【作者】 陈鹏军；

【导师】 林宝清；

【作者基本信息】 厦门大学 ， 保险学， 2009， 博士

【摘要】 “病有所医”是人类社会文明进步的重要标志，也是构建和谐社会重要的基础性工程，党的十七大报告明确将“人人享有基本卫生服务”作为全面建设小康社会的重要目标之一。建国以来，随着社会、经济形态的变化，我国社会医疗保障制度经历了曲折的发展过程，其中有过成绩，但更多的是问题。2005年，国务院发展研究中心一份题为《对中国医疗卫生体制改革的评价与建议》的研究报告指出中国二十年的医改基本不成功，医改再次成为政府、公众关心的焦点问题。2008年10月，万众瞩目的新医改方案终于浮出水面，进入为期一个月的征求意见阶段。方案在深化医药卫生体制改革总体目标中明确提出，到2020年基本建立覆盖城乡居民的基本医疗卫生制度。2009年1月，在分析和吸收社会各界广泛意见之后，国务院常务会议审议并原则通过了新医改方案，并进一步提出到2011年实现基本医疗保障制度覆盖城乡居民的目标。本文以保险学、经济学和风险管理学为理论依托，具体运用制度分析法、历史分析法等方法对全民医疗保险制度构建的思想渊源、政治基础和经济可行性进行系统剖析，旨在构建适合我国当前形势及未来发展趋势的全民医疗保险制度模式，以期为我国医疗保障政策制定和制度建设提供理论参考。全文分成两篇七章，上篇为理论基础部分，内容涵盖前四章，下篇为模式设计部分，内容涵盖后三章。第一章从疾病风险内涵入手，探讨疾病风险的应对方式，以及在疾病风险不断深化形势下，医疗领域市场失灵和政府责任；第二章主要任务在于界定全文的研究对象“全民医疗保险和全民医疗保险制度”的内涵；第三章从资本主义、社会主义和社会意识形态三个方面来探讨全民医疗保险的思想渊源—社会福利思想；第四章探讨全民医疗保险制度构建的政治基础，首先分析英、德早期公共福利型和社会保险型医疗保障制度起源的政治背景，进而分析利益集团和政治体制的影响；第五章回顾了我国自建国以来社会医疗保障制度的历史变迁，并深刻剖析了决定各项制度兴衰的基础因素；第六章以制度变迁成本理论为依托，采用定性和定量相结合的方法分析了我国全民医疗保险制度构建的经济可行性；第七章针对我国全民医疗保险制度构建，提出了“三元一体”的近期发展模式，从资金流角度构建全民医疗保险基金的收入和支出模型，并且分析了道德风险的表现、产生及防范，最后对中远期目标“省级统筹”和“全国统筹”的过渡思路进行了简单探讨。本文的主要创新在于：(1)关于全民医疗保险制度构建，提出“三元一体”近期发展模式，即城镇职工基本医疗保险、城镇居民基本医疗保险和农村居民基本医疗保险三个制度并存，构成一个社会基本医疗保险制度体系，并且分别实现对城镇职工、城镇居民和农村居民的完全覆盖。(2)在“三元一体”框架下，进一步提出中远期渐进发展目标，并简要探讨了从“三元一体”模式过渡到中期目标“省级统筹”，乃至实现最终目标“全国统筹”的基本思路；(3)运用历史分析法，提炼全民医疗保险制度的政治基础：保证社会生产顺利进行、维护社会稳定、世界人权意识增强等等；(4)在筹资模式上，对城镇居民基本医疗保险和农村居民基本医疗保险设计了相对指标的缴费模式，使之能够逐步与城镇职工基本医疗保险接轨。更多还原

【Abstract】 The social status that all patients have economic strength and places to see a doctor is one of the important symbols of civilization and harmoniousness in human society. But in our country, as the changed of the situation of society and economy, the social medical security system had a devious developing process. In this process, there had ever been many achievements, but more problems. In 2005, Development Research Center of the State Council published a research report titled of "Estimate and Advice to the Reform of Medical Care System in China", and pointed out that the reform of medical care system in China was basically unsuccessful. This once again made the reform of medical care system be the focus of the government and public’s attentions.In August 2008, the new reform scheme of medical care system was promulgated, and came into the one month’s collecting opinions phase. The new scheme definitely pointed out that the basic medical care system covering city and countryside would be established in 2020 on the whole. In January 2009, after analyzing and absorbing the public opinions, the State Council deliberated and passed the new reform scheme of medical care system, and further stated the goal of actualizing the basic medical care system covering city and countryside in 2011.Supported by the insurance, economics and risk management theory, and applying the analysis method of the institutionalism, historical analysis, normative analysis and empirical analysis, this dissertation gives a penetrating analysis on the ideological origin, the political basis, and the economic feasibility of the universal medical insurance system, in order to establish a sustainable universal medical insurance pattern, and contribute on providing theory reference for medical insurance policy making in our country.There are two sections and seven chapters exclusive introduction in this dissertation. The first section including four chapters concentrates on the theory basis; and the second section including three chapters concentrates on the pattern design.Chapter one begins with the meaning of the disease risk, analyses the risk situation and treatment methods, then discusses the medical care market failure and government responsibility. Chapter two mainly explains the meaning of the universal medical insurance and the universal medical insurance system. Chapter three discusses the ideological origin of the universal medical insurance from the capitalistic and socialistic aspect. Chapter four discusses the political basis of the universal medical insurance. Chapter five reviews the development history of the social medical security system in our country, and analyses the reasons for the success and failure of the systems. Chapter six applies both the normative and empirical methods to analyze the feasibility of the universal medical insurance system. Chapter seven designs the feasible pattern of the universal medical insurance system, and proposes the concrete measures to achieve the goal.This dissertation tries to innovate as follows: (1) Concerning the universal medical insurance system pattern, It brings forward a new pattern called "three components in one system". (2) Based on the pattern in the near future, It discusses the provincial and countrywide unification pattern. (3) It applies the historical analysis to sum up the ideological origin and the political basis of the universal medical insurance. (4) It designs the relative index pay system instead of the absolute index for the basis medical insurance in both town and village.更多还原