中文摘要：

无论是从西方经济学的公共品和市场失灵视角，还是从我国农村合作医疗制度变迁过程来看，明确农村医疗保障政府责任的主要地位，都十分必要。通过对政府责任必要性和国际上农村医疗保障模式比较研究发现，保险业参与“新农合”的运作模式应该是我国农村医保制度的最优选择，必须明确政府部门与保险公司在“新农合”中的关系，强化政府在法制建设、制度设计、宣传引导、合理监督等方面的主导作用，充分利用商业保险的经营管理经验和技术水平，降低制度运行成本。

英文摘要：

It is very necessary that government responsibility should be emphasized in the course of building the medical security system. Such is proved from the view of both the western economic theories and the institutional change of NCMS. To sum up the existing research about the necessity of emphasizing the government responsibility and comparative analysis of the models of the international rural medical security system, the paper point out that the model of the commercial insurance is optimal for NCMS, and the government should undertake responsibility from the system designing and building and propa- ganda and guiding and supervision, which is beneficial to reduce the system ruing cost based on the experience in administration and technical merit of the commercial insurance.