文档介绍：山西财经大学
硕士学位论文
公共财政框架下农村医疗卫生服务体系的完善
姓名:拜团
申请学位级别:硕士
专业:财政学
指导教师:申长平
2008-09-27
摘要
中国人口的四分之三在农村,解决好农村人口的健康与医疗卫生问题,就
基本解决了中国的初级卫生医疗保健问题,而农村医疗卫生服务体系建设是整
个医疗体制最薄弱和关键的一环。农村公共卫生和基本医疗服务具有纯公共物
品和准公共物品的特点,这就为公共财政赋予了责无旁贷的义务。
本文从公共财政介入农村医疗卫生服务体系的理论基础入手,主要包括公
共财政理论、公共产品理论。分析了当前农村医疗卫生服务体系的历史、现状
及存在的问题,主要表现在农村医疗卫生的财政支出整体不足;医疗费用过高,
导致农民因病返贫、因病致贫;农村和城市的医疗卫生资源配置比例严重失调;
农村卫生人员业务素质低、人才匮乏;新型农村合作医疗制度实施举步维艰等
七个方面。并且分析了几个发达国家和发展中国家的医疗体制。在比较和借鉴
的基础上,确定公共财政框架下农村医疗卫生服务体系完善的总体指导思想,
即明确政府的责任加大政府对农村医疗卫生体系建设的财政支持力度;完善公
共财政体制,规范政府间卫生投入的事权分担体制与机制;对医疗卫生服务领
域的支持应该转换思路从主要提供给供给方转向提供给需求方改变目前医
疗卫生服务低效和低收入阶层不能受益的状况;政府要特别关注农村医疗卫生
服务的供给。最后对公共财政框架下农村医疗卫生服务体系的完善提出了具体
措施,包括加大各级政府投入,建立和完善农村三级医疗卫生服务体系;积极
培养引进医学专业人才,加大人才引进力度;努力降低农民就医成本;建立完
善新型农村合作医疗制度;加快各项农村医疗卫生制度和农村医疗卫生事业管
理制度建设等六个方面。
【关键词】公共财政公共产品农村医疗卫生服务体系新型农村合作医疗
3
Abstract
Three quarters of Chinese population live in countryside, so properly solving the problem of
medical and health care of rural residents means all nation’s primary health care problem is
basically solved. However, building medical and health service system in rural area is the key but
weakest link in the whole medical system. Rural public sanitary and basic medical services have the
characteristics of absolute and almost public goods, which endows inescapable duty to public
finance.
This text starts from the fundamental theory of rural medical and health service system which
public finance has interposed in. It mainly consists public finance theory and public goods theory,
based on which analyzes the history, status quo and existing problems of current medical and
health service system in rural area. Such problems include the following seven aspects: the overall
payouts for countryside medical and sanitary service are insufficient; too high medical care
expenses make people who have an average living standard back to poverty; distribution of medical
and sanitary service resources are severely maladjusted; sanitary service s