中國大陸新型農村合作醫療制度發展與國家角色之研究

本文主要是依據研究者2007年以來在中國大陸農村所作的田野經驗調查為基礎，並參考國內外農村合作醫療制度的相關研究文獻，探討中國大陸新型農村合作醫療制度的特質與發展，以及國家在農村合作醫療制度建立與發展過程中的角色，進而說明國家與農村發展的關係。由於中國大陸幅員廣大，長期以來又給予地方某種形式的分權，以致分析中國大陸國家角色要區分中央國家與地方國家的差異，兩者的國家性質與角色會有很大的不同，甚至兩者之間會因利益與行為的差異而出現相當的緊張關係，以致影響國家對農村發展的影響。本文希望能從這兩個層次分析中國大陸國家在農村合作醫療制度發展的角色。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。

關鍵字

新型農村合作醫療制度；中央國家；地方國家；農村治理

並列摘要

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. 1n 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.