我国城市医疗救助制度分析及其完善研究
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摘要
改革开放以来,我国经济保持平稳较快发展,经济实力不断增强,人民生活水平明显提高。但在社会转型期中,伴随经济增长方式的转变,经济结构、产业结构和就业结构的调整,也同时出现了失业、收入差距拉大、看病贵、看病难、贫病循环等社会问题。贫富分化限制了贫困者对卫生服务的利用,并对其健康产生了负面影响。社会排斥研究通过对社会排斥向度与测量的分析,将健康领域列为社会排斥问题之一。而医疗救助制度作为医疗保障体系的重要组成部分,是对包括医疗资源、社会群体地位及其权利资源等在内的各种经济社会资源进行重新配置,以降低贫困群体的疾病风险,减轻他们的疾病医疗费用负担,保证社会相对公正,具有促进社会融合的作用。本文着重对我国城市医疗救助对象如何能以真正公民的身份更充分地获得必要的医疗资源,从而整合于社会医疗保障体系中进行研究。
本文研究的目的在于,针对医疗救助制度中的排斥因素,力求完善救助制度,发挥其整合作用,以充分体现社会公民权；关注对救助对象(家庭)的人力投资,发挥其参与作用,以体现激发权能的福利思想;创造和谐环境,发挥公民社会提供福利的作用,在促进救助对象社会融合的过程中提高其医疗保障水平。本文具体的研究结构如下：
第一章绪论首先提出问题,明确概念和研究内容,然后是对本文研究背景的具体介绍,最后在研究综述的基础上指明研究意义和研究思路。
第二章系统地提出医疗救助制度分析与完善研究的国内外基础理论,它包括：社会公民权利理论、社会公平理论、福利经济学的社会救助思想、《贝弗里奇报告》、社会排斥与社会融合理论、三次分配理论及底线公平理论等。本文是通过对我国城市医疗救助制度的分析,力求发现其存在的排斥因素并进行完善研究,因而本章在理论阐述中提炼了社会排斥与社会融合理论的核心内涵,表明了理论间的关系。以此为理论依据,探求完善医疗救助的措施。
第三章是对我国城市医疗救助制度发展的梳理,并对其发挥融合作用进行评析。一方面,我国城市医疗救助制度的发展,在保障贫困群体健康权益,促进社会和谐发展方面起到了重要作用；另一方面,作为医疗保障制度框架基础部分和社会安全网网底的医疗救助制度,在发挥保障和融合作用方面并不充分,因而需要更加完善的回应性的制度安排,需要制度创新。
第四章是基于福利三角框架,对医疗救助的融合性做进一步深入分析。针对医疗救助在政策、资金、技术、制度衔接及社区救助等方面存在的排斥因素,运用福利三角理论分析法,通过对提供保障的国家、提供机会的市场和提供团结的市民社会的分析,提出了医疗救助制度理念与目标框架以及实施福利三角下综合型医疗救助。
第五章运用比较研究法,通过对国外不同医疗保障模式的发达和发展中国家的比较分析,探讨医疗救助制度促进受助者医疗保障的一般性借鉴因素。这些国家包括：英国、德国、法国、美国、日本、新加坡、韩国、印度、泰国、菲律宾、墨西哥等。
第六章运用定性分析与定量分析相结合的方法,通过深度访谈和问卷调查对北京市顺义区医疗救助资源的供需状况进行实证研究,找出影响救助对象从制度中受益的因素,并对发现的制度供求缺口提出改进意见。
依据整合、参与、公民权利的实现、资源机会的获得、融合环境的创造等社会融合的核心内涵,通过第四章基于福利三角框架的医疗救助融合性分析、第五章对发达国家和发展中国家医疗救助借鉴性分析及第六章以顺义区为例对城市医疗救助实施进行实证分析,本文在结束语部分对全文研究得出结论：
第一,医疗救助制度理念与目标应遵循一定的价值伦理原则。本文认为,如果以人人享有基本医疗卫生服务为根本出发点和落脚点,针对贫困群体医疗保障不足所表现的社会排斥,从医疗救助的责任主体来看,应强调政府的主导责任。提供保障的国家应从被动出台补救政策向主动回应转变,通过积极主动的制度安排保证公民权利的实现,以达到反社会排斥、促进社会融合为目标。
第二,通过立法确立救助对象获得医疗救助的权利。医疗救助是社会救助的重要内容,医疗救助是以政府为主体的行为,实现医疗救助工作法制化,是这一制度的内在要求,也是维护国民社会救助权利和约束政府承担医疗救助责任的保障。
第三,为救助对象提供基本健康服务以实现全民共享。消除制度中的排斥因素,就是要充分考虑救助对象如何公平享受医疗资源的机会。首先,有助于提高救助对象基本医疗利用率的资金筹集和使用是基础。其次,有助于实现救助对象对基本医疗服务可及的制度安排是关键。
第四,为救助对象创造融合环境以体现发展型福利思想。新福利经济学的社会救助思想和中国发展研究基金会提出的构建全民共享的发展型社会福利体系,更关注人的权利和能力的提高,这也为医疗救助提出了更高的要求,因而我们应更加关注救助对象健康融合环境的创造。通过制度内创新,增强救助对象的自我保障意识；医疗救助与社会福利安排相结合,提升救助对象的社会参与能力；发挥城镇社区的社会功能,充分维护救助对象的权益。
第五,为救助对象提供可及的卫生服务供给。在关注公立医院、发展社区卫生服务的同时,政府还应推动私立医院的发展,引入民营资本举办的非营利性医疗机构作为定点医院,鼓励它们担负一定的社会责任。
本文的特色与创新之处主要有三个方面：
第一,视角新。内容上不单纯就医疗救助制度研究医疗救助制度,而是依托“全民共享的发展型社会福利体系”背景下,拓宽思路,探讨救助对象能够更充分地获得医疗资源,从而整合于社会医疗保障体系的融合因素,因而丰富了此领域的研究成果。
第二,方法新。社会排斥与社会融合理论中基于福利三角框架的分析,以往研究多是从宏观层面对国家、市场和社会多种制度安排结构的分析,本文从微观层面将我国医疗救助对象纳入福利三角框架中对其医疗保障进行深层次分析,是对福利三角框架分析的一种演进。
第三,理念有新意。以往对社会救助的研究多以传统的国外理论为基础,而本文引入了国外社会排斥与社会融合理论和国内底线公平理论,不仅倡导融合方向,提出了新的制度理念与目标,而且提炼了社会排斥与社会融合的核心内涵,支持和促进了理论的发展。
本文主要在两个方面存在不足：国外医疗救助实施情况的资料收集还不够充分,对各国了解的内容不均衡,如能搜集更多的材料,会挖掘到更全面的借鉴因素；实证研究中量化分析有限,如能补充更多的量化指标,会进一步增强调研结果的说服力。
Since the reform and opening-up policy, our country has maintained stable and rapid development in economy, therefore, the economic strength keeps growing continuously, and the people's living standard has been significantly improved. However, during the social transformation, the social problems, such as the unemployment, increased income differential, difficulty and high cost of getting medical care, and poverty-disease circulation, arise with the change of the economic growth mode and the adjustment of the economic structure, industrial structure and employment structure. The polarization between the rich and the poor imposes restrictions on the use of health services by the poor, and has a negative effect on the health of the poor. A social exclusion study lists the health field as one of the social exclusion problems through the analysis of the dimension and measurement of the social exclusion. The medical assistance system, as an important part of the medical security system, reallocates various economic and social resources such as medical resources, social group status and right resources of the social groups to lower the disease risks of the poor groups and reduce their burdens of medical expenses and guarantee the relatively fairness, and has an effect on promoting the social inclusion-this article emphasizes the study on how the urban medical assistance objects of our country obtain the necessary medical resources as real citizens, thereby being integrated into the social medical security system.
This study aims at perfecting the assistance system and exerting its inclusion effect to sufficiently reflect the social civil rights for the exclusion factors in the medical assistance system; paying close attention to the human capital investment to the assistance objects (families) and exerting their participation effect to reflect the empowering welfare thought; and creating a harmonious environment and exerting the people's society's function to provide social welfare for citizens, and increasing their medical security level in the process of promoting the social inclusion of the assistance objects. The specific study structure of this article is as follows:
Chapter I Introduction. First of all, introduces questions and makes concepts and study contents clear; then, makes a specific introduction to the study background of this article; and at last, specifies the significance and thinking of the study based on the study review.
Chapter II Systematically proposes the domestic and overseas basic theories of Medical Assistance System Analysis and Improvement, including social civil right theory, social fairness theory, social assistance thoughts of welfare economics. Beveridge Report, social exclusion and social inclusion theory, triple distribution theory, baseline equality theory and the like.This paper is based on our country city medical assistance system analysis.to find its existing exclusion factors and improvement. so this chapter refines the core connotation of social exclusion and social inclusion theory, shows the relationship between the theory. This as the theory basis, to seek improvement of medical assistance measures.
Chapter III Reviews the development of the urban medical assistance system of our country and makes comments on its inclusion effect. On the one hand, the development of the urban medical assistance system of our country plays a vital role in guaranteeing the healthy rights and interests of the poor groups and promoting the social harmonious development; on the other hand, the medical assistance system, as the basic part of the medical security system frame and the foundation of the social security net, is insufficient in exerting of guaranteeing and inclusion effects; thus, the system arrangement of the responsiveness is required to be more perfect and the system is required to be innovated.
Chapter IV Makes further analysis of the inclusion of the medical assistance based on the welfare triangle frame. For the exclusion factors of the medical assistance in policies, funds, technology, system connection, community assistance and the like, adopts the welfare triangle theoretical analysis method and proposes the medical assistance system concept and target frame as well as the implementation of welfare triangle under the integrated medical assistance through the analysis of countries providing security, markets providing opportunities and citizen society providing unity.
Chapter V Utilizes a comparative method, and discusses the general reference factors of the medical assistance system to promote the health security of the recipients through the comparative analysis of different foreign medical security modes in developed and developing countries. Such countries include UK, Germany, France, USA, Japan, Singapore, Korea, India, Thailand, Philippines, Mexico and the like.
Chapter VI Utilizes a method combining qualitative analysis and quantitative analysis, performs an empirical study on the supply and demand status of the medical assistance resources in Shunyi District of Beijing through deep interview and questionnaire survey to find out factors of affecting the assistance objects benefitting from the system and give improvement advice for the found supply and demand gap of the system.
This article comes to a conclusion for the whole study in the summary part pursuant to the core intension of the social inclusion such as inclusion, participation, realization of civil rights, obtaining of resource opportunities and creation of inclusion environments through the medical assistance inclusion analysis based on the welfare triangle frame in Chapter IV, the medical assistance reference analysis of the developed and developing countries in Chapter V, and the empirical analysis of city medical assistance to carry out taking Shunyi District as example in Chapter VI:
Firstly, the medical assistance system concept and target shall comply with certain value and ethics principles. This article considers that the governmental leading responsibilities shall be emphasized for the social exclusion represented by the insufficient medical security of the poor groups from the responsibility subject of the medical assistance in the case where that everyone enjoys the basic medical care and health services is taken as the fundamental start point and foothold. The countries providing the security shall change to active response from passive issuing of remedial policies and ensure the realization of the civil rights through the active system arrangement to achieve the targets of being against the social exclusion and promoting the social inclusion.
Secondly, establish the rights of the assistance objects obtaining the medical assistance through legalization. The medical assistance is the important content of the social assistance and is a behavior taking the government as a subject, and the realization of the legalization of the medical assistance is an inherent requirement of this system and is also the guaranty of safeguarding national society assistance rights and defining the medical assistance responsibilities undertaken by the government.
Thirdly, provide basic health services for the assistance objects in order to achieve the sharing. To eliminate the exclusion factors in the system is to fully consider how the assistance object to fairly enjoy the opportunities of the medical resources. First of all, the contribution to the increasing of the fund procurement and use in the medical treatment use ratio of the assistance objects is the foundation, and then, the contribution to the realization of the system arrangement that the assistance objects are accessible to the basic medical services is critical.
Fourthly, create an inclusion environment for the assistance objects in order to reflect the development of the welfare thought. The social assistance thoughts of the new welfare economics and the developmental social welfare system enjoyed by all proposed by the China Development Research Foundation pay more attention to the improving of the human rights and abilities, which expresses a higher requirement on the medical assistance; therefore, we shall pay more attention to the creation of the healthy inclusion environment for the assistance objects. Enhance the self-protection awareness of the assistance objects through the innovation in the system:combine the medical assistance with the social welfare arrangement, improve the social participation ability of the assistance objects, and exert the social function of the town's communities to fully safeguard the rights and interests of the assistance object.
Fifthly, provide accessible health service supply for the assistance objects. While paying close attention to the public hospitals and developing the community health services, the government shall also promote the development of private hospitals, introduce the private capital to found non-profit medical institutions as designated hospitals, and encourage them to assume certain social responsibilities.
The features and innovation of this article are mainly in three aspects:
Firstly, new perspectives. It does not simply study the medical assistance system based on the medical assistance system in contents, but based on the "developmental social welfare system enjoyed by all" expands the ideas and discusses how the assistance objects are able to fully obtain the medical resources to be integrated into the inclusion factors of the social medical security system, thereby enriching the study findings in such field.
Secondly, new methods. In the former studies, the analysis based on the welfare triangle framework in the social exclusion and social inclusion theory was analysis of the various system arrangement structures of the countries, markets and society macroscopically, while this article includes the medical assistance objects of our country to the welfare triangle framework microscopically and performs deep analysis on their medical security, which is an evolution of the welfare triangle framework analysis.
Thirdly, the innovative concepts. The former studies on the social assistance were based on the traditional foreign theories, while this article introduces the foreign social exclusion and social inclusion theory and the domestic baseline equality theory, advocates the inclusion direction, proposes new system concepts and targets, refines the core intension of the social exclusion and social inclusion, supports and promotes the theory development.
There're mainly two limitations in this article:the data collection of the implementation situation of the foreign medical assistance is not sufficient, and the awareness of the countries is imbalanced; if more data are collected, the more comprehensive reference factors may be developed. The quantitative analysis in the empirical study is limited; if more quantitative indexes are supplemented, the conviction of the research findings may be further improved.
本文研究的目的在于,针对医疗救助制度中的排斥因素,力求完善救助制度,发挥其整合作用,以充分体现社会公民权；关注对救助对象(家庭)的人力投资,发挥其参与作用,以体现激发权能的福利思想;创造和谐环境,发挥公民社会提供福利的作用,在促进救助对象社会融合的过程中提高其医疗保障水平。本文具体的研究结构如下：
第一章绪论首先提出问题,明确概念和研究内容,然后是对本文研究背景的具体介绍,最后在研究综述的基础上指明研究意义和研究思路。
第二章系统地提出医疗救助制度分析与完善研究的国内外基础理论,它包括：社会公民权利理论、社会公平理论、福利经济学的社会救助思想、《贝弗里奇报告》、社会排斥与社会融合理论、三次分配理论及底线公平理论等。本文是通过对我国城市医疗救助制度的分析,力求发现其存在的排斥因素并进行完善研究,因而本章在理论阐述中提炼了社会排斥与社会融合理论的核心内涵,表明了理论间的关系。以此为理论依据,探求完善医疗救助的措施。
第三章是对我国城市医疗救助制度发展的梳理,并对其发挥融合作用进行评析。一方面,我国城市医疗救助制度的发展,在保障贫困群体健康权益,促进社会和谐发展方面起到了重要作用；另一方面,作为医疗保障制度框架基础部分和社会安全网网底的医疗救助制度,在发挥保障和融合作用方面并不充分,因而需要更加完善的回应性的制度安排,需要制度创新。
第四章是基于福利三角框架,对医疗救助的融合性做进一步深入分析。针对医疗救助在政策、资金、技术、制度衔接及社区救助等方面存在的排斥因素,运用福利三角理论分析法,通过对提供保障的国家、提供机会的市场和提供团结的市民社会的分析,提出了医疗救助制度理念与目标框架以及实施福利三角下综合型医疗救助。
第五章运用比较研究法,通过对国外不同医疗保障模式的发达和发展中国家的比较分析,探讨医疗救助制度促进受助者医疗保障的一般性借鉴因素。这些国家包括：英国、德国、法国、美国、日本、新加坡、韩国、印度、泰国、菲律宾、墨西哥等。
第六章运用定性分析与定量分析相结合的方法,通过深度访谈和问卷调查对北京市顺义区医疗救助资源的供需状况进行实证研究,找出影响救助对象从制度中受益的因素,并对发现的制度供求缺口提出改进意见。
依据整合、参与、公民权利的实现、资源机会的获得、融合环境的创造等社会融合的核心内涵,通过第四章基于福利三角框架的医疗救助融合性分析、第五章对发达国家和发展中国家医疗救助借鉴性分析及第六章以顺义区为例对城市医疗救助实施进行实证分析,本文在结束语部分对全文研究得出结论：
第一,医疗救助制度理念与目标应遵循一定的价值伦理原则。本文认为,如果以人人享有基本医疗卫生服务为根本出发点和落脚点,针对贫困群体医疗保障不足所表现的社会排斥,从医疗救助的责任主体来看,应强调政府的主导责任。提供保障的国家应从被动出台补救政策向主动回应转变,通过积极主动的制度安排保证公民权利的实现,以达到反社会排斥、促进社会融合为目标。
第二,通过立法确立救助对象获得医疗救助的权利。医疗救助是社会救助的重要内容,医疗救助是以政府为主体的行为,实现医疗救助工作法制化,是这一制度的内在要求,也是维护国民社会救助权利和约束政府承担医疗救助责任的保障。
第三,为救助对象提供基本健康服务以实现全民共享。消除制度中的排斥因素,就是要充分考虑救助对象如何公平享受医疗资源的机会。首先,有助于提高救助对象基本医疗利用率的资金筹集和使用是基础。其次,有助于实现救助对象对基本医疗服务可及的制度安排是关键。
第四,为救助对象创造融合环境以体现发展型福利思想。新福利经济学的社会救助思想和中国发展研究基金会提出的构建全民共享的发展型社会福利体系,更关注人的权利和能力的提高,这也为医疗救助提出了更高的要求,因而我们应更加关注救助对象健康融合环境的创造。通过制度内创新,增强救助对象的自我保障意识；医疗救助与社会福利安排相结合,提升救助对象的社会参与能力；发挥城镇社区的社会功能,充分维护救助对象的权益。
第五,为救助对象提供可及的卫生服务供给。在关注公立医院、发展社区卫生服务的同时,政府还应推动私立医院的发展,引入民营资本举办的非营利性医疗机构作为定点医院,鼓励它们担负一定的社会责任。
本文的特色与创新之处主要有三个方面：
第一,视角新。内容上不单纯就医疗救助制度研究医疗救助制度,而是依托“全民共享的发展型社会福利体系”背景下,拓宽思路,探讨救助对象能够更充分地获得医疗资源,从而整合于社会医疗保障体系的融合因素,因而丰富了此领域的研究成果。
第二,方法新。社会排斥与社会融合理论中基于福利三角框架的分析,以往研究多是从宏观层面对国家、市场和社会多种制度安排结构的分析,本文从微观层面将我国医疗救助对象纳入福利三角框架中对其医疗保障进行深层次分析,是对福利三角框架分析的一种演进。
第三,理念有新意。以往对社会救助的研究多以传统的国外理论为基础,而本文引入了国外社会排斥与社会融合理论和国内底线公平理论,不仅倡导融合方向,提出了新的制度理念与目标,而且提炼了社会排斥与社会融合的核心内涵,支持和促进了理论的发展。
本文主要在两个方面存在不足：国外医疗救助实施情况的资料收集还不够充分,对各国了解的内容不均衡,如能搜集更多的材料,会挖掘到更全面的借鉴因素；实证研究中量化分析有限,如能补充更多的量化指标,会进一步增强调研结果的说服力。
Since the reform and opening-up policy, our country has maintained stable and rapid development in economy, therefore, the economic strength keeps growing continuously, and the people's living standard has been significantly improved. However, during the social transformation, the social problems, such as the unemployment, increased income differential, difficulty and high cost of getting medical care, and poverty-disease circulation, arise with the change of the economic growth mode and the adjustment of the economic structure, industrial structure and employment structure. The polarization between the rich and the poor imposes restrictions on the use of health services by the poor, and has a negative effect on the health of the poor. A social exclusion study lists the health field as one of the social exclusion problems through the analysis of the dimension and measurement of the social exclusion. The medical assistance system, as an important part of the medical security system, reallocates various economic and social resources such as medical resources, social group status and right resources of the social groups to lower the disease risks of the poor groups and reduce their burdens of medical expenses and guarantee the relatively fairness, and has an effect on promoting the social inclusion-this article emphasizes the study on how the urban medical assistance objects of our country obtain the necessary medical resources as real citizens, thereby being integrated into the social medical security system.
This study aims at perfecting the assistance system and exerting its inclusion effect to sufficiently reflect the social civil rights for the exclusion factors in the medical assistance system; paying close attention to the human capital investment to the assistance objects (families) and exerting their participation effect to reflect the empowering welfare thought; and creating a harmonious environment and exerting the people's society's function to provide social welfare for citizens, and increasing their medical security level in the process of promoting the social inclusion of the assistance objects. The specific study structure of this article is as follows:
Chapter I Introduction. First of all, introduces questions and makes concepts and study contents clear; then, makes a specific introduction to the study background of this article; and at last, specifies the significance and thinking of the study based on the study review.
Chapter II Systematically proposes the domestic and overseas basic theories of Medical Assistance System Analysis and Improvement, including social civil right theory, social fairness theory, social assistance thoughts of welfare economics. Beveridge Report, social exclusion and social inclusion theory, triple distribution theory, baseline equality theory and the like.This paper is based on our country city medical assistance system analysis.to find its existing exclusion factors and improvement. so this chapter refines the core connotation of social exclusion and social inclusion theory, shows the relationship between the theory. This as the theory basis, to seek improvement of medical assistance measures.
Chapter III Reviews the development of the urban medical assistance system of our country and makes comments on its inclusion effect. On the one hand, the development of the urban medical assistance system of our country plays a vital role in guaranteeing the healthy rights and interests of the poor groups and promoting the social harmonious development; on the other hand, the medical assistance system, as the basic part of the medical security system frame and the foundation of the social security net, is insufficient in exerting of guaranteeing and inclusion effects; thus, the system arrangement of the responsiveness is required to be more perfect and the system is required to be innovated.
Chapter IV Makes further analysis of the inclusion of the medical assistance based on the welfare triangle frame. For the exclusion factors of the medical assistance in policies, funds, technology, system connection, community assistance and the like, adopts the welfare triangle theoretical analysis method and proposes the medical assistance system concept and target frame as well as the implementation of welfare triangle under the integrated medical assistance through the analysis of countries providing security, markets providing opportunities and citizen society providing unity.
Chapter V Utilizes a comparative method, and discusses the general reference factors of the medical assistance system to promote the health security of the recipients through the comparative analysis of different foreign medical security modes in developed and developing countries. Such countries include UK, Germany, France, USA, Japan, Singapore, Korea, India, Thailand, Philippines, Mexico and the like.
Chapter VI Utilizes a method combining qualitative analysis and quantitative analysis, performs an empirical study on the supply and demand status of the medical assistance resources in Shunyi District of Beijing through deep interview and questionnaire survey to find out factors of affecting the assistance objects benefitting from the system and give improvement advice for the found supply and demand gap of the system.
This article comes to a conclusion for the whole study in the summary part pursuant to the core intension of the social inclusion such as inclusion, participation, realization of civil rights, obtaining of resource opportunities and creation of inclusion environments through the medical assistance inclusion analysis based on the welfare triangle frame in Chapter IV, the medical assistance reference analysis of the developed and developing countries in Chapter V, and the empirical analysis of city medical assistance to carry out taking Shunyi District as example in Chapter VI:
Firstly, the medical assistance system concept and target shall comply with certain value and ethics principles. This article considers that the governmental leading responsibilities shall be emphasized for the social exclusion represented by the insufficient medical security of the poor groups from the responsibility subject of the medical assistance in the case where that everyone enjoys the basic medical care and health services is taken as the fundamental start point and foothold. The countries providing the security shall change to active response from passive issuing of remedial policies and ensure the realization of the civil rights through the active system arrangement to achieve the targets of being against the social exclusion and promoting the social inclusion.
Secondly, establish the rights of the assistance objects obtaining the medical assistance through legalization. The medical assistance is the important content of the social assistance and is a behavior taking the government as a subject, and the realization of the legalization of the medical assistance is an inherent requirement of this system and is also the guaranty of safeguarding national society assistance rights and defining the medical assistance responsibilities undertaken by the government.
Thirdly, provide basic health services for the assistance objects in order to achieve the sharing. To eliminate the exclusion factors in the system is to fully consider how the assistance object to fairly enjoy the opportunities of the medical resources. First of all, the contribution to the increasing of the fund procurement and use in the medical treatment use ratio of the assistance objects is the foundation, and then, the contribution to the realization of the system arrangement that the assistance objects are accessible to the basic medical services is critical.
Fourthly, create an inclusion environment for the assistance objects in order to reflect the development of the welfare thought. The social assistance thoughts of the new welfare economics and the developmental social welfare system enjoyed by all proposed by the China Development Research Foundation pay more attention to the improving of the human rights and abilities, which expresses a higher requirement on the medical assistance; therefore, we shall pay more attention to the creation of the healthy inclusion environment for the assistance objects. Enhance the self-protection awareness of the assistance objects through the innovation in the system:combine the medical assistance with the social welfare arrangement, improve the social participation ability of the assistance objects, and exert the social function of the town's communities to fully safeguard the rights and interests of the assistance object.
Fifthly, provide accessible health service supply for the assistance objects. While paying close attention to the public hospitals and developing the community health services, the government shall also promote the development of private hospitals, introduce the private capital to found non-profit medical institutions as designated hospitals, and encourage them to assume certain social responsibilities.
The features and innovation of this article are mainly in three aspects:
Firstly, new perspectives. It does not simply study the medical assistance system based on the medical assistance system in contents, but based on the "developmental social welfare system enjoyed by all" expands the ideas and discusses how the assistance objects are able to fully obtain the medical resources to be integrated into the inclusion factors of the social medical security system, thereby enriching the study findings in such field.
Secondly, new methods. In the former studies, the analysis based on the welfare triangle framework in the social exclusion and social inclusion theory was analysis of the various system arrangement structures of the countries, markets and society macroscopically, while this article includes the medical assistance objects of our country to the welfare triangle framework microscopically and performs deep analysis on their medical security, which is an evolution of the welfare triangle framework analysis.
Thirdly, the innovative concepts. The former studies on the social assistance were based on the traditional foreign theories, while this article introduces the foreign social exclusion and social inclusion theory and the domestic baseline equality theory, advocates the inclusion direction, proposes new system concepts and targets, refines the core intension of the social exclusion and social inclusion, supports and promotes the theory development.
There're mainly two limitations in this article:the data collection of the implementation situation of the foreign medical assistance is not sufficient, and the awareness of the countries is imbalanced; if more data are collected, the more comprehensive reference factors may be developed. The quantitative analysis in the empirical study is limited; if more quantitative indexes are supplemented, the conviction of the research findings may be further improved.
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卫生部：2009-2011年中国卫生统计年鉴
[1]民政部：2005-2009年民政事业发展统计报告
[2]民政部：2010年社会服务发展统计报告
[3]民政部：2006年城市医疗救助试点工作年度报告
[4]民政部：2007年上半年城市医疗救助工作分析报告
[5]民政部：2010年1—6月全国城乡医疗救助工作进展情况的通报
[6]卫生部：1993年第一次国家卫生服务调查分析报告
[7]卫生部：1998年第二次国家卫生服务调查分析报告
[8]卫生部：2003年第三次国家卫生服务调查分析报告
[9]卫生部：2008年第四次国家卫生服务调查分析报告
[10]卫生部：2009年中国卫生统计提要
[11]卫生部：2011年中国卫生统计提要
[12]统计局：中国全面建设小康社会进程统计监测报告(2011)
[1]http://www.moh.gov.cn,中华人民共和国卫生部
[2]http://www.mohrss.gov.cn中华人民共和国人力资源和社会保障部
[3]http://www.drcnet.com.cn,国务院发展研究中心信息网
[4]http://www.ChinaHRD.net中国人力资源开发网
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3杰克逊和斯科特.工作融合了孩子吗?关于家庭收入、时间和压力劳动力市场的效果.莱德劳基金,2002.
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卫生部：2009-2011年中国卫生统计年鉴
[1]民政部：2005-2009年民政事业发展统计报告
[2]民政部：2010年社会服务发展统计报告
[3]民政部：2006年城市医疗救助试点工作年度报告
[4]民政部：2007年上半年城市医疗救助工作分析报告
[5]民政部：2010年1—6月全国城乡医疗救助工作进展情况的通报
[6]卫生部：1993年第一次国家卫生服务调查分析报告
[7]卫生部：1998年第二次国家卫生服务调查分析报告
[8]卫生部：2003年第三次国家卫生服务调查分析报告
[9]卫生部：2008年第四次国家卫生服务调查分析报告
[10]卫生部：2009年中国卫生统计提要
[11]卫生部：2011年中国卫生统计提要
[12]统计局：中国全面建设小康社会进程统计监测报告(2011)
[1]http://www.moh.gov.cn,中华人民共和国卫生部
[2]http://www.mohrss.gov.cn中华人民共和国人力资源和社会保障部
[3]http://www.drcnet.com.cn,国务院发展研究中心信息网
[4]http://www.ChinaHRD.net中国人力资源开发网
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