【摘要】：西藏地處祖國西南邊陲，自然環(huán)境、氣候條件特殊，全區(qū)303.30萬人,其中男性人口為155.29萬人，女性人口是148.01萬人口,農(nóng)牧區(qū)的人口占全區(qū)人口比例的75.9%，大約是220萬。較快的人口增長(zhǎng)率和較慢的收入增長(zhǎng)以及落后的基礎(chǔ)設(shè)施建設(shè)是目前西藏自治區(qū)面臨的主要問題。 西藏農(nóng)牧區(qū)醫(yī)療系統(tǒng)是基于免費(fèi)的醫(yī)療保障系統(tǒng),改革開放30年來，隨著西藏人民生活質(zhì)量的提高和人口數(shù)量的逐年增加，西藏農(nóng)牧區(qū)對(duì)醫(yī)療保健的需求也不斷的提高、醫(yī)療衛(wèi)生服務(wù)范圍也隨之不斷擴(kuò)大，但是政府免費(fèi)的醫(yī)療資金已經(jīng)遠(yuǎn)遠(yuǎn)不能滿足基本醫(yī)療和預(yù)防保健的需求。1993年的時(shí)候頒布了《自治區(qū)免費(fèi)醫(yī)療暫行管理辦法》明確規(guī)定了西藏自治區(qū)地（市）、縣三級(jí)財(cái)政為農(nóng)牧民大眾每人每年的無償?shù)尼t(yī)療專項(xiàng)經(jīng)費(fèi)。1997年，根據(jù)中央政府關(guān)于衛(wèi)生改革與發(fā)展的決定，西藏自治區(qū)提出了在免費(fèi)醫(yī)療基礎(chǔ)上建立和推行農(nóng)牧區(qū)合作醫(yī)療制度，同年9月西藏自治區(qū)提出了建立和發(fā)展合作醫(yī)療試點(diǎn)的原則、措施等。12003年《西藏自治區(qū)免費(fèi)醫(yī)療暫行管理辦法》明確規(guī)定了農(nóng)牧區(qū)醫(yī)療制度覆蓋全區(qū)所有農(nóng)牧民，進(jìn)一步完善以免費(fèi)醫(yī)療為基礎(chǔ)的農(nóng)牧區(qū)醫(yī)療保障制度。到2006年底的時(shí)候，全區(qū)農(nóng)牧民合作醫(yī)療保障覆蓋的面積達(dá)到了74個(gè)縣（市），692個(gè)鄉(xiāng)鎮(zhèn)所有農(nóng)牧民。加強(qiáng)全區(qū)農(nóng)牧民醫(yī)療保障制度的建設(shè)，協(xié)調(diào)與全國各地區(qū)相一致的小康社會(huì)建設(shè)步調(diào)，切實(shí)實(shí)現(xiàn)農(nóng)牧民的醫(yī)療保障水平和利益、全區(qū)農(nóng)牧區(qū)衛(wèi)生事業(yè)的全面健康發(fā)展。 基于西藏的歷史，文化特征，，通過大量搜集文獻(xiàn)，分析西藏農(nóng)牧區(qū)合作醫(yī)療體系的現(xiàn)狀并從五個(gè)部分進(jìn)行論述： 第一章緒論，對(duì)文章研究的目的、意義及國內(nèi)外對(duì)農(nóng)村醫(yī)療體制研究進(jìn)行闡述。西藏處于祖國的西南邊陲，基礎(chǔ)設(shè)施落后，衛(wèi)生事業(yè)建設(shè)起步較晚，農(nóng)牧區(qū)農(nóng)牧民“看病難、看病貴、因病致貧、因病返貧”的現(xiàn)象十分嚴(yán)重，進(jìn)一步建立和完善農(nóng)牧區(qū)醫(yī)療保障制度，從而保障農(nóng)牧民能順利就醫(yī)、提高農(nóng)牧區(qū)的衛(wèi)生條件、質(zhì)量。 第二章對(duì)相關(guān)概念進(jìn)行界定和對(duì)相關(guān)理論進(jìn)行闡述。主要介紹醫(yī)療保障、城鎮(zhèn)醫(yī)療保障、農(nóng)村醫(yī)療保障及西藏農(nóng)牧區(qū)醫(yī)療保障的相關(guān)概念和公共物品理論、人力資本理論、公平效率理論。 第三章對(duì)農(nóng)牧區(qū)醫(yī)療保障制度的現(xiàn)狀進(jìn)行了分析；對(duì)醫(yī)療保障制度建設(shè)取得的成績(jī)、藏醫(yī)藥的發(fā)展進(jìn)行了回顧；對(duì)農(nóng)牧區(qū)農(nóng)牧民合作醫(yī)療的成效及存在的問題分析。 第四章對(duì)上海、山東、新疆等各省地區(qū)的農(nóng)村合作醫(yī)療取得的成效進(jìn)行了分析、比較，對(duì)西藏農(nóng)牧區(qū)農(nóng)牧民合作醫(yī)療的進(jìn)一步完善獲得可借鑒的經(jīng)驗(yàn)。 第五章提出了完善西藏農(nóng)牧區(qū)醫(yī)療保障制度的政策建議如：鞏固完善農(nóng)牧區(qū)醫(yī)療保障制度；進(jìn)一步完善醫(yī)療衛(wèi)生服務(wù)體系；提升農(nóng)牧區(qū)醫(yī)療人才隊(duì)伍素質(zhì)建設(shè)；普及和提高農(nóng)牧區(qū)醫(yī)療知識(shí)水平.繼承和發(fā)展藏醫(yī)藥事業(yè)。
[Abstract]:Tibet is located in the southwest border of the motherland, with a natural environment and special climatic conditions. There are 3.033 million people in the region, of whom 1.5529 million are male and 1.4801 million are female. The population of agricultural and pastoral areas accounts for 75.9 percent of the total population of the region. It's about 2.2 million. Rapid population growth rate and slow income growth, as well as backward infrastructure construction, are the main problems facing the Tibet Autonomous region at present. The medical care system in the agricultural and pastoral areas of Tibet is based on the free medical security system. In the past 30 years of reform and opening up, with the improvement of the quality of life of the Tibetan people and the increase of the population year by year, the demand for medical care in the agricultural and pastoral areas of Tibet has also continuously improved. The scope of medical and health services continues to expand, However, the government's free medical funds are far from meeting the needs of basic medical care and preventive health care. In 1993, the interim measures for the Administration of Free Medical Care in the Autonomous region were promulgated, which clearly stipulated the prefectures (municipalities) of the Tibet Autonomous region. The finance at the county level is a special annual free medical fund for farmers and herdsmen. In 1997, in accordance with the decision of the central government on health reform and development, The Tibet Autonomous region put forward the establishment and implementation of a cooperative medical system in agricultural and pastoral areas on the basis of free medical treatment, and in September of the same year, the Tibet Autonomous region put forward the principle of establishing and developing a pilot cooperative medical system. (1) in 2003, the interim measures for the Administration of Free Medical treatment in Tibet Autonomous region clearly stipulated that the medical treatment system in agricultural and pastoral areas covered all farmers and herdsmen in the whole region, and further improved the medical security system in agricultural and pastoral areas based on free medical treatment. By the end of 2006, the area covered by cooperative medical security for farmers and herdsmen in the region had reached 74 counties (cities) and 692 villages and towns. We will strengthen the construction of the medical security system for farmers and herdsmen in the whole region, coordinate the pace of building a well-off society in line with all regions of the country, realistically realize the level and interests of the medical security of farmers and herdsmen, and develop the health cause of the whole region in an all-round and healthy manner. Based on the historical and cultural characteristics of Tibet, this paper analyzes the present situation of cooperative medical system in agricultural and pastoral areas of Tibet through a large number of literature collection and discusses it from five parts: the first chapter is the introduction, the purpose of which is studied in this paper. The significance and the research of rural medical system at home and abroad are expounded. Tibet is located in the southwest border of the motherland, the infrastructure is backward, the construction of health services starts relatively late, and the phenomenon of "difficult and expensive medical treatment for farmers and herdsmen in agricultural and pastoral areas, poverty caused by illness and return to poverty due to illness" is very serious. To further establish and improve the medical security system in agricultural and pastoral areas, so as to ensure that farmers and herdsmen can obtain medical treatment smoothly and improve the hygienic conditions and quality of agricultural and pastoral areas. The second chapter defines the related concepts and expounds the related theories. This paper mainly introduces the related concepts and theories of medical security, urban medical security, rural medical security and medical security in agricultural and pastoral areas of Tibet, such as the theory of public goods, the theory of human capital and the theory of fairness and efficiency. The third chapter analyzes the present situation of the medical security system in agricultural and pastoral areas, reviews the achievements made in the construction of the medical security system, the development of Tibetan medicine, and analyzes the effectiveness and existing problems of cooperative medical care for farmers and herdsmen in agricultural and pastoral areas. The fourth chapter analyzes and compares the achievements of rural cooperative medical care in Shanghai, Shandong, Xinjiang and other provinces, and obtains the experience that can be used for reference in the further improvement of cooperative medical care for farmers and herdsmen in Tibetan farming and pastoral areas. The fifth chapter puts forward some policy suggestions to improve the medical security system in agricultural and pastoral areas of Tibet, such as: consolidating and perfecting the medical security system in agricultural and pastoral areas; further perfecting the medical and health service system; improving the quality construction of medical personnel in agricultural and pastoral areas; Popularize and improve the level of medical knowledge in agricultural and pastoral areas. Inherit and develop the cause of Tibetan medicine.
【學(xué)位授予單位】：西藏大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：F842.684;R197.1;F323.89

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