【作者】 朱晨姝；

【导师】 刘玉安；

【作者基本信息】 山东大学 ， 国际政治， 2010， 硕士

【摘要】 关于公平与效率的关系问题是理论界长期讨论的一个热门话题,而“效率优先、兼顾公平”曾经一度被确定为我国经济、社会发展的一个原则。在这个原则指导下,我国的经济发展的确取得了明显的成效,国内生产总值出现了较高的增长。但不可否认的是,在我国经济快速发展的同时也出现了收入差距明显拉大、社会冲突加剧的现象。最近,理论界对“效率优先、兼顾公平”原则提出了质疑。特别是在医疗卫生领域,这个原则更值得推敲。正是遵循了这一原则,我国的医疗卫生资源配置曾经一度走向了市场化,其结果不仅导致了公平的下降或缺失,而且还导致了某些资源的闲置和浪费,即既没有得到效率,也没有实现公平。表现在我国医疗卫生总投入略有增加的同时却出现了医疗卫生水平明显下降的现象。最近,国务院又出台了一系列政策,虽然对先前的改革有所矫正,但是我国医疗卫生资源到底该怎样配置还处在探讨与摸索之中。在这种背景下,分析、借鉴国外的不同做法对我医疗卫生事业的发展显然会有所裨益。美国和瑞典代表着两种不同的配置模式,二者在公平与效率的价值选择上存在着较大的差异,使得两国的医疗卫生资源配置情况大有不同。以公平为导向的瑞典比以效率为导向的美国在医疗卫生资源配置上取得了更大的成功。美国虽然强调效率,但其医疗卫生投入的整体效益却并不理想；瑞典公平性很高,却面临着效率低下的危机。通过对美国和瑞典经验的分析比较,本文认为中国医疗卫生资源的配置,必须结合中国的实际,在公平和效率的权衡上做出适当的调整,不应该顾此失彼,而应该实现公平与效率的有机统一。本文包括五个部分：第一章,导论部分。首先介绍本文的研究背景及意义,对国内的医疗卫生资源配置状况进行概述；对国内外学者有关医疗卫生资源配置公平与效率选择问题的研究进行分类综述并分析其特点。交待本文的丰要研究内容和研究方法,为后面的分析研究打下基础。第二章,对相关概念的界定。主要界定了医疗卫生资源以及它的特点,明确了医疗卫生资源的公共产品和准公共产品性质。厘清何为公平,何为效率以及两者之间的相互关系,指出公平与效率之间实际上具有辩证统一的关系。第三章,我国医疗卫生资源配置状况及问题分析。本章主要介绍了我国目前在医疗卫生资源配置上出现的问题,主要包括了国家的卫生总费用不高；政府的医疗卫生预算缺乏；医疗卫生资源配置不公平；医疗卫生资源利用效率低下等几个方面,说明这些问题出现是我国医疗卫生资源配置既不公平也没有效率的表现。本章还详细阐述了导致这些问题出现的主要原因,说明效率优先的价值取向对我国医疗卫生资源配置所造成的伤害。第四章,本文重点章节,介绍美国和瑞典医疗卫生资源配置的经验及给我国的启示。在前几章分析的基础上,研究了美国和瑞典两个国家在医疗卫生资源配置上的差异性以及所获得的成绩,说明以政府为责任主体、覆盖全体国民的“瑞典模式”总体上优于以市场为导向、覆盖特殊群体的“美国模式”。但两国的经验告诉我们,采用完全的公平或是以完全的效率方式来配置医疗卫生资源,都不是长远之计,必然导致医疗卫生资源配置陷入低效率或是不公平的困境。在总结美国和瑞典经验的基础上,探讨中国在医疗资源配置公平与效率价值选择上的出路。结语部分。通过对中国医疗卫生资源配置领域现存问题的分析以及对美国和瑞典两国医疗资源配置经验的借鉴,得出对当代中国医疗卫生资源的配置而言,公平与效率之间应该是“公平优先,兼顾效率”,力争实现公平与效率和谐统一的结论。更多还原

【Abstract】 The relationship between equality and efficiency has been discussed in theoretical circles for a long time as a hot topic, and "Efficiency first, also giving consideration to equality " was once identified as a principle of China’s economic and social development. Under the guidance of this principle, China has made great achievements in economic development and gained higher GDP. However, it can’t be denied that at the mean time the income gap of the people has significantly widened, and social conflict increased. Recently, the principle of "Efficiency first and also gives consideration to equality " was questioned in the theoretical circles. Such principle should be further questioned in the area of medical and healthcare in particular. China has ever made efforts to let the market decide the placement of medical and healthcare resources, only to result in decline even loss of equality, waste of some resources, with neither efficiency nor equality. It can be suggested by the phenomenon that despite of the growth of the total expenditure in such areas in recent years, the quality of China’s medical and healthcare significantly decreased.Recently, the State Council issued a series of policies to correct the previous performance. The issue of how to distribute the medical and healthcare resources still needs to be discussed and probed. Under such situation, it would be beneficial to analyze and learn the different practices of other countries. The United States and Sweden can be seen as two typical models. They have different values for equality and efficiency; accordingly they have different practice in the distribution of medical and healthcare resources. Sweden is equality oriented, and it is doing better than the United States in such areas, which is efficiency-oriented. Although the United States much emphasizes on efficiency, its expenditures in such areas didn’t yield satisfactory results. Through the analysis and comparison between the practices of both the United States and Sweden, this article contends that considering its own situation, China should make proper adjustments to the balance of equality and efficiency of the distribution of its medical and healthcare resource, thus achieving the integration of equality and efficiency, rather than an either-or choice. This article includes five parts: The first chapter, Introduction section. This article first introduces the research background and its significance; it outlines the situation of China’s distribution of medical and health care resources; it categorizes and features of the research on distribution of medical and health care resources made by scholars at home and abroad. It lays the foundation for the subsequent analysis by explaining the main research subjects and methods involved.The second chapter, the definitions of relevant concepts. It defines the concept of medical and health care resources and their features, and specifies the characteristics of public goods and quasi-public goods in such areas. It also explains the terms of equality and efficiency, and their relationship. It points out that there is a co-existing discriminative and integral relationship between equality and efficiency.Chapter three, the analysis of the situation and problems of China’s distribution of medical and health care resources. Such problems include:China’s total health expenditure is not high; the lack of government health budget; the distribution of medical and health care resources is not fair; the utilization efficiency of medical and health care resources is low. These problems show that China is not doing a good job either in equality or in efficiency with regard to the distribution of medical and health care distribution. This chapter also elaborates the main cause of these problems, indicating the value of giving priority to efficiency on medical and health care resources has made negative impact.Chapter four, the major and important chapter of this article. It describes the practices of the United States and Sweden in the distribution of medical and healthcare resources and the experience that China can learn. Based on the analysis of the previous chapters, it studies the achievements that the United States and Sweden have made in the distribution of medical and healthcare resources, as well as the discrepancy between the two countries in such practice. It states that the government-oriented, all citizens covered covering "Swedish model" is superior to the market-oriented groups covered "American model "in general. However, the experience of the two countries tells us that, neither complete equality-oriented way nor complete efficiency-oriented way shall be adopted as long-term policy, because they would inevitably lead to the predicament of low efficiency or inequality. In summing up the experience of the United States and Sweden, it tries to figure out a way China should find as how to balance between equality and efficiency in the distribution of medical and health care resources.Conclusion. Through the analysis of China’s current situation of the distribution of medical and healthcare resources, as well as the learning of the practice the United States and Sweden, the conclusion can be made that "equality first, also giving consideration to efficiency "should be the principle, and efforts should be made to achieve the harmonious integration of equality and efficiency.更多还原