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论文编号：	3988
作者编号：	2220091796
上传时间：	2012/3/9 15:11:29
中文题目：	海南农垦医疗卫生体制改革方案研究
英文题目：	Hainan Land Reclamation Scheme for health
指导老师：	戚安邦
中文关键字：	海南农垦 医疗卫生 体制改革 方案设计
英文关键字：	Hainan State Farms Medical Health System Reform Program Design
中文摘要：	本文研究的是中国医疗卫生改革的一个特定领域——农垦医疗卫生体制改革，以海南农垦为例。本文首选对公共管理理论基础与实践、新制度经济学基本框架、制度变迁内在机理等相关文献进行了综述，对我国医疗卫生体制改革进行了系统地回顾，并比较了国外医疗卫生保障体系政府主导、市场主导、社会主导三种主要类型和基本走向，为本文的研究提供了坚实的理论基础、扩大了研究视野。在此基础上，本文深入剖析了海南农垦医疗卫生体制现状、存在的问题以及改革的关键因素等，海南农垦医疗卫生体制问题的根源在于农垦体制——政企不分、企业办社会；从内在需求、外部压力、历史机遇三个方面论述了海南农垦医疗卫生体制改革的总体需求，明确了改革的总体目标是通过三至五年的改革，逐步建立覆盖全垦区居民的基本医疗卫生制度，实现垦区居民病有所医、健康水平进一步提高，卫生事业和国民健康指标达到全省平均水平；提出了整体移交和部分移交两套改革方案并对改革成本进行了详细地比较分析，整体移交方案比较理想但人员安置压力大、改革经费财政负担重、实施难度较大，部分移交方案当前的改革更容易操作，但改革的结果必将使农垦的医疗卫生机构形成分属市县政府和农垦总局的二元格局，留在农垦系统的局属医院和场办医院，将来的改革和发展道路或许更加艰巨。本文为改革方案的顺利实施还提出了五个“落实”的具体保障措施，即落实人员编制、落实资金投入、落实社会保障、落实部门责任、落实宣传教育。
英文摘要：	This research focuses on a specific topic on the reform of Chinese medical health – The health care reform of Hainan State Farms (HSF). This paper first reviews the relevant literature and practical theories in public administration, new institutional economic framework, and the intrinsic mechanism of institutional changes. It also systematically reviews medical health system reform in China and compares three foreign types and trends of health reforms (including government-led, market-led, and community-led health reform). These reviews provide solid theoretical foundation and broad research horizon for this dissertation. This paper then conducts in-depth analysis of the health care system of Hainan State Farms, including current status, major challenges and critical factors related to the reform. The paper points out that the major problems of medical health reform are rooted in the system of Hainan State Farms itself, specifically the current system of non-separation between the function of government and enterprise, as well as society run by enterprise. This paper further discusses the overall demands of the health care reform of Hainan State Farms from three perspectives: the internal demands, the external pressures and the historical opportunities. It identifies a three to five years’ goal of this reform: to gradually cover basic medical health care of all residents in Hainan State Farms, to improve the whole quality of the health care, and to reach average provincial health indicators of Hainan province. This paper proposes two plans, the plan of complete transfer and the plan of partial transfer, and then compares the cost analysis of proposed plans. The paper concludes that the complete transfer plan is ideal but the challenges lie in the staff placement, the financial burden, and the difficulties of implementation. However, the partial transfer plan is easier to operate but will result in a dual pattern of health care system existing in Hainan State Farms: some hospitals and medical institutes belong to the municipal governments and the others remain in the General Bureau of Hainan State Farms. Such a dual pattern of health care system will make further reform and development of those hospitals and medical institutes remained more difficult. Finally, this paper proposes five implementation steps of health care reform in Hainan State Farms: staffing, capital investment, social security, departmental responsibilities, and public education.
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