【作者】 高选；

【导师】 包国宪；

【作者基本信息】 兰州大学 ， 行政管理， 2010， 博士

【摘要】 农村医疗卫生是我国农村社会事业的一个重要组成部分,它是关系我国农村人口健康和人力资源质量的重大民生问题。20世纪80年代中期以来,由于社会政策的变化和调整,导致农村地区缺乏基本医疗保障制度,许多农民自己无力承担日渐上涨的医疗费用,不能获得基本医疗服务,因病致贫、因病返贫现象严重。2003年以大病统筹为主的新型农村合作医疗制度建立,减轻了参合农民就医经济负担,农民对卫生资源的利用率不断提高。由于欠发达地区社会经济落后,随着新型农村合作医疗制度的推进,逐渐暴露出制度自身存在的缺陷和制度设计与地区差异之间的矛盾,如何评价欠发达地区新型农村合作医疗制度的绩效,为新型农村合作医疗的政策调整和可持续发展提供依据,是当前迫切需要解决的问题。通过对甘肃省实证研究,围绕欠发达地区新农合如何筹资,筹集资金使用的绩效,如何加强对新农合的监管来提升绩效,使新农合可持续发展为基本研究思路。研究得出结论是新型农村合作医疗目前在欠发达地区的实践中己超越其最初设计的目的,成为政府向农村地区提供的一种“公共产品”,解决了农民最需要的医疗卫生可得性问题。目前农村医疗费用上涨是供需双方共同推动的结果,导致新型农村合作医疗基金运行风险不断加大。运用顾客满意度模型研究新型农村合作医疗制度绩效,得出的结论是新型农村合作医疗报销的比例不合理导致政策稳定性差,而且农村各种医疗制度之间的制度兼容性较差,同时欠发达地区新型农村合作医疗过多承担了本应该由国家公共卫生事业承担的责任,有向社会医疗救助制度发展的趋势。从以上研究的结论来看,欠发达地区新型农村合作医疗基本具备了社会医疗保障性质。本文的创新点主要是运用顾客满意度模型来分析新型农村合作医疗制度绩效和对欠发达地区农村卫生资源配置公平性的实证分析,根据研究的结论提出完善农村医疗体制改革要制定不同阶段目标,中短期目标就是实现人人享有基本医疗保障,目前主要任务是完善新型农村合作医疗制度。长期目标着眼于人力资本的投资,减少贫困,由强调疾病治疗转向疾病的早期预防和诊断,为农村新型合作医疗制度逐步向城乡一体化的全民医保过渡打下基础。更多还原

【Abstract】 Rural Health is an important part of China’s rural society, it is important the health of our rural population and human capital of the issue. Since the reform and opening, social policy adjust, rural areas were lack basic medical insurance scheme, many farmers could not afford the increasingly rising medical costs, without any health services, the poverty is serious. Since 2003, the new rural cooperative medical care scheme (NCMS) was established, Participated farmers could reduce the financial burden of medical care, health resources utilization was continued to improve. But with the new rural cooperative medical scheme advanced, exposed the system and its inherent disadvantages, system design and the conflict between regional differences. how to evaluate the NCMS performance, adjust policies can be Continued development of the urgent the problem.As the basic research ideas, the papers study that financing and the effect of spending money (NCMS), improve the performance and strengthen the supervision of NCMS. The first innovation, through gansu province NCMS financing problems research, the new rural cooperative medical treatment in less developed regions is actually rural areas by the government to provide a public product, enhance the ability to resist disease risk and solve the peasant need most medical accessibility. Who’s going to pay medical treatment cost, is the medical security problems, the new rural cooperative medical treatment with the basic social and medical security properties. The new rural cooperative medical care scheme have the moral risk, adverse selection problem, rural medical expenses rise is the result of both supply and demand, the greater for the supple, the new rural cooperative medical fund risk increase. The other innovation, by public satisfaction for the new rural cooperative medical care system performance, makes a positive analysis found unreasonable expense ratio due to the policy of medical treatment, and the stability of the system compatibility between the system, the poor peasants were to solve a problem of accessibility cooperative medical care system become social medical treatment system. While the new rural cooperative medical bear much govement public health programs should be made the responsibility, another system of supervision exist the holes affecting less-developed areas NCMS scheme sustainable development.Research on the new rural cooperative medical scheme, rural medical reform should make short-term and long-term goals.short-term goal is to achieve all farms medical insurance, alleviate difficultly and expensively question. the new rural cooperative medical scheme need to perfect, emphasize the compatibility of the system. The long-term goal of human capital investment, reduceing poverty, by disease treatment to the early diagnosis and prevent diseases. We need to face the reality, the new rural cooperative medical care scheme gradually to the integration of urban and rural areas of universal coverage,.更多还原