直接关系到农民生老病死等切身利益。集体化时期,“政府的决心与群众的智慧和积极性紧密结合”,创造出适合我国国情和经济发展水平的成功模式:一切从广大人民利益和中国实际情况出发;自力更生,勤俭办事业;先从普及做起,在普及的基础上逐步提高,又在提高的指导下进一步普及。1982年,我国人口死亡率已从解放前的25‰下降到6.2‰,婴儿死亡率从解放前200‰左右,下降到城市12‰,农村20-30‰。平均寿命已从解放前的35岁延长到68岁左右。中国“在落后国家的经济水平上达到了先进国家的卫生水平”,取得“低收入发展中国家举世无双的成就”,并成为“发展中国家解决卫生经费的惟一范例”。1980年代初,农村经济体制改革对合作医疗制度与赤脚医生队伍造成的冲击使农村医疗卫生制度改革势在必行。但在合作医疗与赤脚医生问题上,新出台的政策和现实情况严重脱节,无法落实。为适应农村医疗卫生事业的实际状况,各项政策频繁调整。最后,在市场化改革的大潮中,医疗卫生事业被卷入了市场洪流,市场占据了医疗卫生资源配置的主导地位。医疗卫生机构由福利性质转为以盈利为主,最终导致医疗问题成为“三农”难中之难、重中之重。集体化时期,农村的医疗卫生制度为我们积累了成功的经验,即决策者以民意为重,倾听民声,维护民权,制定符合民众需求的制度,让民众切实感受到来自党和政府的关怀,这样中国共产党才真正代表了最广大人民群众的根本利益,才能有助于党和政府形象的提升以及国家凝聚力的增强。同时,还必须加强干部队伍的思想教育和监督约束机制,避免制度扭曲变形或“上有政策、下有对策”的现象发生,使人民利益真正得到保障。这样,以人为本的科学发展观中的“人”也才能在理论和实践中两个层面都以广大民众为重,才能真正促进社会和谐。更多还原

【Abstract】 During the Collectivism Period,the medical care and public health system in rural areas aims to meet the basic medical and health care service needs of commune members.The system is led by Party branch at the grassroots level,supported by collective economy,with commune medical team and production brigade team as organizational units,equipped with unlicensed doctors,with prevention and treatment of diseases as principle task,supervised by Association of Poor and Lower-middle peasants.It is characteristic of distinctive socialist collectivism.During the Collectivism Period,that is,from 1956 to 1965,the medical care and public health system went through three stages:firstly,agricultural cooperation period,when there coexisted collectivist policlinics,agricultural health care centers and private medical practitioners;secondly,the period of the Great Leap Forward and the movement to establish people’s communes,when there is only medical institution of people’s commune;thirdly,the Adjustment Period,when the medical institution was delegated to lower levels,production brigade medical care centers coexisted with private medical practitioners.In accordance with the three stages, during this period of ten years,the medical service of rural medical staff transferred from decentralized and random private behavior to institutionalized public behavior of collectivist medical institution.The transfer facilitates supervision and management of medical work and therefore help promote the widespread development of health and anti-epidemic work.However,after the Great Leap Forward,forms of ownership kept changing:great leap forward,centralization, adjustment,delegation to lower levels,streamlining,all of which left health care career in rural areas in chaos to a certain degree.Frequent changes of medical organizations at grassroots level rendered the Association of Medical Staff titular. The professional training and improvement of rural medical staff was at a standstill, the overall technical level was still comparatively low,some old prestigious doctors of Chinese traditional medicine had no worthy successors to carry the torch. Moreover,more than half of the production brigades had neither doctors nor medication,which failed to suit the new situation in rural areas and the medical needs of peasants. In 1956,Mao Zedong gave orders "the focus of medical work should be on rural areas".In autumn of the year,a large number of urban medical staff formed rural medical care work-team,went deep into the countryside and helped train semi-peasant-semi-doctors,effectively better the predicament of lack of doctors and medication in rural areas.Following it,production brigade clinics were broadly established,thus the initial formation of three-tier medical care network in rural areas.At the end of 1968,the cooperative medical system was fully affirmed by Mao Zedong.Supported by the top leader,the form of cooperative medical system during the "Culture Revolution" period was widespread,relying on production brigade in its organization form at first,then evolving into joint organization of people’s commune and production brigade,or organized by people’s commune.Its capital roughly comprised of fund-raising of production brigade,production team and individual farmers,and solve the problem of lack of capital and medication by employing folk doctors,making use of folk medication,plucking,planting,making and using Chinese traditional medicine.The common practice of cooperative medical system moderately satisfied the medical care needs of peasants.The rural medical care system had achieved a lot in aspects of development of team of unlicensed doctors,medical aid,preventive inoculation,instruction of patriotic public health campaign,maternity and child health care and family planning.Not only the health of peasants was institutionally guaranteed but also the wide recognition was gained from the international world.The achievement was attributed primarily to great importance top leaders attached to it,national policy tendency,self-support character of collective economy and the mechanism of "politicization" advocated by "Culture Revolution" Movement.Although some problems arose in the implementation of cooperative medical system such as malpractice and jobbery of cadres at the grassroots level and unlicensed doctors, the defects can’t obscure the virtues:from the standpoint of life expectancy and infant mortality rate,the former has risen from 35 in 1949 to 68 in 1982 and the latter has dropped from 200%to20-30%,which speaks for itself that rural medical system during the collectivist period has gained remarkable achievements.In early 1980s,the rural economic system reform made the reform of rural medical system necessary by impacting on cooperative medical system and team of unlicensed doctors.But as to the issue of cooperative medical system and unlicensed doctors,the newly-issued policies were seriously out of joint with reality and couldn’t be implemented.To adapt to the reality of rural medical care career,all kinds of policies had to be adjusted.As a result,influenced by tide of market-oriented reform,medical care career was involved in it.Ever since,market dominated medical care resource allocation instead of the government.The rural medical care system in collectivist period and its transformation indicates that policy makers have to attach importance to public opinions,listen to the public,protect their rights,formulate systems suiting public needs and let the public truly feel the care of government and social welfare system.In this way,can the positive image of ruling party and government be enhanced,the cohesiveness of the nation and the people be strengthened.From the perspective of scientific development and humanistic care,the people-oriented system reform option can truly guarantee health of peasants and enhance social harmony on levels of practice.更多还原