基于罗尔斯正义论的我国医疗保障制度改革的伦理思考

发布时间：2018-12-19 10:09

【摘要】：随着全面建设小康社会总目标的不断推进,人们生活水平日益提高,温饱问题逐渐得到解决,“个人权益是否得以保障”逐渐上升到了人人关心的社会层面,尤其是涉及到个人切身利益的社会保障制度的设立、实施以及改革等问题都无一不引起国人的关注。随着近年来医闹事件、挂号难事件、因病返贫困境等等一系列医疗问题的不断涌现,医疗改革已连续多年成为两会热点问题,缓解甚至解决这些医疗问题刻不容缓,在医疗改革过程中“保基本”的医疗保障制度发挥着无可替代的作用。改革医疗卫生体系最重要的无疑是解决“由谁来提供医疗服务”和“由谁来支付医疗费用”这两个问题,其中尤为重要的是解决“由谁来支付医疗费用”这一问题,这就需要发挥医疗保障制度的作用了。只有发挥出医疗保障制度应有的作用,才能实现使老百姓“有钱看病”的目标。然而,事实是我国医疗保障制度在实施过程中出现了许多问题,其中最突出的就是公平性问题,如果不能妥善地处理好我国医疗保障制度公平性问题,将不能发挥出它应有的作用。我国医疗保障制度公平性问题从制度设立之初就一直存在,针对如何解决这一问题不少专家学者从社会改革、经济建设、政府职能等各个方面给出了自己的看法,唯独缺少从伦理的角度进行分析。任何制度都是需要理论支持,而罗尔斯“正义论”自发表之初就一直被认为是政治哲学和道德伦理学的重要著作,借鉴这一理论对指导医疗保障制度改革有重要意义。本文主要分为四个部分来探讨我国医疗保障制度改革与罗尔斯正义论的关系。第一部分是前言部分,介绍本文的研究目的、研究意义以及研究现状和创新点。第二部分是介绍罗尔斯正义论思想及简要分析,通过对正义、公平、公正以及罗尔斯正义论思想主要内容的分析,深化罗尔斯正义论的内涵；再通过罗尔斯正义论思想与其他正义论思想的对比,说明我国医疗保障制度改革要借鉴罗尔斯义论思想的意义。第三部分是我国医疗保障制度现状的分析,主要介绍我国医疗保障制度的历史发展进程,以及发展过程中存在的伦理困境,并找出我国医疗保障制度出现的伦理困境的原因。第四部分是基于罗尔斯正义论的我国医疗保障制度的伦理思考。通过分析罗尔斯正义论的政治伦理内涵,指出借鉴罗尔斯正义论伦理内涵对我国医疗保障制度改革的伦理启示。
[Abstract]:With the continuous advancement of the overall goal of building a well-off society in an all-round way, people's living standards are improving day by day, the problem of food and clothing is gradually solved, and whether the personal rights and interests are guaranteed has gradually risen to the social level that everyone cares about. In particular, the establishment, implementation and reform of the social security system, which involve personal interests, have attracted the attention of Chinese people. With the emergence of a series of medical problems in recent years, such as medical incidents, registered cases, and the plight of returning to poverty due to illness, medical reform has become a hot issue of the two sessions for many years, so it is urgent to alleviate or even solve these medical problems. In the process of medical reform, the basic medical security system plays an irreplaceable role. Undoubtedly, the most important thing in reforming the health care system is to solve the two problems of "who will provide medical services" and "who will pay for medical expenses", especially the issue of "who pays for medical expenses?" This needs to give play to the role of medical security system. Only by exerting the function of medical security system, can we realize the goal of making people have money to see a doctor. However, the fact is that there are many problems in the implementation of our medical security system, among which the most prominent one is fairness. If we cannot properly handle the fairness of our medical security system, Will not play its due role. The fairness of the medical security system in China has existed since the beginning of its establishment. Many experts and scholars have put forward their own views on how to solve this problem from the aspects of social reform, economic construction, government functions, etc. However, there is a lack of ethical analysis. Any institution needs theoretical support, but Rawls' theory of justice has been regarded as an important work of political philosophy and moral ethics since the beginning of its publication. It is of great significance to use this theory for reference in guiding the reform of medical security system. This paper is divided into four parts to discuss the relationship between the reform of medical security system and Rawls' theory of justice. The first part is the preface, which introduces the purpose, significance, research status and innovation of this paper. The second part is to introduce Rawls' theory of justice and brief analysis, through the analysis of justice, fairness, justice and the main content of Rawls' theory of justice, deepen the connotation of Rawls' theory of justice; Through the comparison between Rawls' theory of justice and other ideas of justice, the author points out that the reform of medical security system in our country should draw lessons from Rawls' theory of justice. The third part is the analysis of the current situation of the medical security system in our country, mainly introduces the historical development process of the medical security system of our country, as well as the ethical dilemma existing in the development process, and finds out the reasons for the ethical dilemma in the medical security system of our country. The fourth part is the ethical thinking of medical security system based on Rawls' theory of justice. By analyzing the political and ethical connotation of Rawls' theory of justice, the author points out that drawing lessons from the ethical connotation of Rawls' theory of justice can enlighten the reform of medical security system in China.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：F842.684

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