医疗保障权研究

发布时间：2018-12-27 06:43

【摘要】：历史上，医疗保障经历了由恩惠到权利的演变。欧洲中世纪战乱频仍，国家无力承担医疗保障义务，虽然有《伊丽莎白济贫法》关于医疗患者医疗救助的规定，但严格意义上讲，公民并不享有医疗保障权；经过两次产业革命的发展，资本主义生产方式得以确立，以1883年德国《企业工人疾病保险法》为开端，公民的医疗保障权首次以法律形式明确提出，并要求国家履行义务保障公民的医疗保障权；二次世界大战结束以后，公民医疗保障权开始了新的发展时期，《经济、社会和文化权利国际公约》等一系列国际公约的出台，进一步丰富了医疗保障权的内涵，同时，世界各国不断完善自身医疗保障制度，2012年的奥巴马医疗改革法案即是其中之一。医疗保障权是现代社会基本的、独立的人权，是保障人类生存和发展的需要，目的在于防范生存风险，使公民有尊严地生存下去并获得发展；医疗保障权同时体现了道德的要求，蕴含了对人性的深刻关怀，是现代法律制度中人文精神的生动体现。医疗保障权还是现代社会的公民基本权利，对于维护人的尊严和价值必不可少。医疗保障权是指公民因疾病或其他自然事件及突发事件造成身体和健康损害时获得医疗服务或对其发生的医疗费用损失和其他损失获得经济补偿或救济的权利。我国自建国以来，医疗保障制度经过不断发展，逐步形成了城镇职工基本医疗保障制度、城镇居民基本医疗保障制度、新型农村合作医疗保障制度和城乡医疗救助保障制度的综合发展格局。但公民医疗保障权的发展仍不完善，不同地区、不同行业的公民医疗保障权仍然存在不平等现象，影响社会公平。为此，国家应当积极履行医疗保障义务。针对公民的消极自由和积极自由，国家应当承担消极层面和积极层面的义务。诚如艾德所言，国家之于经济、社会和文化方面的权利负有三个层面的义务，，即尊重、保障和实现的义务，义务的三分法在《经济、社会和文化权利国际公约》中得以体现。医疗保障权作为经济、社会和文化权利的重要内容，同样要求国家履行三个层面的义务。消极层面的义务即为国家的尊重义务，每一个公民都有其特殊性，据此选择医疗保障服务的层次也不同，国家应当尊重公民的自由选择权，同时医疗服务机构在医患关系中应当尊重公民的隐私权。积极层面的义务包括国家的保障和实现义务。受制于城乡二元经济结构，我国公民的医疗保障权在事实上也存在不平等现象。对此，国家的保障义务首先要求自身不侵犯公民的医疗保障权，其次应当防止第三方侵害公民的医疗保障权，努力消除医疗保障差距，维护社会公平正义。国家的实现义务是最高层面的义务要求，应当在立法、财政和制度三个方面积极履行义务，充分体现国家作为义务主体的地位，创造良好的外部环境，满足公民的医疗保障需求。
[Abstract]:In history, medical security has experienced the evolution from favor to right. Because of the frequent wars in the Middle Ages in Europe, the state was unable to undertake the obligation of medical security. Although there are provisions on medical assistance for medical patients in Elizabeth's Law of Relief of Poverty, citizens do not have the right to medical security in the strict sense. After the development of two industrial revolutions, the capitalist mode of production was established. Starting with the German Enterprise Workers Disease Insurance Act of 1883, the citizens' right to medical security was clearly put forward in the form of law for the first time. The state is required to fulfill its obligations to guarantee the right of citizens to medical security; After the end of World War II, the citizens' right to medical security began a new period of development. The publication of a series of international covenants, such as the International Covenant on Economic, Social and Cultural Rights, further enriched the connotation of the right to medical security, and at the same time, The 2012 Obamacare Reform Act is one of the countries around the world that are improving their health care systems. The right to medical security is a basic and independent human right in modern society. It is the need to ensure the survival and development of human beings. The purpose of the right is to guard against the risks of survival and to enable citizens to survive and develop in dignity. At the same time, the right of medical security embodies the requirements of morality and the profound concern for human nature. It is a vivid embodiment of the humanistic spirit in the modern legal system. The right to medical security is still the basic right of modern society, which is indispensable to the maintenance of human dignity and value. The right to medical security refers to the right of citizens to receive medical services or to obtain economic compensation or relief for the loss of medical expenses and other losses caused by illness or other natural events and emergencies. Since the founding of the people's Republic of China, the medical security system has gradually formed the basic medical security system for urban workers and the basic medical security system for urban residents. New rural cooperative medical security system and urban and rural medical assistance security system comprehensive development pattern. However, the development of citizens' right to medical security is still imperfect. To this end, the state should actively fulfill its medical security obligations. In view of the negative and positive freedoms of citizens, the state should undertake the negative and positive levels of obligations. As Eddard said, the State has three levels of obligations to economic, social and cultural rights, namely, the obligation to respect, safeguard and fulfil, and the triple play of obligations is embodied in the International Covenant on Economic, Social and Cultural Rights. As an important part of economic, social and cultural rights, the right to medical security also requires the state to fulfill its obligations at three levels. The negative level of the obligation is the obligation of the state to respect, every citizen has its own particularity, according to the choice of different levels of health care services, the state should respect the free choice of citizens, At the same time, medical service institutions should respect citizens' right to privacy in doctor-patient relations. Positive level of obligations include the State's safeguards and obligations to fulfil. Restricted by the dual economic structure of urban and rural areas, the right of medical security of Chinese citizens also exists inequality in fact. In view of this, the state's duty of security requires, first, not to infringe on citizens' right to medical security; secondly, to prevent third parties from encroaching on citizens' right to medical security, to make efforts to eliminate the gap of medical security, and to safeguard social fairness and justice. The realization obligation of the state is the highest level obligation. It should fulfill the obligation actively in the three aspects of legislation, finance and system, fully reflect the status of the state as the subject of the obligation, and create a good external environment. To meet the medical security needs of citizens.
【学位授予单位】：西南政法大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D922.16

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