政府购买社区公共卫生服务法律制度研究

发布时间：2018-05-31 00:46

本文选题：政府购买 + 社区公共卫生服务　；参考：《广西师范大学》2017年硕士论文

【摘要】：如何真正实现生命面前人人平等,解决“看病难”、“看病贵”甚至是频繁出现的“医闹”、“医暴”事件成为关乎国计民生的重要问题。社区卫生服务是政府实现公共管理职能、提供公共医疗卫生服务的福利性事业,是城市医疗服务体系改革的突破口。上世纪八十年代开始,国内外相关专家就我国社区公共卫生服务实践的可行性进行了相关探索,直到1997年,《中共中央、国务院关于卫生改革与发展的决定》第八条明确提出了:积极发展社区卫生服务,逐步形成功能合理、方便群众的卫生服务网络,标志着我国正式迈出了社区公共卫生服务改革的步伐,在接下来的几年里,进入了社区公共卫生服务的试点及框架建立阶段,很多省份、地区开始探索社区公共卫生服务,在2002年,我国政府创新了公共卫生服务政策,政府可以购买社会医疗卫生机构的服务,2006年进一步强调各地政府要根据本社区居民人口、社区卫生服务的项目内容、数量等相关成本核定财政补助,坚持社区卫生服务要以政府为主导、鼓励社会参与、多渠道发展。经过多年的摸索,我国己经步入公共卫生服务改革的关键时期,部分城市已经取得了突破性的进展。但不可否认,我国在进行政府购买社区公共卫生服务过程中还存在很多问题,相关的法律制度亟待完善,虽然地方政府出台了相应的政策性文件,但杂乱无章,缺少系统化的梳理,效力也比较低,阻碍了改革的进程。因此,对我国政府购买社区公共卫生服务的法律制度进行研究,以期进一步明晰政府购买社区公共卫生服务的内容,明确购买方式,规范购买合同,监督购买程序等等,完善制度保障,用法律为社区公共卫生事业进行保驾护航。政府购买社区公共卫生服务是指政府改变传统由政府直接提供公共服务的方式,在公共卫生服务的提供中引入市场机制,根据人群的健康需要,测算出公共卫生服务的边际成本的基础上,按照既定程序,由政府代表社会公众,以竞争性的价格,向符合标准的社会组织购买社区公共卫生服务。在这个过程中,政府由原来的提供者、管理者、监督者等多种角色合一身转变为宏观调控者、管理者、监督者的角色。这种新型的政府提供公共服务的模式包含了多项重要内容,包括市场运作、政府承担、定向委托、合同管理、评估兑现等内容。本文以政府购买社区公共卫生服务的法律制度为核心,翻阅了大量的参考文献,结合中央以及各地制定的相关法律、法规以及相关政策,对我国政府购买社区公共卫生服务的法律制度进行了研究。第一部分为引言,对政府购买社区公共卫生服务的研究背景、研究思路以及本文的研究目的和意义做了简要的分析,第二部分概述了政府购买社区公共卫生服务的相关理论,分析了政府购买社区公共卫生服务的概念以及政府购买卫生服务的内容和方式,并对政府购买社区公共卫生服务的理论基础进行了深入的剖析,界定了政府购买公共卫生服务的性质。第三部分阐述了我国政府购买社区公共卫生服务的法律制度的发展历程,分析这些年我国政府购买社区公共卫生服务的法律法规现状,全方位分析现行的法律法规对规范政府购买社区公共卫生服务方面所存在的问题。第四部分为域外国家购买社区公共卫生服务法治现状以及对我国的启示。本文选取了美国、英国这两个发达国家,他们经济发达,医疗体系各方面比较成熟,在政府购买方面起步早,有着丰富的实践经验和教训。通过对发达国家在政府购买社区公共卫生服务的法律制度各方面的分析,结合我国的实际情况,筛选出适合我国的实践经验,促进我国政府购买社区公共卫生服务法律制度的发展。第五部分为完善我国政府购买社区公共卫生服务的法律制度。通过分析我国现行的社区公共卫生服务方面的法律法规,总结我国这些年的实践经验以及存在的问题,结合国外一些发达国家的实践经验,对进一步完善我国政府购买社区公共卫生服务方面的法律制度提出了几点建议,以期实现政府购买行为有法可依,购买内容明晰化,购买程序规范化,建立科学、合理的绩效评估制度,深化医疗卫生体制的改革。
[Abstract]:How to realize the equality of all people in the face of life, to solve the problem of "difficult to see a doctor", "to see a doctor" is even a frequent occurrence of "medical trouble", and the incident of "medical violence" has become an important issue concerning the national economy and the people's livelihood. The breakthrough of the system reform began in the 80s of last century. Relevant experts at home and abroad have explored the feasibility of the practice of community public health services in China and abroad. Until 1997, the eighth articles of the Central Committee of the Communist Party of China, the State Council on health reform and development made clear that the development of community health services and gradually formed functional integration. In order to facilitate the public health service network of the masses, our country has formally stepped out the pace of community public health service reform. In the next few years, the pilot and framework of community public health services have been entered. Many provinces and regions have begun to explore community public health services. In 2002, the government of our country has innovated public health. In 2006, the government can purchase the services of the social medical and health institutions. In 2006, it was further emphasized that the local governments should confirm the financial subsidies according to the population of the community, the content of the community health service, the quantity and other related costs, and insist that the community health service should be dominated by the government, encourage the participation of the society and develop through many channels for many years. Our country has stepped into the key period of public health service reform, and some cities have made breakthrough progress. But it is undeniable that there are many problems in the process of government buying community public health services in our country, the relevant legal system needs to be improved, although the local government has issued corresponding policy documents, However, the disorder, lack of systematic combing and the low effectiveness have hindered the process of reform. Therefore, the legal system of the government's government purchase of community public health services is studied in order to further clarify the content of the government's purchase of community public health services, clear the way of purchase and purchase, standardize the purchase contract, supervise purchase procedures and so on, and so on. The government buys the community public health service in the way that the government changes the traditional public service by the government, introduces the market mechanism in the provision of public health service, and calculates the marginal cost of public health service according to the health needs of the crowd. On the basis of the established procedure, the government buys community public health services to the standard social organizations on behalf of the public, at a competitive price. In this process, the government has changed from the original provider, the manager, the supervisor to the macro-control, the manager, the supervisor's role. The government's mode of providing public services contains a number of important contents, including market operation, government commitment, directional entrustment, contract management, evaluation and cashing. This article focuses on the government's legal system for the purchase of community public health services, and has read a large number of references, combined with relevant laws and regulations formulated by the central government and all over the country. And related policies, the legal system of our government to buy community public health services is studied. The first part is the introduction, the research background of the government purchase of community public health services, the research ideas and the purpose and significance of this study are briefly analyzed. The second part outlines the government to buy community public health services. Related theory, the concept of government purchase of community public health service and the content and way of government purchase of health service are analyzed, and the theoretical basis of government buying community public health service is deeply analyzed, and the nature of government purchase of public health service is defined. The third part expounds the government purchase of community public public. The development course of the legal system of health service, analyses the status of the laws and regulations of the government buying community public health services in these years, analyzes the problems existing in the current laws and regulations to standardize the government purchase of public health services in the community. The fourth part is the status of the rule of law for the foreign countries to buy community public health services. In this paper, the two developed countries of the United States and the United Kingdom, which are developed in the United States and the United Kingdom, are economically developed, the medical system is mature in all aspects, early in the purchase of the government and rich in practice and lessons. The actual situation of the country, screening out the practical experience of our country and promoting the development of the legal system of public health service in the community. The fifth part is to improve the legal system of our government to buy community public health services. Through the analysis of the current laws and regulations on community public health services in our country, this paper summarizes the years in our country. On the basis of practical experience and existing problems and combining with the practical experience of some developed countries in foreign countries, some suggestions are put forward to further improve the legal system of the government purchase of community public health service in our country, in order to realize the law of government purchase, clear the content of the purchase, standardize the purchase procedure, establish a scientific and reasonable achievement. The system of effectiveness evaluation should be carried out to deepen the reform of the medical and health system.
【学位授予单位】：广西师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D922.16

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