本文選題：新型農(nóng)村合作醫(yī)療制度　切入點：管辦分離　出處：《鄭州大學(xué)》2013年碩士論文

【摘要】：新型農(nóng)村合作醫(yī)療制度是發(fā)展我國農(nóng)村地區(qū)醫(yī)療衛(wèi)生事業(yè)的一項重要舉措,2003年開始試點工作,目前仍處于完善之中,運行機制的健全關(guān)系到新農(nóng)合制度是否可以持續(xù)健康發(fā)展。自試點以來,多個地區(qū)不斷探索適合本地區(qū)發(fā)展的運行模式。河南新鄉(xiāng)、洛陽分別在2003年和2007年進行了新農(nóng)合制度經(jīng)辦機制改革,通過購買服務(wù)的方式將新農(nóng)合支付審核業(yè)務(wù)委托給商業(yè)保險機構(gòu)辦理,形成了具有示范效應(yīng)的“新鄉(xiāng)模式”和“洛陽模式”。2011年,鄭州借鑒新鄉(xiāng)、洛陽新農(nóng)合制度的發(fā)展經(jīng)驗,進行了委托商業(yè)保險機構(gòu)經(jīng)辦新農(nóng)合業(yè)務(wù)的改革,形成了省會城市新農(nóng)合制度“管辦分離”的“鄭州模式”。 “鄭州模式”證明了省會城市委托商業(yè)保險機構(gòu)經(jīng)辦新農(nóng)合業(yè)務(wù)的可行性,對“鄭州模式”進行系統(tǒng)總結(jié)可以更好的推廣鄭州新農(nóng)合制度的發(fā)展經(jīng)驗,完善我國的新農(nóng)合制度。鄭州作為我國第一批新農(nóng)合制度試點地區(qū)之一,其新農(nóng)合業(yè)務(wù)發(fā)展迅速,呈現(xiàn)出了保障水平不斷上升、籌資標準逐年提高和補償比例趨于優(yōu)化的特點；在鄭州新農(nóng)合制度不斷完善的同時,為了保障新農(nóng)合制度的可持續(xù)發(fā)展,鄭州進行了新農(nóng)合經(jīng)辦機制改革,其具體措施包括優(yōu)化服務(wù)機制、建立合理的補償機制、完善監(jiān)管機制和科學(xué)控制新農(nóng)合基金運行；鄭州新農(nóng)合經(jīng)辦機制改革呈現(xiàn)出了四個創(chuàng)新：開創(chuàng)省會城市新農(nóng)合改革先河、公開招標降低人力成本、創(chuàng)新用人機制和健全商業(yè)補充保險。這些創(chuàng)新使“鄭州模式”具有審核簡便、標準統(tǒng)一、運行高效、監(jiān)管有力和保障全面的優(yōu)點,可以使政府、保險公司、農(nóng)民和醫(yī)療機構(gòu)四個層面獲得利益,具有推廣價值。然而,“鄭州模式”還存在著法律支持缺位、溝通機制不暢、補償標準不統(tǒng)一和保障金額不高的問題。要完善“鄭州模式”,需遵循以農(nóng)民根本利益為出發(fā)點、以健全我國社會保障體系為目標的原則,完善相關(guān)法律法規(guī)、加深各部門之間的溝通、優(yōu)化新農(nóng)合制度設(shè)計和加強對醫(yī)療機構(gòu)的監(jiān)管。 本研究的可能創(chuàng)新之處：第一,系統(tǒng)總結(jié)“鄭州模式”的發(fā)展歷程、特點及創(chuàng)新點,探索“鄭州模式”的復(fù)制價值；第二,探討“鄭州模式”的缺陷和不足,并提出政策建議,以期為新農(nóng)合制度“鄭州模式”的完善提供決策參考。
[Abstract]:The new rural cooperative medical system is an important measure to develop the medical and health services in rural areas of China. The pilot work began in 2003 and is still in the process of perfection. The sound operation mechanism is related to the sustainable and healthy development of the new agricultural cooperation system. Since the pilot, many regions have been exploring the operation mode suitable for the development of their own areas. In 2003 and 2007 respectively, Luoyang carried out the reform of the management mechanism of the new rural cooperative cooperation system, and entrusted the new rural cooperative payment audit business to the commercial insurance institutions through the purchase of services. "Xinxiang Model" and "Luoyang Model" with demonstration effect have been formed. In 2011, Zhengzhou adopted the experience of Xinxiang and Luoyang New Rural Cooperation system and carried out the reform of entrusting commercial insurance institutions to run new rural cooperative business. Formed the provincial capital city new agricultural cooperation system "management separation", "Zhengzhou mode". "Zhengzhou mode" proves the feasibility of entrusting commercial insurance institutions to run the new agricultural cooperative business in provincial capitals, and the development experience of Zhengzhou new agricultural cooperation system can be better promoted by systematically summing up the "Zhengzhou model". Zhengzhou, as one of the first pilot areas of the new agricultural cooperation system, has developed rapidly, showing the characteristics of increasing the level of guarantee, raising the standard of financing year by year and the proportion of compensation tending to be optimized. In order to ensure the sustainable development of the new agricultural cooperation system, Zhengzhou has carried out the reform of the new agricultural cooperation management mechanism. The concrete measures include optimizing the service mechanism and establishing a reasonable compensation mechanism. Improving the supervision mechanism and scientifically controlling the operation of the new rural cooperative fund; the reform of Zhengzhou new rural cooperative fund system presents four innovations: to create the new rural cooperation reform in the provincial capital city, to open the public bidding to reduce the labor cost, Innovative employment mechanisms and sound commercial supplementary insurance. These innovations make the "Zhengzhou model" have the advantages of simple auditing, uniform standards, efficient operation, strong supervision and comprehensive protection, which can enable the government and insurance companies, Farmers and medical institutions gain benefits at four levels, which is worth popularizing. However, there is a lack of legal support and poor communication mechanism in Zhengzhou Model. In order to perfect the Zhengzhou Model, we should follow the principle of taking the fundamental interests of farmers as the starting point and taking the perfection of our social security system as the goal, and perfect the relevant laws and regulations. Deepen the communication between departments, optimize the design of the new rural cooperative system and strengthen the supervision of medical institutions. The possible innovations of this study are as follows: first, systematically summarize the development course, characteristics and innovation points of Zhengzhou Model, explore the replicating value of Zhengzhou Model; second, discuss the defects and shortcomings of Zhengzhou Model. Policy suggestions are put forward in order to provide decision-making reference for the perfection of Zhengzhou model of the new agricultural cooperation system.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：F323.89;F842.684;R197.1

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