【作者】 邵菁；

【导师】 姚兆余；

【作者基本信息】 南京农业大学 ， 社会保障， 2011， 硕士

【摘要】 在农村三级医疗卫生保健网络中,处于最底层的村级卫生医疗机构对于农村公共卫生服务的供给和满足农民基本医疗保障以及新型合作医疗的成功实施起着至关重要的作用。20世纪80年代,随着农村经济体制改革和国家财政体制改革,得不到财政支持的村卫生室逐渐转为私人性质,公共卫生服务功能几乎消失殆尽,村民的基本医疗卫生服务也得不到保障,引发了“看病贵、看病难”这一突出的社会问题。虽然各级政府对此相当重视,采取了很多政策和措施,试图重新构建农村医疗卫生服务体系,但是在实际尝试过程中仍然出现了一系列的问题,特别是欠发达地区。因此,如何对欠发达地区的农村社区卫生服务站进行改造建设,使之重新并入正式的医疗卫生管理体制中,履行提供高质量公共卫生服务的职责和功能成为政府部门和理论界共同关注的重要问题。本文以淮安市农村地区为例,通过对农村社区卫生服务站进行实地调查和深入访谈,分析当前农村社区卫生服务站运行过程中存在的问题,讨论其功能和角色定位问题,结合国内外先进经验,提出了欠发达地区农村社区卫生服务站的发展模式。本文首先从农村医疗卫生服务的公共产品性质出发,为政府提供医疗卫生服务、加大对农村社区卫生服务站的财政支持提供了理论依据。其次,通过对淮安市楚州区7所农村社区卫生服务站运行状况进行分析,指出其运行过程中存在公共卫生功能严重缺失.“六位一体”服务内容不到位；医疗服务水平低下；双向转诊制度“名存实亡”；缺乏与新型农村合作医疗制度的有效衔接等问题,并进行原因分析。最后.借鉴国内外先进经验,提出政府应对私人性质的农村社区卫生服务站进行产权购买,使之重新纳入到正式的医疗卫生行政服务体系当中。为此.本研究从筹资机制、管理体制、竞争机制、考核监督机制、与新农合制度衔接等方面进行尝试性设计,提出了适合欠发达地区的政府购买产权基础上农村社区卫生服务站的发展模式。更多还原

【Abstract】 In the network of rural level 3 medical health care, the village-level health and medical institutions, which is at the bottom of this network, plays an important role in supplying and satisfying the countryside public health service. In the 1980s, with the reformation of rural economic system and national finance system, village medical station was becoming private properties with hardly public health service for the lack of financial support, and villagers’basic medical and health service also is not guaranteed, which leads to prominent social problems like "Poor access and high fee of medical service". Although governments would be quite seriously on this and have taken a lot of policies and measures to try to reconstruct the rural medical and health service system, there are still a series of problems, especially in undeveloped areas. Therefore, how to reform the rural community health service stations in less-developed regions to make it reintegrated into formal medical health management system and provides the high quality of public health service is becoming the government and theorists’ big concerns. This article takes Huaian rural areas for example, to analysis current problems in the operation process of rural community health stations by the on site investigation and in-depth interviews. With the domestic and foreign advanced experience, it brings out the model of development of rural community health service stations in underdeveloped region.This paper starts from the status and nature of the rural health service, providing theory basis for financial support of the medical and health services and rural community health station. Then, by analysing the status of 7 rural community health stations in Chuzhou.Huaian, it pointed out these stations are serious lacking in public health function; "Six in One" service is not working completely; medical service level is low; Two-way referral system is in tatters; Hard to connect with the new rural cooperative medical care. Last, learned from domestic and foreign advanced experience to put forward the government should buy the property right of the private rural community health stations. to make into the formal again among health administrative service system. This study, from financing mechanism, management system, the competition mechanism, check supervision mechanism, and new farming system aspects of cohesion tentative design is going to find out a suitable model of development for underdeveloped region government property.更多还原