新型农村合作医疗制度运行的伦理反思

发布时间：2018-04-24 17:46

本文选题：新农合 + 伦理　；参考：《湖南师范大学》2015年硕士论文

【摘要】：新型农村合作医疗(简称新农合)是我国医疗保障体系的“三驾马车”(城镇职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗)之一,是保障农民生命健康权的重要举措。新农合与伦理道德存在密切关系:第一,伦理道德催生了新农合,并为新农合地顺利实施提供了良好的道德环境;第二,新农合以社会和谐、公平公正和农民的幸福安康为伦理目标,在实施过程中促进了个人道德和社会道德的发展,体现了以人为本、互助共济的伦理精神。然而,新农合在运行实施过程中也存在不少伦理问题,这些问题有其自身独特原因和危害,具体表现如下:第一,不公平问题。由于经济发展的不平衡、制度本身的不完善,导致新农合运行中存在外部地域的不公平和参合农民内部的不公平,这对农民的逆向选择和农村两级分化有一定负面影响。第二,政府道德责任缺失问题。由于政府对新农合定性定位的价值偏离和专职人员的缺失,导致对新农合地监督不到位,这对新农合的保障水平和农民生命健康权的实现有一定负面影响。第三,道德风险。由于第三方支付机制和按服务项目付费的后付制,导致参合农民的过度医疗消费、定点医疗机构的过度医疗供给和医患合谋的道德风险,这对公平与效率的平衡和医疗卫生领域道德水平的提升有一定负面影响。解决新农合运行中存在的伦理问题可以采取如下对策:第一,明确新农合的伦理价值取向即健康平等和人道主义;坚持基本的伦理原则,即公平与效率相结合的原则和责任原则。第二,培养农民的道德主体性,即承认农民的道德主体地位、激发农民的主体意识和培养农民的主体能力。第三,强化政府道德责任,政府应不断完善新农合制度、推动新农合法治建设、加强宣传力度和建立高素质的医护队伍。第四,统筹城乡医疗保障体系,迈向全民医保,真正实现社会公平。
[Abstract]:The New Rural Cooperative Medical system (NCMS) is one of the "three carriages" (basic medical insurance for urban workers, basic medical insurance for urban residents and new rural cooperative medical insurance) for the medical security system of our country. It is an important measure to protect farmers'right to life and health. There is a close relationship between NCMS and ethics: first, ethics and morality give birth to NCMS and provide a good moral environment for its smooth implementation; second, NCMS has a harmonious society. Fairness and justice and farmers' happiness and well-being are the ethical goals. In the process of implementation, they promote the development of personal and social morality, and embody the ethical spirit of people-oriented and mutual aid. However, there are many ethical problems in the implementation of NCMS. These problems have their own unique causes and hazards, which are as follows: first, unfair issues. Due to the unbalance of economic development and the imperfection of the system itself, there are external regional unfairness and the inequity of participating farmers in the operation of NCMS, which has a certain negative effect on the adverse selection of farmers and the differentiation of rural two levels. Second, the lack of government moral responsibility. Due to the deviation of the value of the qualitative positioning of NCMS and the lack of full-time personnel, the supervision of NCMS is not in place, which has a certain negative impact on the level of protection of NCMS and the realization of farmers' right to life and health. Third, moral hazard. As a result of the third-party payment mechanism and the post-payment system of payment according to service items, the excessive medical consumption of participating farmers, the excessive medical supply of designated medical institutions and the moral hazard of doctor-patient collusion, This has a negative impact on the balance between fairness and efficiency and the improvement of the moral level in the field of medical and health care. The following countermeasures can be taken to solve the ethical problems existing in the operation of NCMS: first, to make clear the ethical value orientation of NCMS, that is, health, equality and humanitarianism, to adhere to the basic ethical principles, That is, the principle of the combination of fairness and efficiency and the principle of responsibility. Secondly, it is necessary to cultivate farmers' moral subjectivity, that is, to recognize peasants' moral subject status, to stimulate farmers' subjective consciousness and to cultivate peasants' subjective ability. Third, to strengthen the moral responsibility of the government, the government should constantly improve the new rural cooperative system, promote the construction of the new rural cooperative rule of law, strengthen publicity and establish a high-quality medical team. Fourth, coordinate urban and rural medical security system, towards universal health insurance, real social equity.
【学位授予单位】：湖南师范大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：B82-059

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