乡土社会中农民就医行为与“一村一室”政策的可持续性分析——基于江西省乐平市众埠镇的案例调查

Rural Society,Peasant Medical Behavior,and Sustainability for Policy of "One Village,One Clinics":Case of Zhongbu Town,Leping City of Jiangxi Province

我国正在推行把村医集中到村卫生室执业即"一村一室"政策;未集中执业的村医为"非法行医"。调研发现,该政策改善了村卫生室条件,但也存在两大问题:一是条件更差的"非法诊所"为何依然有竞争力;二是收入分配平均主义,对高水平村医激励不足。建立农民就医行为选择模型分析"非法诊所"存在的原因发现,在乡土社会的农村,因为熟悉和直接间接联系,"非法诊所"可获得村民信任,并在方便度、费用等方面具有优势,其有存在价值。建立村医执业行为选择模型分析收入平均分配的影响发现,在"非法诊所"存在前提下,高水平村医将退出村卫生室而选择单独执业,低水平村医将集中执业,导致村医水平的逆向选择,并导致"一村一室"政策难以持续。

Village clinic in rural areas can serve as a'gatekeeper'role to play an important foundation;it is now undergoing reconstruction after three stages of the establishment,development and decline.In order to improve medical hardware facilities and facilitate the carrying out of new rural cooperative medical service,policy of village clinic integration is being or to be pursued all over the country.That is to gather the country doctors practicing medicine in villages and establish village clinics.However,according to investigation,the integrated village clinics in underdeveloped regions face with three major problems: low current government subvention,competition with illegal private clinics(i.e.the clinics run by the original country doctors who do not work in the village clinics) and the equalitarianism of the internal income distribution.All these problems may lead to the adverse selection of many country doctors who have different calibers,and the high-caliber doctors may quit.Which will make the policy of 'one village,one Village clinic integration' be failure.In this paper,take competitive factors,the local community trust,adverse selection model to of the phenomenon according to the investigation into a theoretical explanation,and that the Government should give up the'one village one'model,shifted from number control to the standard control.