健康是人类追求的永恒主题。俗话说：没有农民的健康，就没有中国人民的小康。建立农村医疗保障制度，不仅仅是农民健康体魄的需要，更是统筹城乡社会经济发展、构建社会主义和谐社会的需要。中国农民原本是有医疗保障的，合作医疗曾在解决农村地区缺医少药、保障农民基本健康方面取得了举世瞩目的成就。随着农村经济体制的变革，一度辉煌的农村合作医疗全面解体，87%的中国农民进入了长达二十年的无任何保障的自费医疗之中。新型农村合作医疗是2002年以来中国政府为解决农村居民大病经济负担的一项重要举措。然而，以往合作医疗制度兴衰沉浮的历史，使百姓及政策的执行者都对新型农村合作医疗能否持续稳定地发展抱有怀疑，如何解决传统合作医疗存在的弊端、促进新型农村合作医疗的科学发展，是当前亟需解决的重要课题。本论文的研究正是基于这样的背景下进行的，主要采用文献研究和实地调研、理论研究与实证分析、总体研究与案例研究、定性研究与定量分析相结合的方法对农村医疗保障制度的理论与实践进行了比较系统而深入的研究。案例研究的资料来源于北京市郊区县新型农村合作医疗运行的统计资料及实地调研的资料。论文共分为六个部分。第一章导论，提出了选题的目的、研究现状，以及论文的基本理论、研究方法、技术路线和研究思路。在第二章，论文应用经济学的相关理论系统研究了在农村建立和完善医疗保障制度的理论基础。重点阐述：不同经济理论对农村医疗保障制度建立的影响；公共产品理论说明了政府在农村医疗保障制度的建立中必须承担主要责任；为解决医疗保险市场上的信息不对称，信息经济学为制度的科学设计提供了理论依据；制度经济学和马克思主义经济学的制度变迁理论为研究合作医疗的制度变迁提供了理论分析工具。在第三章，论文对中国农村医疗保障制度的历史变迁进行了分析，重点阐述三个时期农村医疗保障建设的基本情况及其制度运行的环境，总结制度成败的经验教训；新型农村合作医疗的六大制度创新显示出巨大的制度优越性，使其成为创建和谐社会的重要举措。在第四章，研究了其他国家农村医疗保障制度建设的基本经验，重点选取了三个曾经或现在与我国国情相类似的国家，如日本、泰国和印度农村医疗保障制度的基本做法，通过总结他们的成功经验及存在的问题，为我国新时期农村医疗保障制度的建设提供有益的借鉴。在第五章，论文对北京市郊区县新型农村合作医疗制度的运行进行案例研究，从筹资、支付、管理和医疗服务体系等方面对制度运行的具体情况作深入细致的描述，在总结成绩的同时，也对当前制度运行中出现的问题如公平性、逆向选择、管理成本、医疗费用上涨等进行深刻地剖析。在第六章，基于以上的研究，论文从筹资、支付、管理、卫生服务供给以及立法等方面提出我国新型农村合作医疗可持续发展的对策建议, 并认为新型农村合作医疗是一个阶段性的制度，社会医疗保险制度将是其发展的趋势。

Health is the forever pursuit for human being. No health of rural residents, No “well-off society” of Chinese. Therefore, to establish rural health security system is not only the need for rural people, but also the requirement for the sustainable development of economy and harmony of society of China. Rural medical security system had ever been existed highy in 60’s and 70’s of last century in China. Rural cooperative medical system (RCMS) was played an important role in addressing the status of great lack of medical and medicines, protecting the rural peoples’ basic healthcare. But in early 1980’s, once successful RCMS collapsed when China transformed its system of collective agricultural production to private production. 87% of the rural population paid out-of-pocket for any health service they received. In 2002, new rural cooperation medical system (NCMS) was set up to enhance the capability of resisting “catastrophic diseases” of rural residents, which was put forward by Chinese central government. However, the ups and downs history of RCMS makes people and the executors of policy raise doubts whether NCMS could develop sustainable and stable or not. Therefore it is an urgent and important study on how to solve the shortages of RCMS and improve the scientific development of NCMS.The research is just based on the background above and mainly applies the methods such as combining literature study with investigation survey, theoretic analysis with positive study, macro research and case study, qualitative study and quantitative analysis to execute a systematic and deep research on the rural health security system. The material data of cases used come from the site visit for examining and investigating of the NCMS in the rural area of Beijing.The study consists of the following six parts:Chapter 1 is preface. It includes the goal, the background, the basic theories, the methodology, the technological clue and research ideas.Chapter 2: This dissertation describes the theoretic base of building and improving the rural health security system using related economics theories. It mainly includes, difference economics theories affected the establishment of rural health security system; the responsibility of government and relative supporting should be assured according the Public Goods Theory; to address the information asymmetry in health insurance market, theory of Information Economics provides the foundation for the scientific design of system. The paper analyzes the transition of RCMS using the theory and methods of Institutional Economics and Marxism Economics.In Chapter 3, the research has made on the historic transition of rural health security system in China. It mainly discusses the basic status of three phrases on traditional RCMS, and according to analyze the circulated condition of system in order to conclude the historic experience and lessons. Six creative contents of NCMS show the great advantage, and it becomes an important action to build the harmonious society in recent period. The dissertation studies the experience of rural medical insurance system in other counties in chapter 4. It mainly introduces the basic status of three counties such as Japan, Thailand and India. On the concluding of successful experience and existed problem, some beneficial references are offered.Chapter 5 gives a case study on the NCMS of Beijing. It details the plan including financing mode, payment methods, management mechanism and basic medical package services. Besides the achievement of experiment, some problems are analyzed such as equity, adverse selection, management cost and the increasing of medical expenditure, etc. In the end, Chapter 6，in order to keep the sustainability development of NCMS, some policy suggestions have been given about the financing, payment, management, controlling the improper increase of medical cost, monitoring, medical services and legislation. Meanwhile, the dissertation thinks the NCMS is a staggered system, and the Social Health Insurance is the developmental trend.