利益主体视角下的西部新农合制度运行困境分析

实现新农合制度设计的初衷目标、提升制度的惠农政策效果,是亟待解决的重大现实问题.为探寻制度实施效果与设计预期目标的偏差,科学厘清出影响西部新农合惠农政策效果的主要因素,本文基于西部10省区17县(区)的780份农户调研数据及相关统计数据,从医(医疗服务机构)、患(参合农民)、保(医疗保障机构)、管(政府)四方利益主体的视角,对西部新农合制度运行中的困境进行剖析.研究结果表明,既有的新农合制度运行框架模式,会陷入医疗服务机构行为扭曲与服务供给可及性差并存、医疗保障机构经办能力不足与保障效果欠佳并存、政府市场化导向与公共服务职能缺失并存、农民参合意愿强烈与被动参合并存的运行困境.三方强势主导形成的主体间利益失衡,必然影响到新农合的持续运行发展.因此,在新农合制度由试点普及向规范持续运行转轨的关键时期,必须以激励约束机制为突破,构建利益相关主体的协同联动改革机制,有效调动运行主体的积极性,实现新农合制度的持续运行.

Analysis on Predicament of Western New Rural Cooperatives Medical System in the Perspective of Stakeholder Gambling

It is an urgent issue to achieve the original intention goals of NRCMS(new rural cooperative medical care system) and to enhance its effective implementation.In order to explore the deviations between the implementation effectiveness and anticipated goals,and to clarify the impact factor of policy effect,this paper analysed the operational predicament of the new rural cooperative medical system,based on the questionnaire survey of 780 rural households of 10 provinces in western China.It is shown that under ...