慈溪市新型農(nóng)村合作醫(yī)療制度的現(xiàn)況研究
發(fā)布時(shí)間：2018-11-18 10:30
【摘要】：醫(yī)療保障事關(guān)每一位國民的健康和幸福,意義重大。為改變廣大農(nóng)民因各種歷史原因造成的基本無醫(yī)療保障現(xiàn)狀,我國建立了新型農(nóng)村合作醫(yī)療(以下簡稱“新農(nóng)合”)制度。該制度自2003年試點(diǎn),2008年在全國范圍內(nèi)推廣,到2010年末已基本覆蓋全國各農(nóng)村地區(qū),在很大程度上減輕了農(nóng)民的醫(yī)療負(fù)擔(dān)。盡管,新農(nóng)合制度取得了顯著成效,但在實(shí)施過程中暴露出的一些深層次問題和難點(diǎn),主要是醫(yī)療費(fèi)用的控制和定點(diǎn)醫(yī)療機(jī)構(gòu)的監(jiān)管問題有待進(jìn)一步解決。 目的：通過對(duì)慈溪市新農(nóng)合實(shí)施以來,歷年基金收支、參合農(nóng)民住院費(fèi)用、補(bǔ)償情況以及定點(diǎn)醫(yī)療機(jī)構(gòu)監(jiān)管情況的分析,探討新農(nóng)合當(dāng)前面臨的實(shí)施難點(diǎn)問題——醫(yī)療費(fèi)用增長和定點(diǎn)醫(yī)療機(jī)構(gòu)監(jiān)管困境的相關(guān)因素,并結(jié)合經(jīng)濟(jì)學(xué)有關(guān)理論對(duì)其原因進(jìn)行綜合、全面的分析,在借鑒國外醫(yī)療保險(xiǎn)經(jīng)驗(yàn)的基礎(chǔ)上,對(duì)完善新農(nóng)合制度中規(guī)范醫(yī)療機(jī)構(gòu)服務(wù)、加強(qiáng)監(jiān)管及控制醫(yī)療費(fèi)用不合理增長提出相應(yīng)的對(duì)策建議。 方法：采用定量和定性研究、實(shí)證和規(guī)范研究相結(jié)合的方法,對(duì)慈溪市2004年1月至2012年度12月新農(nóng)合基金收支、各級(jí)醫(yī)療機(jī)構(gòu)門診和住院人次構(gòu)成及醫(yī)療費(fèi)用補(bǔ)償情況進(jìn)行分析,并對(duì)2012年度定點(diǎn)醫(yī)療機(jī)構(gòu)審核和考核中發(fā)現(xiàn)的問題進(jìn)行評(píng)價(jià)；結(jié)合經(jīng)濟(jì)學(xué)相關(guān)理論對(duì)新農(nóng)合制度設(shè)計(jì)本身、醫(yī)療費(fèi)用增長的影響因素和定點(diǎn)醫(yī)療機(jī)構(gòu)監(jiān)管困境進(jìn)行剖析。 結(jié)果：慈溪市實(shí)施新農(nóng)合制度的8年內(nèi),基金運(yùn)行總體不夠平穩(wěn),出現(xiàn)超支、沉淀等情況；在門診率和住院率逐年上升的同時(shí),醫(yī)療費(fèi)用也呈現(xiàn)出逐年上升的趨勢,以住院費(fèi)用的增長尤為明顯；新農(nóng)合統(tǒng)籌基金主要用于住院費(fèi)用的補(bǔ)償,占總補(bǔ)償金額的73.89%；不同級(jí)別醫(yī)療機(jī)構(gòu)的住院人次、住院基金的構(gòu)成中,市級(jí)、市外醫(yī)療機(jī)構(gòu)占70%以上,鎮(zhèn)級(jí)醫(yī)療機(jī)構(gòu)2012年分別下降至12.21%、8.13%,就醫(yī)需求不合理,存在外流現(xiàn)象；在住院補(bǔ)償逐年增加的情況下,參合農(nóng)民的住院補(bǔ)償收益因住院費(fèi)用的日益上漲有所抵消；醫(yī)療機(jī)構(gòu)級(jí)別越高,次均住院費(fèi)用也越高；藥品收入仍作為醫(yī)療機(jī)構(gòu)的主要收入來源,2012年市級(jí)醫(yī)療機(jī)構(gòu)住院費(fèi)用構(gòu)成中藥費(fèi)占42.37%；在提供醫(yī)療服務(wù)過程中定點(diǎn)醫(yī)療機(jī)構(gòu)存在的多種不規(guī)范行為。 結(jié)論： 1.慈溪市新農(nóng)合制度為滿足當(dāng)?shù)剞r(nóng)民的醫(yī)療需求,減輕疾病的經(jīng)濟(jì)負(fù)擔(dān)發(fā)揮了積極的作用； 2.住院費(fèi)用的過快增長和藥品收入的主導(dǎo)地位以及定點(diǎn)醫(yī)療機(jī)構(gòu)的不規(guī)范行為,是新農(nóng)合實(shí)施過程中的難點(diǎn)問題； 3.控制醫(yī)療費(fèi)用的不合理增長,規(guī)范診療行為,加強(qiáng)定點(diǎn)醫(yī)療機(jī)構(gòu)的監(jiān)管,是新農(nóng)合工作的關(guān)鍵環(huán)節(jié)； 4.建議強(qiáng)化政府責(zé)任、科學(xué)調(diào)整補(bǔ)償方案、促使人才下沉、全面開展支付方式改革、創(chuàng)新監(jiān)管模式、加快新農(nóng)合立法、完善醫(yī)療服務(wù)定價(jià)機(jī)制、整合醫(yī)療衛(wèi)生資源等措施完善新農(nóng)合制度,保證可持續(xù)發(fā)展。
[Abstract]:Health care is of great significance to the health and happiness of every nation. In order to change the current situation of farmers' basic lack of medical security caused by various historical reasons, China has established a new rural cooperative medical system (hereinafter referred to as "New Rural Cooperation") system. The system was tested in 2003 and popularized in the whole country in 2008. By the end of 2010, it has basically covered the rural areas of the whole country, and greatly alleviated the medical burden of farmers. Although the new rural cooperative system has achieved remarkable results, some deep problems and difficulties, mainly the control of medical expenses and the supervision of designated medical institutions, have been exposed in the course of implementation. Objective: to analyze the income and expenditure of the fund, the hospitalization expenses of the participating farmers, the compensation situation and the supervision of the designated medical institutions since the implementation of the New Rural Cooperation in Cixi City. This paper probes into the difficult problems in the implementation of NCMS at present-the factors related to the growth of medical expenses and the dilemma of supervision of designated medical institutions, and combines the relevant theories of economics to make a comprehensive and comprehensive analysis of the causes. On the basis of drawing lessons from the experience of foreign medical insurance, this paper puts forward corresponding countermeasures and suggestions to perfect the medical institution service in the new rural cooperative system, to strengthen the supervision and control of the unreasonable increase of medical expenses. Methods: quantitative and qualitative studies, empirical and normative studies were used to study the income and expenditure of the New Agricultural Cooperation Fund from January 2004 to December 2012 in Cixi City. The composition of outpatient service and hospitalization and the compensation of medical expenses were analyzed, and the problems found in the audit and examination of designated medical institutions in 2012 were evaluated. Combined with the relevant economic theory, this paper analyzes the design of NCMS system itself, the influencing factors of medical expenditure growth and the dilemma of supervision of fixed medical institutions. Results: in the 8 years after the implementation of the new agricultural cooperation system in Cixi City, the fund operation was not stable enough, such as overspending, precipitation and so on. At the same time, the outpatient service rate and hospitalization rate are rising year by year, especially the increase of hospitalization expenses, the NCMS fund is mainly used to compensate the hospitalization expenses, which accounts for 73.89% of the total compensation amount. In the composition of hospitalization fund of different level medical institutions, the proportion of municipal and out-of-city medical institutions accounted for more than 70%. In 2012, township level medical institutions fell to 12.21 and 8.13 respectively, the demand for medical treatment was unreasonable, and there was outflow phenomenon. In the case of increasing hospital compensation year by year, the income of compensation for hospitalization of participating farmers is offset by the increasing of hospitalization expenses, and the higher the level of medical institutions, the higher the average hospitalization expenses. Drug revenue is still the main source of income for medical institutions. In 2012, 42.37% of the hospital expenses of municipal medical institutions were made up of drug expenses, and a variety of non-standard behaviors existed in designated medical institutions in the process of providing medical services. Conclusion: 1. Cixi new rural cooperative system has played a positive role in meeting the medical needs of local farmers and reducing the economic burden of disease; 2. The rapid increase of hospitalization expenses, the dominant position of drug income and the nonstandard behavior of designated medical institutions are the difficult problems in the implementation of NCMS. Controlling the unreasonable increase of medical expenses, standardizing the behavior of diagnosis and treatment, and strengthening the supervision of designated medical institutions are the key links of the new rural cooperative work. It is suggested to strengthen the responsibility of the government, adjust the compensation scheme scientifically, urge the talented person to sink, carry out the reform of the payment method in an all-round way, innovate the supervision mode, speed up the legislation of the new rural cooperation, and perfect the pricing mechanism of the medical service. Integration of medical and health resources and other measures to improve the new system of rural cooperation to ensure sustainable development.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R197.1;F842.684;F323.89
本文編號(hào)：2339787
[Abstract]:Health care is of great significance to the health and happiness of every nation. In order to change the current situation of farmers' basic lack of medical security caused by various historical reasons, China has established a new rural cooperative medical system (hereinafter referred to as "New Rural Cooperation") system. The system was tested in 2003 and popularized in the whole country in 2008. By the end of 2010, it has basically covered the rural areas of the whole country, and greatly alleviated the medical burden of farmers. Although the new rural cooperative system has achieved remarkable results, some deep problems and difficulties, mainly the control of medical expenses and the supervision of designated medical institutions, have been exposed in the course of implementation. Objective: to analyze the income and expenditure of the fund, the hospitalization expenses of the participating farmers, the compensation situation and the supervision of the designated medical institutions since the implementation of the New Rural Cooperation in Cixi City. This paper probes into the difficult problems in the implementation of NCMS at present-the factors related to the growth of medical expenses and the dilemma of supervision of designated medical institutions, and combines the relevant theories of economics to make a comprehensive and comprehensive analysis of the causes. On the basis of drawing lessons from the experience of foreign medical insurance, this paper puts forward corresponding countermeasures and suggestions to perfect the medical institution service in the new rural cooperative system, to strengthen the supervision and control of the unreasonable increase of medical expenses. Methods: quantitative and qualitative studies, empirical and normative studies were used to study the income and expenditure of the New Agricultural Cooperation Fund from January 2004 to December 2012 in Cixi City. The composition of outpatient service and hospitalization and the compensation of medical expenses were analyzed, and the problems found in the audit and examination of designated medical institutions in 2012 were evaluated. Combined with the relevant economic theory, this paper analyzes the design of NCMS system itself, the influencing factors of medical expenditure growth and the dilemma of supervision of fixed medical institutions. Results: in the 8 years after the implementation of the new agricultural cooperation system in Cixi City, the fund operation was not stable enough, such as overspending, precipitation and so on. At the same time, the outpatient service rate and hospitalization rate are rising year by year, especially the increase of hospitalization expenses, the NCMS fund is mainly used to compensate the hospitalization expenses, which accounts for 73.89% of the total compensation amount. In the composition of hospitalization fund of different level medical institutions, the proportion of municipal and out-of-city medical institutions accounted for more than 70%. In 2012, township level medical institutions fell to 12.21 and 8.13 respectively, the demand for medical treatment was unreasonable, and there was outflow phenomenon. In the case of increasing hospital compensation year by year, the income of compensation for hospitalization of participating farmers is offset by the increasing of hospitalization expenses, and the higher the level of medical institutions, the higher the average hospitalization expenses. Drug revenue is still the main source of income for medical institutions. In 2012, 42.37% of the hospital expenses of municipal medical institutions were made up of drug expenses, and a variety of non-standard behaviors existed in designated medical institutions in the process of providing medical services. Conclusion: 1. Cixi new rural cooperative system has played a positive role in meeting the medical needs of local farmers and reducing the economic burden of disease; 2. The rapid increase of hospitalization expenses, the dominant position of drug income and the nonstandard behavior of designated medical institutions are the difficult problems in the implementation of NCMS. Controlling the unreasonable increase of medical expenses, standardizing the behavior of diagnosis and treatment, and strengthening the supervision of designated medical institutions are the key links of the new rural cooperative work. It is suggested to strengthen the responsibility of the government, adjust the compensation scheme scientifically, urge the talented person to sink, carry out the reform of the payment method in an all-round way, innovate the supervision mode, speed up the legislation of the new rural cooperation, and perfect the pricing mechanism of the medical service. Integration of medical and health resources and other measures to improve the new system of rural cooperation to ensure sustainable development.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R197.1;F842.684;F323.89
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