本文選題：新型農(nóng)村合作醫(yī)療　切入點(diǎn)：基金管理　出處：《四川農(nóng)業(yè)大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：為建立農(nóng)村醫(yī)療保障體系,國家于2003年正式?jīng)Q定開始建立以大病統(tǒng)籌為主的新型農(nóng)村合作醫(yī)療制度。就新農(nóng)合機(jī)構(gòu)設(shè)置而言,在中央設(shè)有新型農(nóng)村合作醫(yī)療部際聯(lián)席會議負(fù)責(zé)制定宏觀政策,省、地級設(shè)立農(nóng)村合作醫(yī)療協(xié)調(diào)小組和專家技術(shù)指導(dǎo)組。縣級設(shè)有農(nóng)村合作醫(yī)療管理委員會,而經(jīng)辦機(jī)構(gòu)負(fù)責(zé)日常具體事務(wù),并定期向監(jiān)督委員會報(bào)告基金管理情況。目前,作為對中國廣大農(nóng)業(yè)人口的醫(yī)療保障的制度,新農(nóng)合已切實(shí)保障了農(nóng)民的日常醫(yī)療需求。2012年,全國參加新農(nóng)合人數(shù)為8.05億人,參合率超過98%。 在新農(nóng)合的制度建立和完善過程中,出現(xiàn)了財(cái)務(wù)問題、虛報(bào)參合信息套取資金和基金使用不合理等問題。從治理的角度而言,財(cái)務(wù)問題原因是內(nèi)控機(jī)制的失衡。本文旨在基于產(chǎn)權(quán)理論和委托代理理論,研究縣域新農(nóng)合基金管理組織的治理結(jié)構(gòu),并探求內(nèi)部治理失衡的原因。 首先,本文對新農(nóng)合制度的建立和制度變遷作出系統(tǒng)性分析,重點(diǎn)關(guān)注基金管理制度。回溯新農(nóng)合制度的主要政策演變,分析新農(nóng)合制度的四大特征,包括自愿參加,大病統(tǒng)籌,縣域統(tǒng)籌管理和政府監(jiān)督管理。從籌資制度和補(bǔ)償制度入手闡釋新農(nóng)合制度建立的主要基本點(diǎn)。籌資制度主要從個人保費(fèi)收繳方式、財(cái)政補(bǔ)助劃撥制度和籌資水平等三個方面進(jìn)行分析。補(bǔ)償制度主要從補(bǔ)償比例和補(bǔ)償范圍進(jìn)行分析。新農(nóng)合基金管理制度主要從風(fēng)險(xiǎn)基金制度、二次補(bǔ)償制度和監(jiān)督制度進(jìn)行了分析。 目前,國內(nèi)公司治理較非營利組織治理發(fā)展成熟,政府治理較為欠缺�；诖�,本文對公司和非營利組織的內(nèi)部核心機(jī)構(gòu)的職能定位及其治理結(jié)構(gòu)進(jìn)行了研究分析。通過查閱相關(guān)法律和代表性治理原則,對治理結(jié)構(gòu)中的董(理)事會、監(jiān)事會和管理層(執(zhí)行委員會)的職能進(jìn)行了定位。在公司治理中,對單層制董事會和雙層制董事會進(jìn)行了模式演繹和對比分析。相對公司治理結(jié)構(gòu),非營利組織的結(jié)構(gòu)較為松散,相關(guān)法律和行業(yè)規(guī)章約束偏少。借用紅十字基金會的組織框架作為非營利組織代表型的治理結(jié)構(gòu)進(jìn)行分析。此外,公司和非營利組織在內(nèi)部結(jié)構(gòu)上的差異己體現(xiàn)為不同的治理效果。 隨后,對縣域新農(nóng)合基金管理組織的內(nèi)部主體職能部門的治理結(jié)構(gòu)和治理效率進(jìn)行分析。政府,不單是政治上的主管主體,也是經(jīng)濟(jì)上的最大注資者。類比公司和非營利組織的治理結(jié)構(gòu),縣域新農(nóng)合基金管理委員會因?qū)π罗r(nóng)合工作具有管理和組織的決策權(quán),而在治理結(jié)構(gòu)中承擔(dān)相應(yīng)的董事會的職能。監(jiān)督委員會負(fù)責(zé)監(jiān)督新農(nóng)合基金運(yùn)行過程中的資金流動和會計(jì)賬目,扮演監(jiān)事會的角色。經(jīng)辦機(jī)構(gòu)在組織內(nèi)負(fù)責(zé)相應(yīng)的管理層工作。基于此,縣域新農(nóng)合基金管理組織的內(nèi)部主體職能部門的治理可借鑒公司治理和非營利治理的成熟之處。類比這三者,非營利組織與新農(nóng)合基金組織有更相似的市場環(huán)境,而公司的治理結(jié)構(gòu)的職能設(shè)計(jì)更具借鑒意義。 另外,本文對其治理效率做了定量分析。借用全國統(tǒng)計(jì)數(shù)據(jù),對參合情況和基金使用情況等作了簡要分析。本文對中西部33個縣的新農(nóng)合運(yùn)作情況作了詳細(xì)調(diào)查。在籌資穩(wěn)定的前提下,補(bǔ)償模式的選擇是管理委員會最重要的決策之一。通過聚類分析,在有相當(dāng)?shù)拇箢~醫(yī)療費(fèi)用的補(bǔ)償水平下,住院統(tǒng)籌加門診賬戶的補(bǔ)償模式比大病統(tǒng)籌加家庭賬戶的補(bǔ)償模式,在小額門診費(fèi)用的補(bǔ)償上有更好的成效,實(shí)現(xiàn)了更廣泛的受益人群和更高的實(shí)際報(bào)銷比例。再者,通過選擇投入要素和產(chǎn)出要素,應(yīng)用DEA模型對33個縣的綜合效率和規(guī)模報(bào)酬作出相對性效率分析。整體而言,投入要素高效的轉(zhuǎn)變?yōu)楫a(chǎn)出,一半以上的縣達(dá)到了規(guī)模經(jīng)濟(jì)的狀態(tài)。對已達(dá)到規(guī)模經(jīng)濟(jì)的縣,為了實(shí)現(xiàn)更高的補(bǔ)償比例和更廣泛的受益人群,不宜采取增加管理成本和增加人力資本的方案,而應(yīng)考慮補(bǔ)償模式的制定和優(yōu)化具體補(bǔ)償項(xiàng)目的補(bǔ)償比例。 為完善治理結(jié)構(gòu),本文提出了相應(yīng)的政策建議： (1)管理委員會——細(xì)化內(nèi)部分工,設(shè)立專項(xiàng)委員會 (2)監(jiān)督委員會——完善內(nèi)部監(jiān)督,側(cè)重外部監(jiān)督 (3)經(jīng)辦機(jī)構(gòu)——完善信息化建設(shè),實(shí)現(xiàn)IT治理
[Abstract]:For the establishment of the rural medical security system, the state in 2003 formally decided to establish a catastrophic consisting mainly of the new rural cooperative medical system. The new rural cooperative medical institution setting, a new rural cooperative medical system in the inter ministerial joint meeting of the central charge policy, province, prefecture level establishment of rural cooperative medical care coordination team and expert technical guidance group. At the county level with Management Committee of rural cooperative medical care, and agencies responsible for specific affairs, and report regularly to the committee report of fund management and supervision. At present, the majority of the agricultural population as of China medical security system, NCMS has been effectively protect the farmers' daily medical needs.2012 years, the NCMS number of 805 million people, the participation rate of more than 98%.
In the new rural cooperative medical system to establish and perfect the process, the financial problems, false information for participating funds and fund use is not reasonable. From the perspective of governance, financial problems is the imbalance of internal control mechanism. This paper based on the theory of property rights and the principal-agent theory, the governance structure of the fund management organization. Causes and explore the internal governance imbalance.
First, make a systematic analysis of the establishment and change of system of the new rural cooperative medical system, fund management system. The main focus of attention to the evolution of policy back of the new rural cooperative medical system, analysis of the four major characteristics of the new rural cooperative medical system, including voluntary participation, serious co-ordination, county planning management and supervision of the government. From the main financing system and the compensation system established to explain the NCMS the system of the basic points. The financing system mainly collected from individual premiums, financial subsidy allocation system and financing level of three aspects were analyzed. The compensation system mainly from the proportion of compensation and compensation. The scope of the new rural cooperative fund management system mainly from the risk fund system, analyzed two times compensation system and supervision system.
At present, the domestic corporate governance is non-profit organization governance development, government governance is lacking. Based on this, function orientation and governance structure of the inner core of companies and non-profit organizations are analyzed. Through consulting the relevant legal representative and governance principles, the governance structure of the Dong (LI). The board of supervisors, and management (Executive Committee) of the function of the position. In corporate governance, the board of directors of single and double system board are analyzed and compared. The relative mode of interpretation of the corporate governance structure, the structure of nonprofit organization is relatively loose, the relevant laws and regulations. The organization is less constrained industry frame borrowing the Red Cross Foundation as a non-profit organization governance representative type were analyzed. In addition, differences between companies and non-profit organizations in the internal structure has reflected the different governance effect.
Then, analyze the governance structure and governance efficiency of the fund management organization's internal departments. The main functions of government is not only the main political director, is also the largest economic capital. The governance structure of analogy companies and non-profit organizations, the new agricultural county and fund management committee with the management and organization of the new rural cooperative medical decision-making authority, and in the governance structure to bear the corresponding functions of the board of directors. The supervisory committee is responsible for the flow of funds and accounting supervision of NCMS fund operation in the process of playing the role. The board of supervisors office within the organization responsible for the management of the corresponding work. Based on this, it governance County fund management the main functions of the organization's internal departments can learn from corporate governance and nonprofit governance. The three analogy, non-profit organizations and the new rural cooperative fund has more similar In the market environment, the function design of the corporate governance structure is more useful for reference.
In addition, the governance efficiency is quantitatively analyzed. By national statistical data on the participation of the situation and funds usage. This paper makes a brief analysis on the operation of the NCMS Midwest in 33 counties were investigated. On the premise of the financing stability, choose the model of compensation is one of the most important management decision the Committee. Through cluster analysis, the compensation level has quite large medical expenses under the hospital outpatient co-ordination plus account compensation mode than compensation mode of pooling with family account, have a better effect on small outpatient expense compensation, realized the benefit the wider population and higher proportion of the actual reimbursement and., by selecting the input elements and output elements, make the relative efficiency analysis of application of DEA model in 33 counties, the comprehensive efficiency and returns to scale. Overall, efficient output input transition elements And more than half of the county reached a scale economy. To achieve economies of scale, in order to achieve a higher proportion of compensation and benefit the wider population, should not be taken to increase management costs and increase human capital plan, and should consider making the proportion of compensation compensation mode and optimize the specific compensation project.
In order to improve the governance structure, this paper puts forward the corresponding policy suggestions:
(1) the Management Committee - refine the internal division of labor and set up a special committee
(2) the Supervision Committee - the improvement of internal supervision and the emphasis on external supervision
(3) run institutions - improve information construction and realize IT governance

【學(xué)位授予單位】：四川農(nóng)業(yè)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：F323.89;R197.1;F842.684

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