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90珺908090901290150C20012AbstractThisdissertationmainlyresearchinthefieldofmedicalprotectionmechanismintheruralChina,particularabouttheinstitutionofCMS.Theresearchworkconsistsoftheoreticalpartandempiricalone.Ifgivenspaceandtimelocation,theempiricalresearchisabouttwotownshipCMSinstitutionsinsouthofandnorthofJiangsuprovincesince1990s.thistwoCMSisdifferentphenomenally:oneevolutesfrom1950sandhaslongtradition,theotherisconstructedsince1992;onelookslikealludingtransformation,theotherlikecompulsorychange.Nevertheless,theyallfacewithseriouscrisis.Inordertoanalysistheproblem,wewouldrathertosearchforsometheoreticalinstrumentsbeforebeginningourempiricalresearch.Tothistopic,thereisnomaturesociologicaltheory,evenasystematicalone,soIwouldhavetoputhandstotheeconomicsorpoliticaltheory.Ifthefeatureofsociologicalresearchiscomprehensive,empiricalandscientific,thisstudyissociologicalone.BecauseCMSisknownasonekindofprimaryinsuranceinstitution,wewouldresearchinthefieldsofinstitutionanalysis,socialprotection,medicalinsurance.Intheaspectofinstitutionanalysis,wetrytofindfitfulgeneralmethodtoanalysistheinstitutionalchangeofCMS.Insocialprotectionaspect,wewanttofindtheprincipalsofsocialsecurityandsocialinsurance,andwhatisfitfulaimofhealthprotectioninstitution.Inmedicalinsurance,weattempttodrawantryingdecision-makingmodelofChinesepeasants.Fromviewofgametheory,theinstitutionistheoutcomeofgameofparticipantsinconditionofgivenconditions.Therefore,weinvestigatethethreeparticipants:CMSmanager,ruralmedicalserversandlocalpeople,whichisthedemanderofmedicalserviceandCMSpayer.Aftertheinvestigationandanalysis,thedissertationwouldgiveanexplanationofCMSchangeintwodifferentlocalcontents.Thisdissertationfallsintoeightchapters.1stchapteristheintroductorypart,whichisdevotedtobriefingtheresearchbackgrounds,status,intention,possiblemeaning.The2ndchapterisaboutthetopic,basicconceptsandanalysisframeworksofsocialprotectionmechanism.Thischapteristheoutlineofthetotalresearch.Thesucceed3rdchapterisaboutinstitutionanalysis;inthischapterweregardtheinstitutionasansystemconsistedinstitutioncircumstance,structure,function,organization,andparticipants.InthispaperItrytocombinetherelatedviewsofinstitutionanalysisineconomics,politicaleconomy,sociologytocreateavariousdimensionanalysis.In4thchapter,werethinkthesocialinsurance,focusedonthesocialprincipleandinsuranceprinciple,anditscompulsorycharacter.Inthe5thchapter,wetalkaboutthebasicruleofinsurance,medicalinsurance,medicalinsurancedemand,andproveanempiricalmodel,includingfivesuppositions2whichreflectsuchfactorsasempiricanticipationstyle,residualrisk,transitioncost,alternativeeffect,excludingconstrains.Thenthesucceedpartisempiricalresearch.The6thandthe7thchapteraretwocasestudiesaboutCMSandmedicalprotectionofruralresidents.Thesetwochaptersareaffluentphenomenallyinresearchofthetopics.Thenthe8thchapteristhecomparisonofthetwocases,bothusingquantitativeandqualitativedatum.ThekeyviewsofthisdissertationpresentedinthefrontchaptersarescrutinizedandacreativeexplanationofCMSinstitutionchangearedrawninthischapter.Keywords:CMSInstitutionanalysisSocialinsurancePeasantMedicalinsurancedemand1331417182432404551355576470758697108114123155162178194217223422623430~2002.7:2002.5~7:2002.8~9:2002.10~2003.4:,2003.4~5:13223534/520016385193941997550199862002619946-7mechanismstructuringmechanism745167711757191998788318119494935204019501930~193719971161997210193674193419372132198019521958196040%1966196691978198090%198167.990%380198590%5%19894.8%8090901993199819939.81%199812.56%6.50%22.21%28.21%199844.13%87.44%1949035196040%4323.34/41.2%198090%68113.64/42.17%905%6979.473.5%906.5%70438.513.95%8020102001200190120001234567810%10%9/200220022001230001150%70%32%40%45%60%2002301025%9850%200121234562002200195020026000200012120021999120.2%1-1.5%5-7%3-4%2.5-3.5%2000192200122770072.1%33.6%3.4%200231958~19944319941997515073.58%46912630199924364080%131%200241-20001995/1420001020%12%“”“”199410-111999857520009109200114~15102001915//20002000200024-2531802000%7235167055-60655-1020012000232001174765520021820022002medicaidmedicare1160stigma901111PJFeldstein32933319200212—13NIEOIE1234512200212132000620011201993/200214NIEOIE199151998175/16-200214448~651520017162002112119981998-1997-1718172000184182290301920entitlement121234519202000421~19IP1MNP2PMNS/P1P2P2+P1P0SP0023GIMNGINM262319949GMINNGMI2001/Health20017/242001724199472720022526801992279020001992()2890-19951629-3025200252627199252819921491529199511616301996343283119941132100~10165819441922710A33915B39316313220014199951996129C96018D4451308819108~10ABCD-199813-2720018-22301MSGranovetter19983949199851197319991999199960%212000146-15015615818031199912001285166-167290199818%19%85.4%33(42.9%)(16.5%)(11.8%)(8.8%)3319993200143234638200119871959-19612000858840801977112-11831999186-189lay-referralsystemEliotFreidson196020001041213419992108-1181998431-37332ABCDBCDN51-53195213-216M1999643761~6320001997334122HB=/3HB*=H