【作者】 轩志东；

【导师】 罗五金；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2007， 博士

【摘要】 一、研究背景与研究目的目前,卫生服务物品社会生产效率不能够满足居民的健康需要;卫生服务物品社会分配的不公平极大地影响着居民健康状况的不平等。这些问题,必须得立足于国家或者地区整体社会才能够最大程度地解决。现有的卫生经济学理论,属于微观范畴,不能够担当此重任。因此,有必要开发用于解决卫生服务物品社会生产效率和社会分配公平问题的宏观理论。本课题研究的目的就是创建宏观卫生经济学学科。二、研究内容与技术路线本课题研究内容有八个方面,①宏观卫生经济学的理论支撑体系;②宏观卫生经济学的基础理论探讨;③卫生服务物品生产和分配的结构及其运行规则;④国际卫生经济制度比较研究;⑤我国改革开放以来宏观卫生经济政策的实践;⑥宏观卫生经济政策的理论研究;⑦我国未来宏观卫生经济政策的框架;⑧宏观卫生经济学发展前景展望。研究技术路线是,①学习理论文献,利用逻辑推理的方法,对研究对象进行分析,综合,演绎,归纳,借用制度经济学、宏观经济学、卫生经济学、社会学、社会医学等学科的理论,构建宏观卫生经济学理论框架。②查阅政府统计文献,按照理论研究开发的分析框架,验证有关卫生服务物品社会生产效率与社会分配公平的理论假说。③将理论规范分析与数据实证分析结合在一起,开发用于实践工作的宏观卫生经济政策框架。三、研究方法本课题的理论研究部分应用规范分析方法,实践研究部分采用实证分析方法。用逻辑的规范分析方法提出理论,用数据的实证分析方法验证理论。四、研究结果①在宏观卫生经济学的理论支撑体系研究方面,阐述了系统论、卫生事业管理学、卫生经济学、社会医学、制度经济学、人力资本理论、福利经济学、宏观经济学、社会学、公平理论,“人民健康优先”理念和人本主义经济学等学科理论在创建和发展宏观卫生经济学学科过程中可能起到的作用。同时,指出了其中的一些理论在解决卫生服务物品社会生产效率和社会分配公平问题时的不足之处,对此进行了修正发展。②在宏观卫生经济学的基础理论方面,我们提出了劳动交易价值论、社会合作竞争理论,论述了社会合作竞争理论与罗尔斯主义公正理论的联系,阐明了这些理论构建宏观卫生经济学的作用。③在宏观卫生经济学的微观基础方面,论述了卫生服务物品生产和分配的结构及其运行规则。④在国际卫生经济制度比较研究方面,我们选择美国与英国为样本,根据社会合作竞争理论规定的框架,进行了卫生经济制度比较研究。得出结论,英国卫生计划体制的效率和公平程度低,美国卫生市场体制的效率和公平程度高。以卫生计划经济制度为基础的社会合作不能够达致卫生效率和公平;以卫生市场经济制度为基础的社会合作能够达致卫生效率和公平。⑤在我国改革开放以来宏观卫生经济政策实践研究方面,调查发现,今天中国的卫生经济制度是卫生计划经济制度,还不是卫生市场经济制度,虽然整个卫生系统置身于正在逐渐成熟的市场经济制度之中;数据证明,我国宏观卫生经济政策的社会效率低下,社会公平程度低下。经过理论规范分析,我们认为,在提高居民健康水平、改善居民健康公平性的道路上,应该选择卫生市场经济制度,而不应该实行卫生计划经济制度。⑥在宏观卫生经济政策的理论研究方面,我们做了理论分析,卫生财政政策资助经济主体的顺序应该是公共卫生服务物品生产和分配机构,医疗保障机构,患者,医生,医疗机构。应该向国有医疗机构和其他非营利医疗机构征收税收;应该实行差别税率,以调节医疗服务物品结构和区域卫生事业发展速度,促进社区卫生服务工作发展。我国现阶段应该制定有效的宏观卫生经济政策,促进卫生总费用增长,合理调整卫生总费用的结构,增进社会健康资本数量和质量,以此促进国内生产总值的增长。⑦根据以上理论规范研究和数据实证研究结果,在社会合作竞争理论规定的范围内,我们设计了我国未来宏观卫生经济政策的框架。⑧宏观卫生经济学发展前景展望。在前面研究的基础上,我们提出了宏观卫生经济学的研究领域和研究方向。五、研究创新1.劳动交易价值论;2.社会合作竞争理论;3.社会公平决定社会效率、公平与效率统一于公正的理论论断;4.衡量社会平等程度的平等系数X系数;5.修正的帕累托原理,帕累托最优状态也是最公平状态的结论;6.卫生事业性质公域性理论。六、研究不足之处:1.规范研究结论还需要实践验证。2.实证研究范围还需要扩大。更多还原

【Abstract】 ⅠResearch background and objectiveNow, the social production efficiency of the health service goods does not catch up people’s health need; the social distribution unfairness of the health service goods influence people health inequality extremely. These problems will be resolved at biggest degree, only if they are based on the whole society of the nation or the region. The existing health economics theories which belong to microscopic category can’t take this heavy responsibility enough. Therefore, it is necessary to develop macroscopic theories that resolve the problems of social production efficiency and social distribution fairness of the health service product. The objective of the research is to establish the macro-health-economics subject.ⅡResearch content and technic routeThe research covers eight parts: first, the theory system supporting macro-health-economics system; second, the foundation theories of the macro-health-economics; third, the microscopic foundation of the macro-health-economics; fourth, the international health economic system comparison research; fifth, the study of our country macroscopic health economic policy practice since reform and open; sixth, the theory research of the macroscopic health economic policy; seventh, the future macroscopic health economic policy framework of our country; eighth, the macro-health-economics development prospect.The research technic route is: first, study theoretic literatures, make use of logic inferential methods to analyze, to synthesize, to deduce and to induce the research objects. By the theory of institutional economics, macroeconomics, health economics, sociology, social medicine, etc., build the theory framework of macro-health-economics. Second, according to the analysis framework developed by the research, consult governmental statistic data; prove the theoretic hypothesis of health service goods social production efficiency and social distribution fairness. Third, combine the theoretic normative analysis with the data-based positive analysis to develop the future macroscopic health economic policy framework.ⅢResearch methodsIn the theoretic analysis parts of the research, we make use of normative analysis methods; while in the practice investigation parts, adopt the positive analysis methods. By the logical normative analysis methods, bring forward the theory. By the data-based positive analysis methods, prove the theory.ⅣResultsThe first, in the theory system supporting the macro-health-economics, we expound the function of some studies and theories to propping up the macro-health-economics in the process of creating and developing the macro-health-economics. These studies and theories are the system theory, the health service management, the health economics, the social medicine, the institutional economics, the manpower capital theory, the welfare economics, the macroeconomics, sociology, the fairness theory, the "the people health is superior to others”ideal, and the human-centered economics etc. In the meantime, when these studies and theories resolve the problems of social production efficiency and social distribution fairness of the health service product, we pointed out some errors of them and revised the errors or developed the theories.The second, in the foundation theory aspect of macro-health-economics, we put forward a labor transaction axiology, a social cooperation-competition theory, discussed the relationship of a social cooperation-competition theory with the John Rawls’s fairness theory and clarified the function of these theories to set up the macro-health-economics.The third, the microscopic foundation of the macro-health-economics is the structure of health service goods production and distribution, and its operation rules.The fourth, for the international health economic system comparison research, according to the framework ruled by social cooperation-competition theory, we chose the United States and Britain as samples to make a comparison research on the health economic system. The conclusion is that: the efficiency and fairness degree of the British health plan system are lower, while the efficiency and fairness degree of the American health market system are higher. it is improbable that the social cooperation which is based on health planned economy system attains to health efficiency and fairness; it is probable that the social cooperation which is based on health market economy system attains to health efficiency and fairness.The fifth, in the study of our country macroscopic health economic policy practice since reform and open, the investigation result is, that the health economy system of China is the health planned economy system; and it is not yet a health market economy system, although the whole health system is marinated in the gradually ripe market economy system. The data has proved that the social efficiency and fairness of our country’s macroscopic health economic policy is lower. Combining with theoretic normative analysis, we deem that, on the road to elevate people health level and to improve people health fairness, should select the health market economy system, but should not put into practice health planned economy system.The sixth, in the theory research of the macroscopic health economic policy, our conclusions are that: the sequence of the economic subjects who is subsidized by health fiscal policy should be the public health service goods production and distribution organization, the hospitalization insurance organization, the patient, the doctor and the medical organization; the tax should be collected from the national medical organization and other not-for-profit medical organization, and the differential tax rates should be implemented, to adjust medical service goods structure and region health service developing speed, to improve the community health service development. Currently, our country should institute valid macroscopic health economic policy, promote health expenditure growth, reasonably adjust health expenditure structure, improve the quantity and quality of social health capital, so as to promote the growth of gross domestic product.The seventh, according to the above theoretic normative research and data-dependent positive research results, in the area ruled by the social cooperation-competition theory, we have designed our country’s future macroscopic health economic policy framework.The eighth, we forecast the macro-health-economics development prospect. On the foundation of the above research, the research realm and the research direction of the macro-health-economics have been put forward.ⅤResearch creationsIn the research, the main creations are the labor transaction axiology; the social cooperation-competition theory; the theory judgement that the social fairness determine the social efficiency and that the social fairness and the social efficiency were unified to the social justice; the equality coefficient (X coefficient) which measured the social fairness degree; the corrected Pareto principle, and the theory conclusion that Pareto-optimal state is the most fairness state; and the public domain theory of the health industry nature, etc.ⅥResearch deficienciesCertainly, our research report has also two deficiencies.First, the conclusion of normative analysis needs the confirmation of practice. Second, the area of positive analysis should be expanded.更多还原