發(fā)布時(shí)間：2018-05-09 16:12

  本文選題：新型農(nóng)村合作醫(yī)療 + 市級(jí)統(tǒng)籌�。� 參考：《內(nèi)蒙古大學(xué)》2013年碩士論文

【摘要】：新型農(nóng)村牧區(qū)合作醫(yī)療(以下簡(jiǎn)稱新農(nóng)合)是我國(guó)新形勢(shì)下農(nóng)村牧區(qū)社會(huì)保障制度中的一項(xiàng)重要內(nèi)容。它的深入推進(jìn)在一定程度上緩解了“看病難、看病貴”的問(wèn)題,有效地遏制了部分農(nóng)牧民群眾因病致貧、因病返貧的現(xiàn)象,但隨著制度的進(jìn)一步發(fā)展,也出現(xiàn)許多新的問(wèn)題,如基金風(fēng)險(xiǎn)分擔(dān)能力差、管理成本高昂、異地報(bào)銷困難,受益的公平性較差,容易對(duì)新農(nóng)合產(chǎn)生誤解等,因此有必要提高新農(nóng)合的統(tǒng)籌層次。市級(jí)統(tǒng)籌是保險(xiǎn)學(xué)追尋大數(shù)法則以及基本公共服務(wù)均等化內(nèi)在要求。大數(shù)法則可通過(guò)擴(kuò)大群眾受益的覆蓋面與提高統(tǒng)籌層次這兩種途徑實(shí)現(xiàn)。目前,全國(guó)的擴(kuò)面工作基本完成,實(shí)施市級(jí)統(tǒng)籌是未來(lái)新農(nóng)合發(fā)展的必然趨勢(shì)。因此,應(yīng)該在鄂爾多斯市范圍內(nèi)實(shí)施新農(nóng)合市級(jí)統(tǒng)籌。 本文將理論結(jié)合實(shí)證進(jìn)行研究,闡述了鄂爾多斯市新農(nóng)合的現(xiàn)狀及存在的問(wèn)題,并深入地調(diào)查鄂爾多斯市新農(nóng)合的運(yùn)行績(jī)效,縣級(jí)統(tǒng)籌存在問(wèn)題,同時(shí)對(duì)鄂爾多斯市新農(nóng)合市級(jí)統(tǒng)籌運(yùn)行模式進(jìn)行分析,通過(guò)橫向(與全國(guó)、全自治區(qū)的比較；與當(dāng)?shù)爻擎?zhèn)居民醫(yī)保的比較)、縱向(縣級(jí)統(tǒng)籌的市級(jí)統(tǒng)籌比較)的比較,從而得出鄂爾多斯市實(shí)施新農(nóng)合市級(jí)統(tǒng)籌的優(yōu)越性,不僅籌資水平高,報(bào)銷比例大,受益人次數(shù)多,而且進(jìn)一步體現(xiàn)了保險(xiǎn)的公平性,統(tǒng)籌后的便民性。 本文進(jìn)一步對(duì)鄂爾多斯市新農(nóng)合運(yùn)行進(jìn)行SWOT分析,根據(jù)鄂爾多斯市實(shí)施市級(jí)統(tǒng)籌的發(fā)展機(jī)會(huì),主要是政策環(huán)境良好、政府責(zé)任加大、人力資源有保障；實(shí)施市級(jí)統(tǒng)籌的外部威脅,主要是醫(yī)藥費(fèi)用上漲快、各旗區(qū)經(jīng)濟(jì)不平衡、財(cái)政較困難；利用實(shí)施市級(jí)統(tǒng)籌的優(yōu)勢(shì),如六統(tǒng)一政策實(shí)施、參合農(nóng)牧民收益率高、抗風(fēng)險(xiǎn)能力強(qiáng)等；避免實(shí)施市級(jí)統(tǒng)籌的劣勢(shì),如具體制度設(shè)計(jì)不成熟、醫(yī)療服務(wù)提供與費(fèi)用控制矛盾、監(jiān)管不能及時(shí)到位。利用SWOT分析找出一條最合適、最科學(xué)的鄂爾多斯市新農(nóng)合發(fā)展道路,達(dá)到趨利避害、充分發(fā)展的目的。鄂爾多斯市市級(jí)統(tǒng)籌政策宜采取中等發(fā)達(dá)地區(qū)的WO和ST策略,并通過(guò)“六個(gè)統(tǒng)一”使得該策略實(shí)施,即：統(tǒng)一籌資標(biāo)準(zhǔn)、統(tǒng)一組織管理、統(tǒng)一基金管理、統(tǒng)一補(bǔ)償標(biāo)準(zhǔn)、統(tǒng)一服務(wù)監(jiān)管、統(tǒng)一信息化管理。鄂爾多斯市新農(nóng)合市級(jí)統(tǒng)籌的順利實(shí)施,需要政府部門給予支持,需要建立穩(wěn)定的籌資機(jī)制、通過(guò)多種手段提高農(nóng)民的受益程度、提高基層醫(yī)療衛(wèi)生服務(wù)質(zhì)量、商業(yè)保險(xiǎn)參與新農(nóng)合運(yùn)作、進(jìn)一步加強(qiáng)新農(nóng)合定點(diǎn)醫(yī)療機(jī)構(gòu)的監(jiān)管。
[Abstract]:The new cooperative medical system in rural pastoral areas (hereinafter referred to as NCMS) is an important part of social security system in rural pastoral areas under the new situation in our country. Its further promotion alleviates to a certain extent the problem of "difficult and expensive to see a doctor," and effectively restrains the phenomenon of some farmers and herdsmen returning to poverty as a result of illness. However, with the further development of the system, many new problems have also emerged. If the fund's risk sharing ability is poor, the management cost is high, it is difficult to reimburse in different places, the fairness of benefit is poor, and it is easy to misunderstand NCMS, so it is necessary to improve the overall planning level of NCMS. City-level planning is the inherent requirement of the pursuit of the law of large numbers and the equalization of basic public services. The law of large numbers can be realized by expanding the coverage of the benefit of the masses and improving the overall level. At present, the expansion of the country is basically completed, the implementation of the city-level coordination is the inevitable trend of the development of new agricultural cooperation in the future. Therefore, it should be in Ordos City to implement the new agricultural cooperation city-level coordination. In this paper, the current situation and existing problems of NCMS in Ordos are expounded, and the operational performance of NCMS in Ordos is investigated deeply, and the existing problems at county level are also discussed in this paper. At the same time, through the analysis of the overall operation mode of the new agricultural cooperation in Ordos, the paper compares the horizontal (compared with the whole country and the whole autonomous region; the comparison with the local urban residents' medical insurance; the vertical (the county level as a whole); Therefore, it is concluded that Ordos City has the superiority of implementing the new rural cooperative planning, which not only has a high level of financing, a large proportion of reimbursement, many times of beneficiaries, but also further reflects the fairness of insurance, and the convenience after planning. This article further carries on the SWOT analysis to the Ordos new agriculture cooperation movement, according to the Ordos city implements the city overall plan development opportunity, mainly is the policy environment is good, the government responsibility increases, the human resources has the safeguard; The external threats to the implementation of the overall planning at the municipal level are mainly the rapid rise of medical expenses, the imbalance in the economy of the flag areas and the difficulty in finance, and the utilization of the advantages of the implementation of the overall plan at the municipal level, such as the implementation of the six unified policies, the high rate of return of participating farmers and herdsmen, and the strong ability to resist risks, etc. To avoid the disadvantages of implementing municipal overall planning, such as the immaturity of specific system design, the contradiction between medical service provision and cost control, and the lack of timely supervision. SWOT analysis is used to find out the most suitable and scientific way for the development of the new agricultural cooperation in Ordos, in order to achieve the goal of seeking advantages and avoiding disadvantages and fully developing. In Ordos city, WO and St strategies should be adopted in the middle developed areas, and through "six unification", the strategy should be implemented, that is, unified financing standard, unified organization management, unified fund management and unified compensation standard. Unified service supervision, unified information management. The smooth implementation of the new rural cooperative plan in Ordos requires the support of government departments, the establishment of a stable financing mechanism, the improvement of farmers' benefit through various means, and the improvement of the quality of primary medical and health services. Commercial insurance participate in the operation of NCMS, and further strengthen the supervision of NCMS designated medical institutions.
【學(xué)位授予單位】：內(nèi)蒙古大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：F842.684;F323.89;R197.1

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