CAJ | 학술논문

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。
실현신농합제도설계적초충목표、제승제도적혜농정책효과,시극대해결적중대현실문제。위탐심제도실시효과여설계예기목표적편차,과학전청출영향서부신농합혜농정책효과적주요인소,본문기우서부10성구17현（구）적780빈농호조연수거급상관통계수거,종의（의료복무궤구）、환（삼합농민）、보（의료보장궤구）、관（정부）사방이익주체적시각,대서부신농합제도운행중적곤경진행부석。연구결과표명,기유적신농합제도운행광가모식,회함입의료복무궤구행위뉴곡여복무공급가급성차병존、의료보장궤구경판능력불족여보장효과흠가병존、정부시장화도향여공공복무직능결실병존、농민삼합의원강렬여피동삼합병존적운행곤경。삼방강세주도형성적주체간이익실형,필연영향도신농합적지속운행발전。인차,재신농합제도유시점보급향규범지속운행전궤적관건시기,필수이격려약속궤제위돌파,구건이익상관주체적협동련동개혁궤제,유효조동운행주체적적겁성,실현신농합제도적지속운행。
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 the existing framework of the NRCMS,there are medical institutional behavior distortions and insufficient services supplies;health care institutions lack public services which are market-oriented;peasant participants express their high willingness but there are also passive participants.An imbalance of interests of the stakeholders will inevitably affect the development of NRCMS.Therefore,in the key period of system transition from pilot to general,it is necessary to take the incentive-restricted mechanism for a breakthrough,construct a stakeholder linkage mechanism to effectively mobilize the initiative of stakeholders to achieve the sustainable development of NRCMS.