【作者】 张宝同；

【导师】 黄春蕾；

【作者基本信息】 山东大学 ， 行政管理， 2010， 硕士

【摘要】 随着社会的进步和人民生活水平的提高,健康问题已经成为全世界关注的焦点。在国内,从2006年至2010年,出现次数最高、最闪亮的字眼莫过于“新医改”。在新出台的医改方案中,健康教育已被纳入国家基本公共卫生服务体系,凸显了健康教育的基础性和公共性,同时也为文章选择从公共物品研究健康教育提供了实践依据。另外,考虑到我国农村社会,农村居民健康状况不容乐观,农民自我保健意识缺乏、不健康的生活行为方式甚至“大病拖、小病扛”的现象还依然存在。而健康教育活动的开展恰恰可以增强农民保健意识,降低疾病发生率,减少因病致贫和返贫,减轻家庭经济负担,提高农村居民的生活水平和发展能力。因此文章将农村健康教育作为研究对象,力争从“上游”解决农村居民的健康问题。首先,文章对健康教育的内涵进行重新界定：健康教育是一项有计划、有组织、有系统的社会和教育活动,主要包含一般性的健康知识宣传和预防性的卫生服务。然后文章从三个层面对农村健康教育的供给进行理论梳理和探析：健康教育的物品属性分析、健康教育的供给方式分析、不同供给方式的内部运行机制分析(包括决策、筹资、使用、激励约束),旨在从规范理论上提供农村健康教育供给方式的多重选择。其次,文章从现实层面对农村健康教育供给的历史发展和供给现状进行描述。前者主要在于总结农村健康教育供给的演变规律：坚持政府主导,关注社会参与,注重合作供给等；后者通过现状描述揭示了当前农村健康教育供给存在的问题：供给主体单一,社会力量参与不足；投入不足,筹资渠道单一；供给规模较小；供给渠道不规范；供给效能较低。文章紧接着从现行农村健康教育供给方式的内部运行机制进行剖析,结果表明：自上而下的决策机制忽视农民的健康教育需求；内在局限的筹资机制掣肘地方政府的健康教育投入；不健全的使用机制束缚农村健康教育的供给效率；激励约束机制的缺乏制约农村健康教育供给的能力。最后,立足供给现状和供给理论、结合发展规律、引入合作治理思想的新元素,文章提出构建农村健康教育优化供给的基本架构与运行机制。在基本架构方面,通过整合不同参与主体的优势,力求达到农村健康教育有效供给的合作网络体系。在运行机制方面,通过建构主体准入机制、决策(利益整合)机制、投融资机制、成本补偿机制、监管激励机制等,以此调适和归置不同参与主体之间的相互关系,力求实现并达到彼此之间良性的互动合作和有机啮合。更多还原

【Abstract】 Along with the social progress and the improvement of people’s living standards, health issues have become a focus of the world. In China, from 2006 to 2010, the word which is mentioned most frequent and glittering must be the "New Rural Coopetative Medical System." To this end, the paper selects the Rural Health Education as a response to health concerns. In the New Rural Coopetative Medical System Schema, Health Education has been incorporated into the state’s primary public health service system, which highlights the basic and public nature of the Health Education. Simultaneously, this also provides a practical basis for the study of Health Education in the perspective of public goods. Furthermore, in our rural society, we still can not be optimistic about the health status of rural residents, lots of peasnts still lack the awareness of self-health, various of unhealthy living behavior and so on. The implementation of the Health Education Activities can exactly enhance the peasants’consciousness of health, decrease the incidence, reduce the financial burden and improve the living standards and developmental capacity of the rural population.First of all, the paper re-defines the implication of Health Education. Health Education is a series of planned, organized, systematic social and educational activities, which mainly contain the promotion of the general health knowledge and the preventive health services. Then the article analyses the supply of Rural Health Education from three levels:goods attribution analysis of Health Education, mode analysis of Health Education provision and internal operating mechanism analysis which includes decision-making, financing, application, incentive and constraint mechanism, so as to provide multiple choices for the mode of Health Education provision from the perspective of normative theory.Secondly, the paper describes the historical development and the supply status of Rural Health Education on the realistic level. The former mainly summarizes the evolution of the supply of Rural Health Education, which includes adhering to government-led, highlighting social participation, focusing on cooperation in the supply and so on. The latter reveals the problem of Health Education in rural areas by describing the current status, which includes the single of the supply entity, the inadequate participation of social forces, the inadequate investment, the single of financing channels, the small scale of provision, the nonstandard of supply channel, the low efficiency of supply and so on. Then the article analyzes the internal operating mechanism of the implementing supply of Rural Health Education, the results show that the top-down decision-making mechanism neglects the need of peasants, the inherent limitations of the financing mechanism constraint the investment on Health Education, the imperfect mechanism of the application impacts the efficiency of the provision and the lack of incentive and constraint mechanism restricts the capacity of the supply of Rural Health Education.Finally, based on the supply situation and supply theory, combined with the law of development and by introducing new element of co-governance thinking, the paper proposes to build the basic structure and operation mechanism of the optimizing supply of Rural Health Education. In the basic structure, the paper tries to achieve the co-operation network of the effective supply of Rural Health Education by integrating the advantages of different participating entities. In the operating mechanism, by the construction of the access mechanism, decision-making (interest integration) mechanism, investment and financing mechanism, cost compensation mechanism and supervision & incentive mechanism, the paper tries to sort out and adjust the relationship of different participants, and also thrives to achieve the positive interaction and co-operation.更多还原