本文選題：道德風險 + 共付制度��； 參考：《四川農(nóng)業(yè)大學》2013年碩士論文

【摘要】：“看病貴、看病難”的問題已成為影響居民生活的問題之一,社會醫(yī)療保險制度的引入可以部分解決這一問題。但是,醫(yī)療保險制度的引入有可能加劇醫(yī)療費用支出的增加、造成不必要的醫(yī)療資源浪費。為了解決道德風險問題,在對參�；颊叩难a償方式上通常有共付制度的安排,但共付制度也降低了保險的風險防護功效,對參保患者的健康造成了負面的沖擊。我國新型農(nóng)村合作醫(yī)療自2003年開始試點,到近幾年的大力推進,新農(nóng)合在解決農(nóng)民因病致貧和因病返貧的問題上,發(fā)揮了重大的作用。但是,近年來的實踐也暴露了新農(nóng)合制度設計和治理結(jié)構(gòu)的缺陷,如道德風險和供方誘導造成的對醫(yī)療服務的過度需求。在新農(nóng)合的不斷上漲的醫(yī)療費用和農(nóng)民受益比例之間找到一種平衡,對新農(nóng)合的健康持續(xù)發(fā)展十分必要。 本文在醫(yī)療保險需求理論、健康經(jīng)濟學相關理論、福利經(jīng)濟學和衛(wèi)生經(jīng)濟學相關理論的基礎上,通過總結(jié)國內(nèi)外醫(yī)療保險中的道德風險問題,借鑒社會醫(yī)療保險的相關理論實踐,對保險中的道德風險產(chǎn)生原因、應對機制進行了理論分析。在新農(nóng)合的統(tǒng)籌補償制度調(diào)整和農(nóng)民受益關系及醫(yī)療服務利用的問題上,利用中西部36個調(diào)查縣2008-2010年的新農(nóng)合機構(gòu)的調(diào)研數(shù)據(jù)和四川省366戶農(nóng)民的個體樣本數(shù)據(jù),運用廣義線性回歸模型對新農(nóng)合的不同調(diào)查縣的農(nóng)民補助受益比例的影響因素進行分析,使用多元線性回歸模型和logistic模型對農(nóng)民的醫(yī)療服務利用影響因素進行分析。研究發(fā)現(xiàn)了經(jīng)濟因素對新農(nóng)合補償受益比例和醫(yī)療服務費用率影響顯著、住院和門診統(tǒng)籌補償模式適宜現(xiàn)階段新農(nóng)合的發(fā)展、起付線和住院補償比例不同對新農(nóng)合受益比例有顯著影響、農(nóng)民的個體特征對新農(nóng)合醫(yī)療服務利用影響顯著、新農(nóng)合共付比例的調(diào)整和優(yōu)化對防止道德風險有積極作用。 并對研究結(jié)果提出了相應的政策建議：逐步減少家庭賬戶補償模式,引導補償模式向住院和門診統(tǒng)籌轉(zhuǎn)變；合理設置住院補償方案,有效提高患者保障力度；提高籌資水平,進一步擴大新農(nóng)合補償面；深化醫(yī)療服務質(zhì)量的管理,提高農(nóng)村醫(yī)療服務資源的利用度；加大農(nóng)村公共衛(wèi)生投入,提供免費體檢,提高農(nóng)戶健康水平；促進農(nóng)村基層醫(yī)療機構(gòu)發(fā)展,為農(nóng)民就醫(yī)提供便利。
[Abstract]:The problem of "expensive to see a doctor, difficult to see a doctor" has become one of the problems affecting residents' life, and the introduction of social medical insurance system can partly solve this problem. However, the introduction of medical insurance system may aggravate the increase of medical expenses and lead to unnecessary waste of medical resources. In order to solve the moral hazard problem, there is usually the arrangement of co-payment system in the way of compensation for insured patients, but the co-payment system also reduces the risk protection effect of insurance, which has a negative impact on the health of insured patients. The New Rural Cooperative Medical system (NCMS) in our country has been piloted since 2003, and in recent years, NCMS has played an important role in solving the problems of peasants' poverty caused by illness and returning to poverty because of illness. However, the practice in recent years has also exposed the defects in the design and governance structure of the NCMS system, such as moral hazard and excessive demand for medical services caused by supply-side inducement. It is necessary to find a balance between the rising medical expenses of NCMS and the ratio of farmers' benefits to the healthy and sustainable development of NCMS. Based on the theories of medical insurance demand, health economics, welfare economics and health economics, this paper summarizes the moral hazard in medical insurance at home and abroad. Based on the theory and practice of social medical insurance, this paper analyzes the reason and mechanism of moral hazard in insurance. With regard to the adjustment of the overall compensation system of NCMS, the relationship between farmers' benefits and the utilization of medical services, the survey data from 36 survey counties in central and western China from 2008 to 2010 and individual sample data from 366 farmers in Sichuan Province were used. Based on the generalized linear regression model, the factors influencing the benefit ratio of farmers' subsidy in different counties were analyzed, and the influencing factors of farmers' medical service utilization were analyzed by using multiple linear regression model and logistic model. It is found that the economic factors have a significant impact on the benefit ratio of NCMS and the rate of medical service cost, and the in-patient and out-patient compensation model is suitable for the development of NCMS at the present stage. The difference of starting line and hospitalization compensation ratio has significant influence on the benefit ratio of NCMS, the individual characteristics of farmers have a significant influence on the utilization of NCMS medical service, and the adjustment and optimization of NCMS's co-payment ratio has a positive effect on preventing moral hazard. And put forward the corresponding policy suggestions to the research results: gradually reduce the family account compensation model, guide the compensation model to the in-patient and out-patient coordination, set up a reasonable hospitalization compensation program, effectively improve the patient protection, raise the level of financing. Further expand the compensation area of NCMS, deepen the management of medical service quality, improve the utilization of rural medical service resources, increase rural public health investment, provide free physical examination, improve the health level of rural households; To promote the development of primary-level medical institutions in rural areas and provide convenience for farmers to seek medical treatment.
【學位授予單位】：四川農(nóng)業(yè)大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：F323.89;F842.684;R197.1

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