【作者】 韩衍顺；

【导师】 边慧敏；

【作者基本信息】 西南财经大学 ， 行政管理， 2010， 硕士

【摘要】 2009年4月6日,新华社受权发布了《中共中央国务院关于深化医药卫生体制改革的意见》(以下简称《意见》)。《意见》提出了“有效减轻居民就医费用负担,切实缓解‘看病难、看病贵’的近期目标,以及‘建立健全覆盖城乡居民的基本医疗卫生制度,为群众提供安全、有效、方便、价廉的医疗卫生服务’的长远目标”。从另一个角度而言,这正对我国城乡居民一直以来面临的“看病贵、看病难”难题的回应,对于缺医少药、缺少社会保障的广大农村地区而言,更是意义重大。本文基于城乡统筹背景,运用公共产品理论、市场失灵理论、公共服务理论以及统筹城乡发展理论,利用相关数据指标对我国城乡医疗卫生资源供给不均的现状进行了描述,深刻分析其原因以及带来的影响。最后在借鉴国内外统筹城乡医疗卫生资源均等化先进经验的基础上,提出了统筹城乡医疗卫生资源供给均等化的原则以及若干促进城乡医疗卫生资源供给均等化的对策和建议。通过认真分析和研究,本文认为造成我国城乡居民“看病贵、看病难”的主要原因在于,城乡医疗卫生资源分配结构不合理,利用效率不高；公共医疗卫生财政投入较低；社会保障制度不健全；城乡二元分割的医疗卫生资源供给制度以及政府职能的缺位、错位等。在借鉴国内外统筹城乡医疗卫生资源供给均等化典型案例先进经验后,我们发现无论是市场化的医改抑或政府主导的医疗卫生保障制度都有其可借鉴之处,医疗卫生资源供给模式不是医疗卫生资源均等化程度及其效率的决定性因素,其关键是看此模式是否能够适合国情、因地制宜。为加快统筹城乡医疗卫生资源供给均等化进程,本文分别从调整医疗卫生资源分配结构,统筹城乡医疗卫生财政投入,建立城乡互助社会保障机制,加强卫生防疫以及强化政府职能和责任等五个方面提出促进城乡医疗卫生资源供给均等化的对策和建议。此部分作为对策和建议是理论上的应然,由于医改的复杂性,在实际操作过程中可能会受到种种条件的限制而使得执行显得苍白无力。即便如此,本文仍期望能够起到抛砖引玉的作用,期待更多有操作性的对策和建议促进城乡医疗卫生资源供给均等化目标的逐步实现。本文的创新之处主要有两点。1.研究角度的创新。本文主要从统筹城乡医疗卫生资源供给均等化问题的角度出发,结合统筹城乡一体化背景,探讨实现城乡医疗卫生资源供给均等化以及提高既有医疗卫生资源使用效率的对策和建议。前人关于医疗卫生资源供给问题的研究主要集中在城乡内部不均,使用效率不高等方面,比如城市内部、城镇内部、乡村内部等,而且主要研究的是获得医疗卫生资源的公平性和各自的效率等,而对于均等化问题以及城乡医疗卫生资源交叉配置的研究相对较少。本文从医疗卫生资源整体出发,以统筹城乡医疗资源供给均等化和提高城乡医疗卫生资源供给效率为研究视角,具有一定的创新意义。2.研究内容的创新。研究内容的创新集中在供给“均等化”定义和医疗卫生资源供给均等化原则的探讨,以及利用大量数据对城乡医疗卫生资源供给不均的现状进行比较,在深刻剖析其原因之后,提出若干具有创新性的建议,比如实施“一村一名医科大学生”项目,建立城乡互助医疗保障机制和建立农村贫困居民健康档案制度以及贫困居民重大疾病全额报销制度等。另外,对如何促进现有城乡医疗卫生资源的供给效率,尽而使医疗卫生资源在城乡之间实现供给均等化,促进城乡协调可持续发展,也进行了探讨。更多还原

【Abstract】 This paper based on the backgrounds of integrating urban and rural areas, used the public goods theory, the theory of market failure, public services, urban and the theory of integrating urban and rural areas, used the data and indicators described the situation of medical and health resources supply unequal, and deeply analysis the reasons and the influence. Finally, on the basis of drawing on domestic and international advanced experience of co-ordination of urban and rural medical and health resources for equalization, proposed the principle of promoting the urban and rural medical and health resources supply equalization and a number of suggestions to promote the supply of equalization.Through analysis and research carefully, the cause of China’s urban and rural residents "medical treatment is expensive and difficult", the main reason as follows, Urban and rural medicals and health resources allocation structure are irrational, efficiency is low; the financial of Public health input was not enough; Public social security system is not cover all the residents; Residents of urban-rural division of medical and health resource supply system and the absence and dislocation of government functions, etc. Learned about home and abroad typical cases in the supply of urban and rural medical and health resources in the equalization, we found that both market-oriented and government-led medical reform health insurance system had its merits, and we found that the medical model of reform is not the decisive factor in effective, the key is choice the appropriate, according the local conditions was the best one.In order to promote the process of supplying equalized medical and health resources between urban and rural, this paper put forward five countermeasures and suggestions. In this section, as it ought to be theoretical, due to the complexity of medical reform, in the actual operation will be subject to various conditions, not all the suggestion would be helpful. However, we still expected the suggestion to play an active role in attracting valuable opinions and looking forward to more operational measures and recommendations to promote the supply of urban and rural medical and health resources for the progressive realization of the goal of equalization.There are two main innovations of this paper. Firstly, the innovation of the view of research point. This paper demonstrated the urban and rural medical and health resources equalization combined with the integration of urban and rural backgrounds, to explore the supply of urban and rural medical and health resources as well as put forward countermeasures and suggestions to promote the equalization of the existing medical and health resources and improves the efficiency.The previous research concentrate on the allocation of medical and health resources on the study of inequality within urban or rural areas, such as inside cities, inside towns and the rural house, etc. And the main studies are how to obtain medical and health resources fearlessly and efficiency, but for equalization of urban and rural medical and health resources allocation in a relatively is not very large. This article’s research perspective is based on the equalization of supplying medical resources and the efficiency of urban and rural medical and health resources, which has a certain degree of innovation.The contents of paper have innovation. The Contents of the study focused on the definition of "equalization" and the principles of supply medical and health resources, and used a large number of continuous data to compare the status of the supply imbalance between urban and rural. In deeply analysis the causes, and proposed several operability proposals, such as the implementation of "one village, a Medical student" project; established mutual medical protection mechanism between urban and rural areas and establishment of for the health of residents of rural poverty in the file system as well as major diseases of poor residents in full reimbursement system, have a certain degree of innovation. What is more, how to promote the efficiency of medical and health resources, and preventing medical and health resources in the supply of imparity between urban and rural areas, and promote coordinated and sustainable development in urban and rural areas were also discussed.更多还原