本文選題：新型農(nóng)村合作醫(yī)療制度 + 基金風險�。� 參考：《新疆醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過對新疆某縣新農(nóng)合運行狀況的分析,對該縣新農(nóng)合基金風險進行識別、建立新農(nóng)合基金風險管理指標體系、構建基金風險預警模型及基金風險預警體系。方法:收集新疆某縣2009～2015年新農(nóng)合報表及統(tǒng)計年鑒相關數(shù)據(jù),結合關鍵知情人訪談分析該縣新農(nóng)合制度運行狀況及存在問題;通過三輪德爾菲專家咨詢建立新農(nóng)合基金風險管理指標體系,基于該縣新農(nóng)合歷年數(shù)據(jù)利用MIV算法篩選變量并建立灰色GM(1,n)預測模型。結果:(1)新疆某縣新農(nóng)合覆蓋面不斷擴大,2015年參合率達1000%;籌資標準由2009年的120元/人.年提高到2015年的520元/人·年;2015年門診和住院補償人次分別為104563人次和7523人次,實際補償比分別為76.12%和51.78%;累計基金結余支付能力由2009年的0.53年減少到2015年的-0.04年。(2)德爾菲專家咨詢共咨詢專家19人,專家的權威程度為0.8,專家對指標重要性、風險發(fā)生可能性和風險危害程度三個維度意見的協(xié)調(diào)系數(shù)均為0.3,經(jīng)一致性檢驗(x_(指標重要程度)~2=27.65;x_(風險發(fā)生可能性)~2=26.33;x_(風險危害程度)~2=26.54,p0.05)有意義。建立起包括環(huán)境風險、制度風險、基金籌集風險、基金支付風險和管理風險5個一級指標和30個二級指標的新農(nóng)合基金風險管理指標體系。對指標均值進行綜合排序,排名前三位的一級指標是基金支付風險、制度風險和管理風險,二級指標為縣外住院比例、縣外住院補償金額占住院補償總額比例和次均住院費用。(3)利用MIV算法篩選出地區(qū)慢性病患病率、目錄內(nèi)藥品報銷比例、參合人員住院率和次均住院費用4個變量并建立起關于新農(nóng)合基金結余支付能力的灰色GM(1,n)預測模型,模型精度為92.44%。結論:新疆某縣新農(nóng)合基金風險主要來自基金籌集和支付環(huán)節(jié);德爾菲專家咨詢結果可靠,建立的新農(nóng)合基金風險管理指標體系完善.且符合實際;通過篩選關鍵變量建立的新農(nóng)合基金風險預警模型合格能用來預測。
[Abstract]:Objective: to identify the risk of the new rural cooperative fund in a county of Xinjiang, to establish the risk management index system of the new rural cooperative fund, and to construct the early-warning model of the fund risk and the early-warning system of the fund risk. Methods: to collect the relevant data of the NCMS report form from 2009 to 2015 and the statistical yearbook in a certain county of Xinjiang, and analyze the operating status and existing problems of the NCMS system in the county with interviews with key insiders. The risk management index system of NCMS is established through three rounds of Delphi expert consultation. Based on the data of NCMS over the years, the variables are screened by MIV algorithm and the grey GMGM1n) prediction model is established. Results (1) the coverage of NCMS in a certain county of Xinjiang was continuously expanded, and the participation rate reached 1000 yuan in 2015, and the funding standard was 120 yuan per person in 2009. In 2015, the number of outpatient and in-patient compensations was 104563 and 7523, respectively. The actual compensation ratio is 76.12% and 51.78%, respectively; the cumulative capacity to pay fund balances has decreased from 0.53 years in 2009 to -0.04% in 2015.) the Delphi expert consultation has 19 consultants, with a degree of authority of 0.8.The experts are important to the indicators. The coordination coefficient of the three dimensions of risk occurrence possibility and risk hazard degree is 0.3, which is meaningful after consistency test. A new index system of NCMS risk management including environmental risk, institutional risk, fund raising risk, fund payment risk and management risk is established. According to the comprehensive ranking of the average index, the top three first-level indicators are fund payment risk, institutional risk and management risk, and the second level index is the proportion of hospitalization outside the county. Using MIV algorithm to screen the prevalence rate of chronic diseases and the proportion of drug reimbursement in the catalogue. The four variables of hospitalization rate and average hospitalization cost of the participants and the grey GM1N) prediction model about the balance and payment ability of the new rural cooperative fund are established. The precision of the model is 92.4444. Conclusion: the risk of NCMS in a county of Xinjiang mainly comes from fund raising and payment, the expert consultation result of Delphi is reliable, and the risk management index system of NRCF is perfect. The risk early warning model established by screening key variables can be used to predict the risk.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1;F842.684;F323.89

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