本文關鍵詞： 新型農(nóng)村合作醫(yī)療 運行 分析 建議　出處：《山西醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：背景與意義 新型農(nóng)村合作醫(yī)療制度(以下簡稱“新農(nóng)合”)自2003年實施以來,在緩解農(nóng)民“因病致貧、因病返貧”方面發(fā)揮了積極作用,對于貫徹落實黨的十八大精神,促進城鄉(xiāng)協(xié)調(diào)發(fā)展,全面建設小康社會,具有十分重要的意義。但實際運行中也存在著一些不容忽視的深層次問題,如籌資渠道單一、補償制度不完善、醫(yī)療費用增長較快等問題日漸顯現(xiàn)。 目的 本研究通過系統(tǒng)地分析太原市2006-2012年新農(nóng)合運行數(shù)據(jù),了解太原市新農(nóng)合運行情況,指出運行中存在的問題,提出建議和措施,為完善和促進太原市新農(nóng)合持續(xù)健康發(fā)展提供依據(jù)。 方法 數(shù)據(jù)主要來源于太原市及各縣(市、區(qū))新農(nóng)合管理中心的新農(nóng)合報表,獲取太原市各縣(市、區(qū))的人口、經(jīng)濟、健康和衛(wèi)生資源狀況及總體運行數(shù)據(jù)。本研究主要采用描述性和分析性研究方法闡明太原市新農(nóng)合運行情況,分析太原市新農(nóng)合運行中存在的問題。 結果 1.參合情況：2006-2012年,太原市新農(nóng)合參合人數(shù)從84.02萬人增加到104.52萬人；平均參合率從84.30%上升到99.38%,新農(nóng)合參合人數(shù)、平均參合率實現(xiàn)了穩(wěn)中有升,基本實現(xiàn)了制度全覆蓋,農(nóng)民也開始逐漸接受和認同這項制度。 2.籌資情況：2006-2012年,太原市新農(nóng)合籌資標準從50元/人提高到294元/人,其中,財政補助標準由40元/人提高到244元/人,所占比例從80%上升到83%；籌資額從3879.01萬元增加到30912.36萬元,年平均增長率41.33%。無論是籌資標準還是籌資額的增長都說明了各級政府對新農(nóng)合的支持與投資力度越來越大,且財政投入比例在上升。 3.基金使用情況：2006-2012年,太原市新農(nóng)合基金支出從2400.92萬元增加到29243.07萬元,年平均增長率51.68%,且住院支出構成比在80%以上,新農(nóng)合實際用于參合農(nóng)民的基金越來越多,也說明了新農(nóng)合以大病統(tǒng)籌為主,適當兼顧小病的政策目標,與此同時,基金使用率提高,累計結余率下降。 4.參合農(nóng)民受益情況：2006-2012年,太原市新農(nóng)合總受益人次從34.50萬增加到110.57萬,次均住院補償額從1281元增加到3527元,住院實際補償比從26.51%提高到45.50%,參合農(nóng)民受益面和受益水平提高,對醫(yī)療衛(wèi)生服務的利用率也同步上升。 結論 實現(xiàn)太原市新農(nóng)合可持續(xù)發(fā)展,切實減輕農(nóng)民醫(yī)療負擔,需要加強以下幾個方面的工作。 參合與籌資方面：加大新農(nóng)合宣傳力度,擴大籌資渠道,創(chuàng)新和規(guī)范籌資方式。基金補償與管理方面：加強新農(nóng)合信息系統(tǒng)管理,嚴格醫(yī)療費用審核；完善新農(nóng)合基金結算,加強基金運行的動態(tài)監(jiān)測,推進支付方式改革。參合農(nóng)民受益等方面：加大對定點醫(yī)療機構的監(jiān)管力度,控制醫(yī)療費用不合理增長；提升基層醫(yī)療機構服務水平,嚴格轉(zhuǎn)診管理,引導參合農(nóng)民基層就醫(yī)；完善門診統(tǒng)籌補償方案和管理。
[Abstract]:Background and significance. Since the implementation of the new rural cooperative medical system (hereinafter referred to as "New Rural Cooperative Medical system") in 2003, it has played an active role in alleviating the peasants'"poverty caused by illness and returning to poverty because of illness", and has played an active role in implementing the 18 spirit of the Party. It is of great significance to promote the coordinated development of urban and rural areas and to build a well-off society in an all-round way. However, there are some deep-seated problems that cannot be ignored in the actual operation, such as the singleness of financing channels, the imperfection of the compensation system, Medical costs are growing faster and so on. Purpose. Based on the systematic analysis of the operation data of the new rural cooperative cooperation in Taiyuan from 2006 to 2012, this study finds out the operation situation of the new agricultural cooperation in Taiyuan, points out the problems existing in the operation, and puts forward some suggestions and measures. To improve and promote the sustainable and healthy development of new agricultural cooperation in Taiyuan. Method. The data mainly come from the new rural cooperative report form of the new rural cooperative management center of Taiyuan city and each county (city, district), get the population and economy of each county (city, district) of Taiyuan city. In this study, descriptive and analytical methods were used to elucidate the operation of New Rural Cooperation (NCMS) in Taiyuan, and the existing problems in the operation of NCMS in Taiyuan were analyzed. Results. 1. Participation: from 2006 to 2012, the number of new rural cooperative partners in Taiyuan increased from 840,200 to one million forty-five thousand and two hundred ; the average participation rate rose from 84.30% to 99.38; the number of new rural cooperative participants and the average participation rate rose steadily and steadily, and the overall coverage of the system was basically achieved. Farmers also began to gradually accept and identify with this system. 2. Financing situation: from 2006 to 2012, the standard for raising funds for new agricultural cooperation in Taiyuan increased from 50 yuan per person to 294 yuan per person, of which the financial subsidy standard was raised from 40 yuan per person to 244 yuan per person, the proportion of which rose from 80% to 833 yuan; the amount of funds raised increased from thirty-eight million seven hundred and ninety thousand and one hundred yuan to three hundred and nine million one hundred and twenty-three thousand and six hundred yuan. The average annual growth rate of 41.33% indicates that governments at all levels are increasing their support and investment in NCMS, and the proportion of financial investment is increasing. 3. Fund utilization: from 2006 to 2012, the expenditure of the New Agricultural Cooperation Fund in Taiyuan increased from twenty-four million nine thousand and two hundred yuan to two hundred and ninety-two million four hundred and thirty thousand and seven hundred yuan, with an average annual growth rate of 51.68 yuan, and the proportion of hospital expenses was more than 80%. More and more funds were actually used by the new rural cooperative fund for participating farmers. It also shows that the new rural cooperation should focus on the coordination of serious illness and give due consideration to the policy goal of minor illness. At the same time, the utilization rate of the fund has increased and the cumulative balance rate has decreased. 4. From 2006 to 2012, the total beneficiaries of the new rural cooperative in Taiyuan increased from 345,000 to one million one hundred and five thousand and seven hundred , the average hospitalization compensation increased from 1,281.81 yuan to 3,527 yuan, the actual compensation ratio of hospitalization increased from 26.51% to 45.50 yuan, and the benefit area and benefit level of the participating farmers increased. The utilization rate of medical and health services has also risen simultaneously. Conclusion. It is necessary to strengthen the following work to realize the sustainable development of new agricultural cooperation in Taiyuan and to lighten the medical burden of farmers. Participation and financing: increase the publicity of NCMS, expand funding channels, innovate and standardize the ways of raising funds. Fund compensation and management: strengthen the management of NCMS information system, strictly audit medical expenses; improve the settlement of NCMS funds; Strengthen the dynamic monitoring of fund operation, promote the reform of payment methods, participate in the benefits of farmers and other aspects: strengthen the supervision of designated medical institutions, control the unreasonable growth of medical expenses, improve the service level of primary medical institutions, Strict referral management, guide farmers to seek medical treatment at the grass-roots level, improve the out-patient compensation scheme and management.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R197.1;F323.89;F842.684

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