农村基本医疗卫生体系建设中的地方政府——基于宁波市江北区的研究

基本公共服务均等化是缩小城乡差距、统筹城乡发展的重要途径.政府在构建农村基本医疗卫生体系中必须发挥关键性作用.中央政府应承担其中的财政投入、目标规划、政策制定和政府间协调职能,而地方政府可以承担农村基本医疗卫生服务的主要生产者、提供者、制度建构者和监管者等多重角色.宁波市江北区的经验表明:地方政府可以是公共卫生服务的主要生产者,其目标是建立起城乡一体化的公共卫生系统;地方政府可以是基本医疗保障体系的安排者,其责任是建立起覆盖城乡的基本医疗保障体系;在基本医疗服务体系中,政府既可能是生产者,也可能是安排者,因此,地方政府往往以生产者、提供者和监管者的多重角色促进基本医疗服务提供的可及性和均等性.

The Role of Local Governments in the Construction of Primary Health Care System in Rural Areas: A Case of Jiangbei District,Ningbo City

The equalization of basic public services has been seen as an important way to reduce urban-rural disparities and coordinate urban-rural developments.A vital recognition is that the governments have to play critical roles in the construction of the rural health care system.The Central Government must take the responsibility of increasing financial investments,establishing national health goals,improving national health policies,and enhancing inter-governmental coordination to rebuild the rural primary health care system.Meanwhile,the multiple characteristics of local governments in the primary health care system can be divided into major producer,provider and supervisor.The research on the case of Jiangbei District in Ningbo City gives us an idea that the local government can be:(1) a major producer of public health services, who sets up an urban-rural integrated public health system;(2) a provider in medicare and medicaid services,who institutes a planned overall urban-rural medical security system;(3)and a producer or provider in primary health services,who depends on the cost of bureaucratized system and cost of transaction.The role of local governments as a supervisor is also capable of improving the primary health service and promoting equity and accessibility in public services.