中國大陸新型農村合作醫療制度發展與國家角色之研究

Abstract

我們的研究發現：黔東南的地方國家具有高度的制度創新，使當地的新型農村合作醫療制度能順利運作，農民的衛生醫療得到大幅改善；晉西的地方國家嚴格遵守中央國家的規定，以致新農合實施後，村衛生員反而處境更為困難；冀北農村因為醫療高度市場化，以致地方國家很難採取有效措施使新型農村合作醫療制度順利發展。

By comparing the results of a field investigation on the impact of the New Cooperative Medical Schemes（NCMS）in the rural areas of China, this article aims to examine the status of medical services in rural areas, the characteristics of the NCMS, the problems that exist within the system and potential reforms. In addition, as social policy establishment and administration in China has become decentralized, there is considerable variance in the execution of the NCMS in different places, which is also discussed in this study.The geographic area of China is large and therefore decentralization has been adopted. Decentralization leads to a division of the role of the nation: central state and local state. The nature and role of these two states are quite different and could even cause tension if any conflicts in interests and behaviors occur, which further affects the development in rural areas. Hence, the purpose of this study is to analyze the role of the nation on the implementation of the NCMS from the perspective of the two governing levels.The results of our study show that the operation of the local state in southeast Guizhou was qualified in creating systems, and thus the NCMS ran smoothly there. The local state in west Shanxi followed the regulations of the central state strictly, and because of this, the NCMS presented several problems for local physicians. In the rural areas of north Hebei, the healthcare system was highly market-oriented, and therefore, the local state could not enact effective measures to maintain the development of the NCMS.