封建社会医疗保障思想与制度探析
发布时间:2018-08-20 16:12
【摘要】:随着经济快速发展,人们生活水平的逐步提高,建立完善的医疗保障体系已经成为政府必须要面临的一个严重问题。本篇文章从历史的角度作为出发点,以宋朝的安济坊为例,着重介绍了封建社会医疗保障机构的设置。通过对历史的回顾和探讨,希望能从中探寻出一些对今日“新医改”建设有益的相关建议。 整篇文章一共由前言和正文两部分构成。前言部分主要介绍了选题目的和意义、文献综述以及文章的研究资料、方法和架构。正文部分由六章内容构成,前两章从整体上介绍了安济坊产生的思想渊源及宋朝以前医疗保障机构设置的演变;第三、四、五章则详细讲述了安济坊的具体实施内容、发展历程及利弊分析和对后世的影响;第六章则结合当前“新医改”现状提出了几点建议。大致内容如下: 第一章主要从儒、道、释三家有关医疗保障思想的记载中介绍了安济坊产生的思想渊源。 儒家思想以“仁”为核心,认为恻隐之心是“仁”的开始。一切慈善活动都可以归结为人的本性使然。仁爱思想上升到国家的高度,即为民本思想。民本思想要求国家必须以人民利益为重,“民为贵,社稷次之,君为轻”。以仁爱思想为基础,民本思想为指导,进而构筑起“老有所终,壮有所用,幼有所长,矜寡、孤独、废疾者皆有所养”的大同社会。 早期道教内部对药物医疗的观点各有不同,大体可以分为三种:第一种以旧天师道、南朝“新天师道”和灵宝经派为代表的反对药物医疗观,主张采用符水、首过之法和“斋醮”等一些宗教仪式进行疾病治疗。第二种是以《太平经》和北朝“新天师道”为代表的有条件接受药物医疗观,认为用来治病的药物必须得到仙人的力量才有效,因此在进行药物治疗时必须要辅之以宗教仪式。第三种则是以葛氏道和上清经派为代表的肯定并接受药物治疗观,虽然肯定药物在疾病治疗方面的作用,却主张进行药物治疗的最终目的是修炼成仙,药物治疗只不过是其中的一个必然阶段而已。到了隋唐时期,由于统治者崇尚道教,所以那时道教的社会教化功能更为突出,尤其在利用医术医治病人方面。 佛教自西汉末年传入我国,逐渐与中国传统文化相融合,对社会发展的影响也越来越大。因为坚信因果报应说,所以佛教提倡多行积善,主张对一切世人都应该抱有怜悯的心态,以慈悲为怀,用博爱感化他们,并帮助其脱离苦海。在具体的行善方法上,佛教有“修福田”、“布施”之说。《梵纲经》中记载有八大福田,其中之一就是病福田。建立在病福田基础上的悲田养病坊是寺院教徒专门用来救助贫疾之人的场所。之后,随着政府的介入,悲田养病坊逐渐向着规范化方向发展。 第二章主要介绍宋朝以前医疗保障机构设立的演变过程。 在我国历史上,医疗官职的设置由来已久。《周礼》中记载了我国最早的典章制度设置,其中就有医师一职。虽然那时医师职责的仅仅局限于疾患治疗,但是它却已经成为了国家的一种职责。 《礼记》中出现的“矜寡、孤独、废疾者皆有所养”则是我国历史上有关社会保障思想的最早记载。《管子》一书将《礼记》中提到的社会保障思想运用到了国家的制度设计中,提出了“九慧之政”之一的“养疾”。这是我国历史上首次将医疗保障的思想转变成国家的制度设计,尽管这一制度设计是否真正得到实施尚不可知,但是它在我国医疗保障制度史上却占有非常重要的地位。 到了魏晋南北朝时期,随着佛教在中原地区影响力逐渐扩大,统治者也开始受到佛家思想的感染。南齐文惠太子创立的“六疾馆”在我国历史上具有划时代意义,该机构的设立第一次将医疗保障正式引入到国家的制度管理中,使管子的“养疾”思想由制度设计转变为现实。此后,历朝统治者都开始关注疾病之人的救助,并设置专门机构进行管理。 唐朝时期,统治者以悲田养病坊为基础,先派遣使者监督,进而由政府提供资金和土地支持其发展。如此一来,原本只是寺院出于救济之心而建立的慈善救助设施,转变为国家医疗保障机构,国家在社会保障方面的实际职能进一步扩大。 第三章基于安济坊产生的历史背景,分别从对象条件、财政资金支持及监察三个方面详细介绍了安济坊的具体实施内容。 宋承唐制,在建国初期,政府曾建立福田院对老弱贫疾之人给予保障。起初只设置东、西福田院,每座福田院以二十人为限。由于规模小,难以满足社会需求。英宗在位时期(公元1064-1067年),又增置南、北福田院,保障人数扩大至三百人,同时还制定奖罚措施,使福田院的管理进一步趋于规范化、合理化。元yP四年(公元1089年),苏轼在杭州设立安乐坊,救助饱受疾疫困扰的贫苦民众。由于其实施成功,得到政府的褒奖。崇宁元年(公元1102年),吴居厚奏请朝廷在诸路建立将理院,收养病人,于是朝廷赐名为安济坊。从此,安济坊作为国家医疗保障机构正式出现。 由于文献资料记载有限,本文在结合考古发掘成果的基础之上,将安济坊的保障对象主要分为四个方面:第一、无依无靠的病人和贫病无力医治的本地人和外地人;第二、军人及其家属;第三、服刑的犯人;第四、官宦人家的雇工。安济坊的发展得到了国家强大的资金支持。创立之初,政府不仅为那些需要保障的人员提供房屋,还根据他们自身病情轻重程度进行屋舍分配。每一位安济坊人员除了能够得到政府定期定量的生活支给外,还有医师定期对其进行身体检查。、安济坊采纳了僧人管理模式,在机构内部有专门的掌管和监督人员,有火头、出纳、医生;在外部,上自京师,下到诸路府、州、军、监都有提督、检点、管勾。除此之外,安济坊还设有一整套严格的监察制度。安济坊的监察主要有事前监察和事后监察两种。所谓事前监察是指从察看验实到登记在册的过程,分为实地巡视、办理登记、“结罪保明”、“差官验实”四步。这四步环环相扣,确保每一个需要救助之人都能及时、合理地得到国家的救助。事后监察采取“立赏举报”的方式,主要为了弥补事前监察过程的疏漏,防止奸猾狡诈之人趁机骗取国家保障。 在对安济坊产生的背景、具体实施内容进行详尽介绍之后,第四章阐述了其在宋朝的整个发展过程。纵观安济坊在宋朝的发展,可以分为七个阶段,即初创时期、曲折时期、改进时期、衰退时期、重建时期、破坏时期以及修复时期。在苏轼所建安乐坊的影响下,政府开始在全国创建安济坊。安济坊仍然采用了僧人主持的模式,加以政府的监督管理和财政支持。到蔡京上台后,安济坊逐步在全国推广。随着蔡京仕途跌宕起伏,安济坊的发展也出现了曲折、改进、衰退、重建及破坏等不同阶段。宣和六年(公元1124年)十二月以后,蔡京致仕。朝廷感念其往日言行,于次年四月下诏重修安济坊。到南宋时期,安济坊的发展一直较为稳定,基本没有大的发展变动。 第五章主要针对安济坊制度的利弊和对后世产生的影响进行分析。任何一项制度总有其不完善的一面,安济坊也是如此。对于安济坊制度的缺陷,本文主要指出了两个方面:其一是政策的不稳定性;其二是监督过程中存在疏漏。南宋后期,安济坊的影响越来越弱。南宋灭亡后,安济坊便也永久的退出了历史舞台。但是,安济坊作为我国封建社会最为完备的官办医疗保障机构,对以后朝代医疗保障机构的发展和设置产生了深远影响,如宗族义庄、惠民药局的出现和发展以及民间个人慈善行为的壮大等。 第六章一则是对前面内容的补充和完善,二则针对当前的“医改”现状提出了几点相关建议。与宋之前的医疗保障机构相比,安济坊无论是在制度、组织还是精神方面都得到了强化,并实现了超越。对于这样一项完善的制度,我们应该加以肯定和借鉴。结合当前“新医改”现状,笔者主要从社会伦理道德的构建、充足的财政资金保障以及政府在基本医疗服务提供中的主导责任、政府投入逐渐向需求方转变四个方面来探讨如何改进和完善我国医疗保障体系,促进“新医改”的顺利实施。
[Abstract]:With the rapid development of economy and the gradual improvement of people's living standards, the establishment of a sound medical security system has become a serious problem that the government must face. This article, starting from a historical point of view, takes Anji Fang in the Song Dynasty as an example, emphatically introduces the establishment of medical security institutions in the feudal society. Gu and he hoped to find some useful suggestions for today's "new health care reform".
The preface mainly introduces the topic and significance, literature review and the research materials, methods and framework of the article. The main body is composed of six chapters. The first two chapters introduce the ideological origin of Anji Fang and the evolution of medical security institutions before Song Dynasty. The third, fourth and fifth chapters elaborate on the specific implementation of Anji Fang, the development process and pros and cons of the analysis and impact on future generations; the sixth chapter is combined with the current situation of the "new medical reform" made a few suggestions.
The first chapter mainly introduces the ideological origin of Anji Fang from the records of Confucianism, Taoism and Buddhism.
Confucianism takes "benevolence" as its core and holds that compassion is the beginning of "benevolence". All philanthropic activities can be attributed to the nature of human beings. On the basis of the people-oriented thought, a harmonious society has been constructed, in which the old have the end, the strong have the use, the young have the growth, the widowed, the lonely, the disabled have the support.
Early Taoism had different opinions on medicine treatment, which could be divided into three kinds: the first was against medicine treatment, represented by the old Tianshi Dao, the new Tianshi Dao and the Lingbao Sutra School in the Southern Dynasty, which advocated ruling water, the first passing method and some religious rituals such as Zhaiqin. The conditional acceptance of medication represented by the New Heavenly Master's Daoism in the Dynasty believed that medicines used to cure diseases must be given the power of immortals to be effective, and therefore must be supplemented by religious rituals in the course of medication. In the Sui and Tang Dynasties, because the rulers advocated Taoism, Taoism's social and educational function was more prominent, especially in the use of medicine to treat patients.
Buddhism was introduced into China in the late Western Han Dynasty, and gradually merged with the traditional Chinese culture. It had a greater and greater impact on social development. In the way of doing good, Buddhism has the doctrine of "repairing Futian" and "giving." There are eight Futian documented in the Sanskrit Sutra, one of which is "sick Futian". The Beitan Ward-rearing House, which is built on the basis of "sick Futian", is a place where the temples are dedicated to helping the poor and the sick. Exhibition.
The second chapter mainly introduces the evolution process of the establishment of medical insurance institutions before the Song Dynasty.
In the history of our country, the establishment of medical official position has a long history. recorded the earliest rules and regulations in our country, including a doctor. Although the doctor's duty was limited to the treatment of diseases, it has become a national duty.
It is the earliest record of social security thought in Chinese history that the book Guan Zi applies the social security thought mentioned in the Book of Rites to the system design of the country and puts forward one of the "Nine Wisdom Governments" to "keep sick". The idea of security has been transformed into the system design of the state. Although it is still unknown whether this system design has been implemented, it occupies a very important position in the history of China's medical security system.
In the period of Wei, Jin, Southern and Northern Dynasties, as Buddhism gradually expanded its influence in the Central Plains, the rulers began to be influenced by Buddhist ideas. The "Six Diseases Pavilion" founded by Prince Wen Hui of Southern Qi Dynasty had epoch-making significance in the history of our country. The establishment of this institution formally introduced medical security into the state's system management for the first time and made Guanzi's. Since then, the rulers of all dynasties began to pay attention to the relief of the sick and set up special organizations to manage them.
In the Tang Dynasty, the rulers first sent envoys to supervise the development of the hospital, and then the government provided funds and land to support its development.
In the third chapter, based on the historical background of the emergence of Anji Fang, the concrete implementation contents of Anji Fang are introduced in detail from three aspects: the object conditions, financial support and supervision.
In the early days of the founding of the Tang Dynasty, the government established Futian courtyard to protect the elderly, the weak and the poor. Originally, only East and West Futian courtyards were set up. Each Futian courtyard was limited to 20 people. In the fourth year of Yuan YP (1089 A.D.), Su Shi set up an alleyway in Hangzhou to help the poor people suffering from epidemic diseases. Because of its successful implementation, he was commended by the government. In the first year of Chongning (1102 A.D.), Wu Juhou called on the court to establish a General Academy and adopt it in Zhulu. The patient was given the name of Anji Fang. Since then, Anji square has officially appeared as a national health insurance agency.
On the basis of archaeological excavations, this paper mainly divides the protection objects of Anji Fang into four aspects: firstly, the helpless patients and the indigenous and outsiders who are unable to cure the poor and sick; secondly, the soldiers and their families; thirdly, the prisoners serving sentences; fourthly, the hired workers of the official eunuch families; and finally, Anji Fang. At the beginning of its founding, the government not only provided housing for those who needed to be protected, but also allocated housing according to the severity of their illness. Anjifang adopted the management mode of monks, and there were special supervisors and supervisors inside the organization, such as fire, cashier and doctor; outside, from the capital, down to the various roads, state, army and supervisors all had supervisors, checkpoints and checklists. In addition, Anjifang also had a set of strict supervision system. The so-called pre-inspection refers to the process from inspection and verification to registration, which is divided into four steps: on-the-spot inspection, registration, clearance of the crime, and inspection by officials. The main purpose is to make up for the oversight in the pre monitoring process and prevent the crafty and sly people from taking advantage of the opportunity to defraud national security.
After introducing the background of the emergence of Anji Fang and the concrete contents of its implementation, the fourth chapter expounds the whole development process of Anji Fang in the Song Dynasty. Under the influence of Anle Fang, the government began to set up Anji Fang in the whole country. Anji Fang still adopted the model of monks'presiding over it, which was supervised and financially supported by the government. After the sixth year of Xuanhe (1124 A.D.), Cai Jing sent his official address. The imperial court, mindful of his past words and deeds, ordered the restoration of Anji Square in April the following year.
The fifth chapter mainly analyzes the pros and cons of the Anji Fang system and its influence on the later generations.Any system always has its imperfections, so does Anji Fang.For the defects of the Anji Fang system, this paper mainly points out two aspects: one is the instability of the policy; the other is the oversight process. In the period of the Southern Song Dynasty, the influence of Anji Fang became weaker and weaker. After the collapse of the Southern Song Dynasty, Anji Fang withdrew from the historical stage permanently. However, as the most complete official medical security institution in the feudal society of China, Anji Fang exerted a far-reaching influence on the development and establishment of medical security institutions in the later dynasties, such as the emergence and development of the ancestral village, the Huimin Pharmaceutical And the growth of private philanthropy.
Chapter 6 is a supplement and improvement of the previous content, and the second is a few suggestions for the current "medical reform" situation. Compared with the medical security institutions before the Song Dynasty, Anji Fang has been strengthened in terms of system, organization and spirit, and has achieved transcendence. In order to affirm and draw lessons from the current situation of the "new medical reform", the author mainly discusses how to improve and perfect the medical security system and promote the "new doctor" from the following four aspects: the construction of social ethics and morality, the guarantee of adequate financial funds, the government's leading responsibility in the provision of basic medical services, and the gradual transformation of government investment to the demand side. The smooth implementation of reform.
【学位授予单位】:西南财经大学
【学位级别】:硕士
【学位授予年份】:2011
【分类号】:D691;R-09
本文编号:2194221
[Abstract]:With the rapid development of economy and the gradual improvement of people's living standards, the establishment of a sound medical security system has become a serious problem that the government must face. This article, starting from a historical point of view, takes Anji Fang in the Song Dynasty as an example, emphatically introduces the establishment of medical security institutions in the feudal society. Gu and he hoped to find some useful suggestions for today's "new health care reform".
The preface mainly introduces the topic and significance, literature review and the research materials, methods and framework of the article. The main body is composed of six chapters. The first two chapters introduce the ideological origin of Anji Fang and the evolution of medical security institutions before Song Dynasty. The third, fourth and fifth chapters elaborate on the specific implementation of Anji Fang, the development process and pros and cons of the analysis and impact on future generations; the sixth chapter is combined with the current situation of the "new medical reform" made a few suggestions.
The first chapter mainly introduces the ideological origin of Anji Fang from the records of Confucianism, Taoism and Buddhism.
Confucianism takes "benevolence" as its core and holds that compassion is the beginning of "benevolence". All philanthropic activities can be attributed to the nature of human beings. On the basis of the people-oriented thought, a harmonious society has been constructed, in which the old have the end, the strong have the use, the young have the growth, the widowed, the lonely, the disabled have the support.
Early Taoism had different opinions on medicine treatment, which could be divided into three kinds: the first was against medicine treatment, represented by the old Tianshi Dao, the new Tianshi Dao and the Lingbao Sutra School in the Southern Dynasty, which advocated ruling water, the first passing method and some religious rituals such as Zhaiqin. The conditional acceptance of medication represented by the New Heavenly Master's Daoism in the Dynasty believed that medicines used to cure diseases must be given the power of immortals to be effective, and therefore must be supplemented by religious rituals in the course of medication. In the Sui and Tang Dynasties, because the rulers advocated Taoism, Taoism's social and educational function was more prominent, especially in the use of medicine to treat patients.
Buddhism was introduced into China in the late Western Han Dynasty, and gradually merged with the traditional Chinese culture. It had a greater and greater impact on social development. In the way of doing good, Buddhism has the doctrine of "repairing Futian" and "giving." There are eight Futian documented in the Sanskrit Sutra, one of which is "sick Futian". The Beitan Ward-rearing House, which is built on the basis of "sick Futian", is a place where the temples are dedicated to helping the poor and the sick. Exhibition.
The second chapter mainly introduces the evolution process of the establishment of medical insurance institutions before the Song Dynasty.
In the history of our country, the establishment of medical official position has a long history.
It is the earliest record of social security thought in Chinese history that the book Guan Zi applies the social security thought mentioned in the Book of Rites to the system design of the country and puts forward one of the "Nine Wisdom Governments" to "keep sick". The idea of security has been transformed into the system design of the state. Although it is still unknown whether this system design has been implemented, it occupies a very important position in the history of China's medical security system.
In the period of Wei, Jin, Southern and Northern Dynasties, as Buddhism gradually expanded its influence in the Central Plains, the rulers began to be influenced by Buddhist ideas. The "Six Diseases Pavilion" founded by Prince Wen Hui of Southern Qi Dynasty had epoch-making significance in the history of our country. The establishment of this institution formally introduced medical security into the state's system management for the first time and made Guanzi's. Since then, the rulers of all dynasties began to pay attention to the relief of the sick and set up special organizations to manage them.
In the Tang Dynasty, the rulers first sent envoys to supervise the development of the hospital, and then the government provided funds and land to support its development.
In the third chapter, based on the historical background of the emergence of Anji Fang, the concrete implementation contents of Anji Fang are introduced in detail from three aspects: the object conditions, financial support and supervision.
In the early days of the founding of the Tang Dynasty, the government established Futian courtyard to protect the elderly, the weak and the poor. Originally, only East and West Futian courtyards were set up. Each Futian courtyard was limited to 20 people. In the fourth year of Yuan YP (1089 A.D.), Su Shi set up an alleyway in Hangzhou to help the poor people suffering from epidemic diseases. Because of its successful implementation, he was commended by the government. In the first year of Chongning (1102 A.D.), Wu Juhou called on the court to establish a General Academy and adopt it in Zhulu. The patient was given the name of Anji Fang. Since then, Anji square has officially appeared as a national health insurance agency.
On the basis of archaeological excavations, this paper mainly divides the protection objects of Anji Fang into four aspects: firstly, the helpless patients and the indigenous and outsiders who are unable to cure the poor and sick; secondly, the soldiers and their families; thirdly, the prisoners serving sentences; fourthly, the hired workers of the official eunuch families; and finally, Anji Fang. At the beginning of its founding, the government not only provided housing for those who needed to be protected, but also allocated housing according to the severity of their illness. Anjifang adopted the management mode of monks, and there were special supervisors and supervisors inside the organization, such as fire, cashier and doctor; outside, from the capital, down to the various roads, state, army and supervisors all had supervisors, checkpoints and checklists. In addition, Anjifang also had a set of strict supervision system. The so-called pre-inspection refers to the process from inspection and verification to registration, which is divided into four steps: on-the-spot inspection, registration, clearance of the crime, and inspection by officials. The main purpose is to make up for the oversight in the pre monitoring process and prevent the crafty and sly people from taking advantage of the opportunity to defraud national security.
After introducing the background of the emergence of Anji Fang and the concrete contents of its implementation, the fourth chapter expounds the whole development process of Anji Fang in the Song Dynasty. Under the influence of Anle Fang, the government began to set up Anji Fang in the whole country. Anji Fang still adopted the model of monks'presiding over it, which was supervised and financially supported by the government. After the sixth year of Xuanhe (1124 A.D.), Cai Jing sent his official address. The imperial court, mindful of his past words and deeds, ordered the restoration of Anji Square in April the following year.
The fifth chapter mainly analyzes the pros and cons of the Anji Fang system and its influence on the later generations.Any system always has its imperfections, so does Anji Fang.For the defects of the Anji Fang system, this paper mainly points out two aspects: one is the instability of the policy; the other is the oversight process. In the period of the Southern Song Dynasty, the influence of Anji Fang became weaker and weaker. After the collapse of the Southern Song Dynasty, Anji Fang withdrew from the historical stage permanently. However, as the most complete official medical security institution in the feudal society of China, Anji Fang exerted a far-reaching influence on the development and establishment of medical security institutions in the later dynasties, such as the emergence and development of the ancestral village, the Huimin Pharmaceutical And the growth of private philanthropy.
Chapter 6 is a supplement and improvement of the previous content, and the second is a few suggestions for the current "medical reform" situation. Compared with the medical security institutions before the Song Dynasty, Anji Fang has been strengthened in terms of system, organization and spirit, and has achieved transcendence. In order to affirm and draw lessons from the current situation of the "new medical reform", the author mainly discusses how to improve and perfect the medical security system and promote the "new doctor" from the following four aspects: the construction of social ethics and morality, the guarantee of adequate financial funds, the government's leading responsibility in the provision of basic medical services, and the gradual transformation of government investment to the demand side. The smooth implementation of reform.
【学位授予单位】:西南财经大学
【学位级别】:硕士
【学位授予年份】:2011
【分类号】:D691;R-09
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