【摘要】：隨著經(jīng)濟(jì)快速發(fā)展,人們生活水平的逐步提高,建立完善的醫(yī)療保障體系已經(jīng)成為政府必須要面臨的一個(gè)嚴(yán)重問(wèn)題。本篇文章從歷史的角度作為出發(fā)點(diǎn),以宋朝的安濟(jì)坊為例,著重介紹了封建社會(huì)醫(yī)療保障機(jī)構(gòu)的設(shè)置。通過(guò)對(duì)歷史的回顧和探討,希望能從中探尋出一些對(duì)今日“新醫(yī)改”建設(shè)有益的相關(guān)建議。 整篇文章一共由前言和正文兩部分構(gòu)成。前言部分主要介紹了選題目的和意義、文獻(xiàn)綜述以及文章的研究資料、方法和架構(gòu)。正文部分由六章內(nèi)容構(gòu)成,前兩章從整體上介紹了安濟(jì)坊產(chǎn)生的思想淵源及宋朝以前醫(yī)療保障機(jī)構(gòu)設(shè)置的演變；第三、四、五章則詳細(xì)講述了安濟(jì)坊的具體實(shí)施內(nèi)容、發(fā)展歷程及利弊分析和對(duì)后世的影響；第六章則結(jié)合當(dāng)前“新醫(yī)改”現(xiàn)狀提出了幾點(diǎn)建議。大致內(nèi)容如下： 第一章主要從儒、道、釋三家有關(guān)醫(yī)療保障思想的記載中介紹了安濟(jì)坊產(chǎn)生的思想淵源。 儒家思想以“仁”為核心,認(rèn)為惻隱之心是“仁”的開(kāi)始。一切慈善活動(dòng)都可以歸結(jié)為人的本性使然。仁愛(ài)思想上升到國(guó)家的高度,即為民本思想。民本思想要求國(guó)家必須以人民利益為重,“民為貴,社稷次之,君為輕”。以仁愛(ài)思想為基礎(chǔ),民本思想為指導(dǎo),進(jìn)而構(gòu)筑起“老有所終,壯有所用,幼有所長(zhǎng),矜寡、孤獨(dú)、廢疾者皆有所養(yǎng)”的大同社會(huì)。 早期道教內(nèi)部對(duì)藥物醫(yī)療的觀點(diǎn)各有不同,大體可以分為三種：第一種以舊天師道、南朝“新天師道”和靈寶經(jīng)派為代表的反對(duì)藥物醫(yī)療觀,主張采用符水、首過(guò)之法和“齋醮”等一些宗教儀式進(jìn)行疾病治療。第二種是以《太平經(jīng)》和北朝“新天師道”為代表的有條件接受藥物醫(yī)療觀,認(rèn)為用來(lái)治病的藥物必須得到仙人的力量才有效,因此在進(jìn)行藥物治療時(shí)必須要輔之以宗教儀式。第三種則是以葛氏道和上清經(jīng)派為代表的肯定并接受藥物治療觀,雖然肯定藥物在疾病治療方面的作用,卻主張進(jìn)行藥物治療的最終目的是修煉成仙,藥物治療只不過(guò)是其中的一個(gè)必然階段而已。到了隋唐時(shí)期,由于統(tǒng)治者崇尚道教,所以那時(shí)道教的社會(huì)教化功能更為突出,尤其在利用醫(yī)術(shù)醫(yī)治病人方面。 佛教自西漢末年傳入我國(guó),逐漸與中國(guó)傳統(tǒng)文化相融合,對(duì)社會(huì)發(fā)展的影響也越來(lái)越大。因?yàn)閳?jiān)信因果報(bào)應(yīng)說(shuō),所以佛教提倡多行積善,主張對(duì)一切世人都應(yīng)該抱有憐憫的心態(tài),以慈悲為懷,用博愛(ài)感化他們,并幫助其脫離苦海。在具體的行善方法上,佛教有“修福田”、“布施”之說(shuō)�！惰缶V經(jīng)》中記載有八大福田,其中之一就是病福田。建立在病福田基礎(chǔ)上的悲田養(yǎng)病坊是寺院教徒專(zhuān)門(mén)用來(lái)救助貧疾之人的場(chǎng)所。之后,隨著政府的介入,悲田養(yǎng)病坊逐漸向著規(guī)范化方向發(fā)展。 第二章主要介紹宋朝以前醫(yī)療保障機(jī)構(gòu)設(shè)立的演變過(guò)程。 在我國(guó)歷史上,醫(yī)療官職的設(shè)置由來(lái)已久�！吨芏Y》中記載了我國(guó)最早的典章制度設(shè)置,其中就有醫(yī)師一職。雖然那時(shí)醫(yī)師職責(zé)的僅僅局限于疾患治療,但是它卻已經(jīng)成為了國(guó)家的一種職責(zé)。 《禮記》中出現(xiàn)的“矜寡、孤獨(dú)、廢疾者皆有所養(yǎng)”則是我國(guó)歷史上有關(guān)社會(huì)保障思想的最早記載。《管子》一書(shū)將《禮記》中提到的社會(huì)保障思想運(yùn)用到了國(guó)家的制度設(shè)計(jì)中,提出了“九慧之政”之一的“養(yǎng)疾”。這是我國(guó)歷史上首次將醫(yī)療保障的思想轉(zhuǎn)變成國(guó)家的制度設(shè)計(jì),盡管這一制度設(shè)計(jì)是否真正得到實(shí)施尚不可知,但是它在我國(guó)醫(yī)療保障制度史上卻占有非常重要的地位。 到了魏晉南北朝時(shí)期,隨著佛教在中原地區(qū)影響力逐漸擴(kuò)大,統(tǒng)治者也開(kāi)始受到佛家思想的感染。南齊文惠太子創(chuàng)立的“六疾館”在我國(guó)歷史上具有劃時(shí)代意義,該機(jī)構(gòu)的設(shè)立第一次將醫(yī)療保障正式引入到國(guó)家的制度管理中,使管子的“養(yǎng)疾”思想由制度設(shè)計(jì)轉(zhuǎn)變?yōu)楝F(xiàn)實(shí)。此后,歷朝統(tǒng)治者都開(kāi)始關(guān)注疾病之人的救助,并設(shè)置專(zhuān)門(mén)機(jī)構(gòu)進(jìn)行管理。 唐朝時(shí)期,統(tǒng)治者以悲田養(yǎng)病坊為基礎(chǔ),先派遣使者監(jiān)督,進(jìn)而由政府提供資金和土地支持其發(fā)展。如此一來(lái),原本只是寺院出于救濟(jì)之心而建立的慈善救助設(shè)施,轉(zhuǎn)變?yōu)閲?guó)家醫(yī)療保障機(jī)構(gòu),國(guó)家在社會(huì)保障方面的實(shí)際職能進(jìn)一步擴(kuò)大。 第三章基于安濟(jì)坊產(chǎn)生的歷史背景,分別從對(duì)象條件、財(cái)政資金支持及監(jiān)察三個(gè)方面詳細(xì)介紹了安濟(jì)坊的具體實(shí)施內(nèi)容。 宋承唐制,在建國(guó)初期,政府曾建立福田院對(duì)老弱貧疾之人給予保障。起初只設(shè)置東、西福田院,每座福田院以二十人為限。由于規(guī)模小,難以滿足社會(huì)需求。英宗在位時(shí)期(公元1064-1067年),又增置南、北福田院,保障人數(shù)擴(kuò)大至三百人,同時(shí)還制定獎(jiǎng)罰措施,使福田院的管理進(jìn)一步趨于規(guī)范化、合理化。元yP四年(公元1089年),蘇軾在杭州設(shè)立安樂(lè)坊,救助飽受疾疫困擾的貧苦民眾。由于其實(shí)施成功,得到政府的褒獎(jiǎng)。崇寧元年(公元1102年),吳居厚奏請(qǐng)朝廷在諸路建立將理院,收養(yǎng)病人,于是朝廷賜名為安濟(jì)坊。從此,安濟(jì)坊作為國(guó)家醫(yī)療保障機(jī)構(gòu)正式出現(xiàn)。 由于文獻(xiàn)資料記載有限,本文在結(jié)合考古發(fā)掘成果的基礎(chǔ)之上,將安濟(jì)坊的保障對(duì)象主要分為四個(gè)方面：第一、無(wú)依無(wú)靠的病人和貧病無(wú)力醫(yī)治的本地人和外地人；第二、軍人及其家屬；第三、服刑的犯人；第四、官宦人家的雇工。安濟(jì)坊的發(fā)展得到了國(guó)家強(qiáng)大的資金支持。創(chuàng)立之初,政府不僅為那些需要保障的人員提供房屋,還根據(jù)他們自身病情輕重程度進(jìn)行屋舍分配。每一位安濟(jì)坊人員除了能夠得到政府定期定量的生活支給外,還有醫(yī)師定期對(duì)其進(jìn)行身體檢查。、安濟(jì)坊采納了僧人管理模式,在機(jī)構(gòu)內(nèi)部有專(zhuān)門(mén)的掌管和監(jiān)督人員,有火頭、出納、醫(yī)生；在外部,上自京師,下到諸路府、州、軍、監(jiān)都有提督、檢點(diǎn)、管勾。除此之外,安濟(jì)坊還設(shè)有一整套嚴(yán)格的監(jiān)察制度。安濟(jì)坊的監(jiān)察主要有事前監(jiān)察和事后監(jiān)察兩種。所謂事前監(jiān)察是指從察看驗(yàn)實(shí)到登記在冊(cè)的過(guò)程,分為實(shí)地巡視、辦理登記、“結(jié)罪保明”、“差官驗(yàn)實(shí)”四步。這四步環(huán)環(huán)相扣,確保每一個(gè)需要救助之人都能及時(shí)、合理地得到國(guó)家的救助。事后監(jiān)察采取“立賞舉報(bào)”的方式,主要為了彌補(bǔ)事前監(jiān)察過(guò)程的疏漏,防止奸猾狡詐之人趁機(jī)騙取國(guó)家保障。 在對(duì)安濟(jì)坊產(chǎn)生的背景、具體實(shí)施內(nèi)容進(jìn)行詳盡介紹之后,第四章闡述了其在宋朝的整個(gè)發(fā)展過(guò)程�？v觀安濟(jì)坊在宋朝的發(fā)展,可以分為七個(gè)階段,即初創(chuàng)時(shí)期、曲折時(shí)期、改進(jìn)時(shí)期、衰退時(shí)期、重建時(shí)期、破壞時(shí)期以及修復(fù)時(shí)期。在蘇軾所建安樂(lè)坊的影響下,政府開(kāi)始在全國(guó)創(chuàng)建安濟(jì)坊。安濟(jì)坊仍然采用了僧人主持的模式,加以政府的監(jiān)督管理和財(cái)政支持。到蔡京上臺(tái)后,安濟(jì)坊逐步在全國(guó)推廣。隨著蔡京仕途跌宕起伏,安濟(jì)坊的發(fā)展也出現(xiàn)了曲折、改進(jìn)、衰退、重建及破壞等不同階段。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,于次年四月下詔重修安濟(jì)坊。到南宋時(shí)期,安濟(jì)坊的發(fā)展一直較為穩(wěn)定,基本沒(méi)有大的發(fā)展變動(dòng)。 第五章主要針對(duì)安濟(jì)坊制度的利弊和對(duì)后世產(chǎn)生的影響進(jìn)行分析。任何一項(xiàng)制度總有其不完善的一面,安濟(jì)坊也是如此。對(duì)于安濟(jì)坊制度的缺陷,本文主要指出了兩個(gè)方面：其一是政策的不穩(wěn)定性；其二是監(jiān)督過(guò)程中存在疏漏。南宋后期,安濟(jì)坊的影響越來(lái)越弱。南宋滅亡后,安濟(jì)坊便也永久的退出了歷史舞臺(tái)。但是,安濟(jì)坊作為我國(guó)封建社會(huì)最為完備的官辦醫(yī)療保障機(jī)構(gòu),對(duì)以后朝代醫(yī)療保障機(jī)構(gòu)的發(fā)展和設(shè)置產(chǎn)生了深遠(yuǎn)影響,如宗族義莊、惠民藥局的出現(xiàn)和發(fā)展以及民間個(gè)人慈善行為的壯大等。 第六章一則是對(duì)前面內(nèi)容的補(bǔ)充和完善,二則針對(duì)當(dāng)前的“醫(yī)改”現(xiàn)狀提出了幾點(diǎn)相關(guān)建議。與宋之前的醫(yī)療保障機(jī)構(gòu)相比,安濟(jì)坊無(wú)論是在制度、組織還是精神方面都得到了強(qiáng)化,并實(shí)現(xiàn)了超越。對(duì)于這樣一項(xiàng)完善的制度,我們應(yīng)該加以肯定和借鑒。結(jié)合當(dāng)前“新醫(yī)改”現(xiàn)狀,筆者主要從社會(huì)倫理道德的構(gòu)建、充足的財(cái)政資金保障以及政府在基本醫(yī)療服務(wù)提供中的主導(dǎo)責(zé)任、政府投入逐漸向需求方轉(zhuǎn)變四個(gè)方面來(lái)探討如何改進(jìn)和完善我國(guó)醫(yī)療保障體系,促進(jìn)“新醫(yī)改”的順利實(shí)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.
【學(xué)位授予單位】：西南財(cái)經(jīng)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：D691;R-09

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