【摘要】：在建設(shè)社會(huì)主義和諧社會(huì)的進(jìn)程中，農(nóng)村與城市的和諧成為建設(shè)的重要內(nèi)容之一，而農(nóng)村醫(yī)療保障制度的建設(shè)又是重中之重。但是我國由于長(zhǎng)期存在著城鄉(xiāng)二元經(jīng)濟(jì)結(jié)構(gòu)，城鎮(zhèn)與農(nóng)村之間實(shí)行的是不同的二元醫(yī)療保障結(jié)構(gòu)，使得城市享受到了更多的政策優(yōu)惠和資源配置，這對(duì)農(nóng)村地區(qū)的醫(yī)療衛(wèi)生事業(yè)發(fā)展造成了嚴(yán)重滯后的影響，農(nóng)村地區(qū)存在著非常普遍的“看病難、看病貴”、“因病致貧、因病返貧”的現(xiàn)象。因此，，必須將農(nóng)村醫(yī)療保障制度作為當(dāng)前新農(nóng)村建設(shè)的一項(xiàng)重要的基礎(chǔ)性工程來建設(shè)。 本文以新型農(nóng)村合作醫(yī)療為研究對(duì)象，通過對(duì)其建設(shè)歷程、運(yùn)行現(xiàn)狀、實(shí)施途徑以及取得的成效做系統(tǒng)的分析，提出現(xiàn)行新型農(nóng)村合作醫(yī)療制度在實(shí)施過程中仍然存在醫(yī)藥衛(wèi)生體制改革困難重重、城鄉(xiāng)區(qū)域衛(wèi)生發(fā)展不平衡、藥品加成政策短期內(nèi)難以取消、基本藥物制度的實(shí)施面臨嚴(yán)峻考驗(yàn)和社保拖欠定點(diǎn)醫(yī)療機(jī)構(gòu)的費(fèi)用大幅增加的問題。這些問題阻礙了湛江市深入實(shí)施新型農(nóng)村合作醫(yī)療保險(xiǎn)的進(jìn)程。本文并以湛江市東海島三明村為個(gè)案，筆者前后用了兩個(gè)多月的時(shí)間，隨機(jī)選取三明村的農(nóng)戶，進(jìn)行問卷調(diào)查。雖然有效問卷只有117份，但是調(diào)查是以“戶”為單位，基本了解到每戶農(nóng)民新型農(nóng)村合作醫(yī)療的情況，涉及總?cè)藬?shù)為500多人。通過對(duì)此樣本的分析，基本掌握了三明村新型農(nóng)村合作醫(yī)療的實(shí)施狀況，也在一定程度上對(duì)湛江市新型農(nóng)村合作醫(yī)療工作有更進(jìn)一步的了解與說明。從問卷調(diào)查中，也反映出了一些問題，通過研究分析，并借鑒國外農(nóng)村醫(yī)療保險(xiǎn)制度的經(jīng)驗(yàn)，就如何進(jìn)一步改進(jìn)新農(nóng)村合作醫(yī)療制度進(jìn)行了討論：通過健全鄉(xiāng)鎮(zhèn)醫(yī)療衛(wèi)生服務(wù)體系、建立國家基本藥物制度、促進(jìn)農(nóng)村基本公共衛(wèi)生服務(wù)逐步均等化、抓好公立醫(yī)院改革試點(diǎn)以及推進(jìn)衛(wèi)生重點(diǎn)項(xiàng)目建設(shè)等具體措施來完善湛江市新型農(nóng)村合作醫(yī)療制度，使農(nóng)民的身體健康得到保障，享受到與城鎮(zhèn)居民無差別的公平醫(yī)療衛(wèi)生待遇。
[Abstract]:In the process of building a harmonious socialist society, the harmony between the countryside and the city becomes one of the important contents of the construction, and the construction of the rural medical security system is the most important. However, due to the existence of a dual economic structure between urban and rural areas for a long time, the dual medical security structure between urban and rural areas is different, which makes cities enjoy more preferential policies and resource allocation. This has caused serious lag in the development of medical and health services in rural areas. In rural areas, there is a very common phenomenon of "difficult to see a doctor, expensive to see a doctor", "to be poor because of illness, and to return to poverty because of illness". Therefore, the rural medical security system must be built as an important basic project in the construction of the new countryside. This article takes the new rural cooperative medical system as the research object, through the systematic analysis to its construction course, the running present situation, the implementation way and the achievement. It is pointed out that there are still many difficulties in the reform of the medical and health system during the implementation of the current new rural cooperative medical system, the development of health in urban and rural areas is not balanced, and it is difficult to cancel the policy of drug addition in the short term. The implementation of the essential drugs system is facing severe challenges and the cost of social security defaulting on designated medical institutions has increased substantially. These problems hindered Zhanjiang City from implementing the new rural cooperative medical insurance. This paper takes Sanming Village of East Island of Zhanjiang City as a case. The author used more than two months to select the farmers of Sanming Village at random and carry on the questionnaire survey. Although there are only 117 valid questionnaires, the survey is based on the "households", and basically understands the situation of the new rural cooperative medical system for each farmer, involving a total of more than 500 people. Through the analysis of this sample, the author basically grasps the implementation situation of the new rural cooperative medical system in Sanming village, and to a certain extent has a further understanding and explanation of the new rural cooperative medical treatment in Zhanjiang city. From the questionnaire survey, also reflects some problems, through research and analysis, and learn from the experience of foreign rural medical insurance system, This paper discusses how to further improve the new rural cooperative medical service system: by perfecting the township medical and health service system, establishing the national essential medicine system, and promoting the gradual equalization of rural basic public health services, To improve the new rural cooperative medical care system in Zhanjiang, and to ensure the health of farmers, we should do a good job of carrying out the pilot reform of public hospitals and promoting the construction of key health projects. Enjoy fair medical and health treatment without distinction with urban residents.
【學(xué)位授予單位】：廣東海洋大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：F323.89;F842.684;R197.1

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