本文選題：新型農(nóng)村合作醫(yī)療制度 + 評價指標(biāo)體系　； 參考：《遼寧大學(xué)》2013年博士論文

【摘要】：我國農(nóng)村居民在傳統(tǒng)農(nóng)村合作醫(yī)療制度瓦解、新型農(nóng)村合作醫(yī)療制度建立之前一直處于無社會醫(yī)療保障狀態(tài)，就醫(yī)時發(fā)生的醫(yī)療費(fèi)用主要由農(nóng)民個人負(fù)擔(dān)，到上個世紀(jì)90年代末，醫(yī)療費(fèi)用的增長速度遠(yuǎn)遠(yuǎn)超過農(nóng)村居民收入的增長速度，尤其是患大病時，他們不堪醫(yī)療費(fèi)用的重荷，其最終結(jié)果往往是農(nóng)村居民因病致貧。農(nóng)民看病難、看病貴，致使身體健康狀況下降，嚴(yán)重影響我國農(nóng)村人力資本的積累與社會穩(wěn)定。針對這種情況為扭轉(zhuǎn)我國農(nóng)村居民的就醫(yī)困境，2003年開始，我國先以部分省市的農(nóng)村為試點(diǎn)建立以“大病統(tǒng)籌”為主的“新型”農(nóng)村合作醫(yī)療制度和醫(yī)療救助制度（簡稱新農(nóng)合）。該醫(yī)療制度是由政府組織、引導(dǎo)、支持，農(nóng)民自愿參加，個人、集體和政府多方籌資，以大病統(tǒng)籌為主的農(nóng)民醫(yī)療互助共濟(jì)制度①，是我國各地農(nóng)村正在推行的一項(xiàng)農(nóng)村醫(yī)療保障制度，是促進(jìn)社會公平、協(xié)調(diào)發(fā)展、惠及七億六千萬農(nóng)村人口的戰(zhàn)略性政策，對于縮小城鄉(xiāng)差距、扭轉(zhuǎn)不平衡的社會發(fā)展結(jié)構(gòu)、構(gòu)建和諧社會具有深遠(yuǎn)的意義。 本篇論文的寫作目的是考察新農(nóng)合制度的實(shí)施績效，并分析其存在的主要問題，以期為完善新農(nóng)合制度做出應(yīng)有的貢獻(xiàn)。為了實(shí)現(xiàn)論文的寫作目的，筆者通過對遼寧、吉林、山東、河南四省參合農(nóng)民的問卷調(diào)查與實(shí)地走訪調(diào)研，掌握了新農(nóng)合制度運(yùn)行的實(shí)際情況和論文寫作的一手資料。在此基礎(chǔ)上進(jìn)行了論文的框架設(shè)計和寫作。論文的主要內(nèi)容如下： 第一，論文的理論基礎(chǔ)。首先，，系統(tǒng)梳理與客觀評價了國內(nèi)外學(xué)者對農(nóng)村醫(yī)療保障問題的研究成果。包括國外學(xué)者對農(nóng)村醫(yī)療保障制度運(yùn)行、農(nóng)村醫(yī)保制度對防范疾病風(fēng)險的作用、政府在醫(yī)療保障中的作用及干預(yù)失靈等問題的研究；國內(nèi)學(xué)者對我國新農(nóng)合制度的建設(shè)、籌資、醫(yī)療補(bǔ)償、基金分配，以及農(nóng)村合作醫(yī)療制度建設(shè)的國際經(jīng)驗(yàn)等方面的研究。并對國內(nèi)外學(xué)者的研究成果進(jìn)行了客觀評價�，F(xiàn)有的相關(guān)研究成果不僅為本論文的研究提供了知識基礎(chǔ)和參考借鑒，現(xiàn)有理論的研究不足也構(gòu)成了本文的研究重點(diǎn)。其次，概括闡述了社會公平理論、信息不對稱理論、利益集團(tuán)理論、帕累托效率理論和納什均衡理論，從而為本文在評價指標(biāo)選取、問題成因分析提供了理論依據(jù)。 第二，新型農(nóng)村合作醫(yī)療制度實(shí)施績效研究。首先，介紹了作者對新農(nóng)合制度調(diào)研的基本情況，并對調(diào)研數(shù)據(jù)與調(diào)研結(jié)果進(jìn)行了整理、分析；其次，根據(jù)社會保障的生存公平與勞動公平理論和我國城鄉(xiāng)醫(yī)療保障的實(shí)際情況，建立了新農(nóng)合制度績效評價指標(biāo)體系，對各項(xiàng)指標(biāo)賦以不同的權(quán)重，并依據(jù)調(diào)研的一手資料和官方統(tǒng)計資料對新農(nóng)合制度的實(shí)施績效進(jìn)行了客觀評價；最后根據(jù)績效評價結(jié)果探討了新農(nóng)合制度存在的主要問題，即：新農(nóng)合的籌資水平低、保障病種范圍受限、轉(zhuǎn)診制度不完善、監(jiān)督與管理不到位、新農(nóng)合的定點(diǎn)醫(yī)療機(jī)構(gòu)技術(shù)水平低下等。這些問題的存在使參合農(nóng)民的就醫(yī)需求難以得到滿足，與新農(nóng)合制度的設(shè)計初衷相矛盾。 第三，新型農(nóng)村合作醫(yī)療制度存在問題的原因分析。以信息不對稱理論、利益集團(tuán)理論、帕累托效率理論、納什均衡理論為基礎(chǔ)，通過對新農(nóng)合制度設(shè)計、運(yùn)行與管理的出資責(zé)任、監(jiān)督與管理等方面的博弈分析，剖析了新農(nóng)合制度存在問題的原因。新農(nóng)合制度實(shí)施中存在諸多問題，都與制度設(shè)計的先天不足直接相關(guān)。新農(nóng)合低水平保大病制度的安排不僅不能滿足于農(nóng)民大病小病全保的利益訴求，更與農(nóng)村定點(diǎn)醫(yī)療機(jī)構(gòu)的選擇相矛盾。這一矛盾又派生了限制性轉(zhuǎn)診制度，并由此引發(fā)了農(nóng)民工就醫(yī)難及患大病農(nóng)民轉(zhuǎn)診難等新問題。由于新農(nóng)合制度的運(yùn)行管理及其所需資金均由地方政府負(fù)責(zé)，但業(yè)績考核卻依然是GDP導(dǎo)向，使得地方政府對新農(nóng)合制度運(yùn)行管理的財權(quán)與事權(quán)不配套、責(zé)權(quán)利不統(tǒng)一，從而導(dǎo)致地方政府既缺乏對新農(nóng)合制度運(yùn)行管理的內(nèi)在動力，又沒有對新農(nóng)合制度進(jìn)行有效監(jiān)督與管理的足夠財力。在政府監(jiān)管不到位的條件下，定點(diǎn)醫(yī)療機(jī)構(gòu)過度醫(yī)療、參合農(nóng)民與定點(diǎn)醫(yī)療機(jī)構(gòu)合謀套用新農(nóng)合資金的情況時有發(fā)生。而保大病的合作醫(yī)療制度、農(nóng)村定點(diǎn)醫(yī)療機(jī)構(gòu)的選擇、新農(nóng)合制度運(yùn)行管理責(zé)任與出資的制度安排，不僅與中國現(xiàn)階段經(jīng)濟(jì)發(fā)展水平低的國情有關(guān)，更取決于制度博弈參與雙方的博弈力量對比。 第四，完善新型農(nóng)村合作醫(yī)療制度對策研究。“哲學(xué)家只是用不同的方法解釋世界，而問題在于改變世界”。①論文針對新農(nóng)合制度存在的問題及其成因，借鑒國外日本、英國、德國的農(nóng)村醫(yī)療保險制度在資金籌集、就醫(yī)方式、農(nóng)村醫(yī)療水平提升等方面的經(jīng)驗(yàn)，提出了完善新農(nóng)合制度的對策建議，主要有：為新農(nóng)合制度立法；加大政府對新農(nóng)合制度運(yùn)行的資金投入；提高定點(diǎn)醫(yī)療機(jī)構(gòu)的服務(wù)水平；完善就醫(yī)轉(zhuǎn)診制度；加強(qiáng)對新農(nóng)合制度運(yùn)行的監(jiān)督與管理。
[Abstract]:China's rural residents have disintegrated in the traditional rural cooperative medical system, and the new rural cooperative medical system has been in the state of non social medical security before the establishment of the new rural cooperative medical system. The medical expenses occurred mainly by the individual farmers. By the end of the 90s of last century, the growth rate of medical expenses was far more than the growth rate of rural residents' income. Especially in the case of serious illness, they are not able to bear the burden of medical expenses. The final result is that the rural residents are poor. The farmers are difficult to see the disease, and the health conditions are expensive. The health status of the rural residents is declining, and the accumulation of human capital and social stability in rural areas are seriously affected. In order to reverse the dilemma of rural residents in China, this situation began in 2003, In China, the "new type" rural cooperative medical system and medical assistance system (nncms) are set up in the rural areas of some provinces and cities as a pilot project. The medical system is organized by the government, guided, supported, voluntary participation of farmers, individual, collective and government fund-raising, and the mutual assistance of farmers with major diseases as a co-ordinate. The Freemasonry system is a rural medical security system which is being carried out in rural areas of China. It is a strategic policy to promote social fairness, coordinate development and benefit the seven hundred and sixty million rural population. It has far-reaching significance for reducing the gap between urban and rural areas, reversing the unbalanced social development structure, and building a harmonious society.
The purpose of this paper is to investigate the implementation performance of the new rural cooperative system and analyze its main problems in order to contribute to the improvement of the new rural cooperative system. In order to achieve the purpose of writing the paper, the author has grasped the new farmers through the survey and field visits of the farmers in the four provinces of Liaoning, Jilin, Shandong and Henan. On the basis of the actual situation of the system operation and the first-hand information of the thesis writing, the framework of the thesis is designed and written. The main contents of the paper are as follows:
First, the theoretical basis of the thesis. First, it systematically reviews and objectively evaluates the research results of domestic and foreign scholars on rural medical security, including the operation of rural medical security system by foreign scholars, the role of rural medical insurance system on preventing the risk of disease, the role of government in medical security and the failure of intervention, and so on; The internal scholars have studied the construction, financing, medical compensation, fund distribution, and the international experience of the construction of rural cooperative medical system in China, and made an objective evaluation on the research results of scholars at home and abroad. The lack of theoretical research also constitutes the focus of this study. Secondly, it summarizes the theory of social equity, information asymmetry theory, interest group theory, Pareto efficiency theory and Nash equilibrium theory, thus providing a theoretical basis for the selection of evaluation indicators and the analysis of the causes of the problems.
Second, the implementation of the new rural cooperative medical system performance research. First, the author introduced the basic situation of the investigation of the new rural cooperative system, and analyzed the survey data and research results. Secondly, according to the theory of social security and the theory of labor equity and the actual situation of urban and rural medical security in our country, the new rural cooperative system was established. The system performance evaluation index system is assigned to various indexes with different weights, and the implementation performance of the new rural cooperative system is evaluated objectively according to the one hand data and official statistics. Finally, the main problems of the new rural cooperative system are discussed according to the results of performance evaluation, that is, the financing level of the new rural cooperative system is low and the disease species is guaranteed. Limited scope, imperfect referral system, inadequate supervision and management, low technical level of the designated medical institutions of the NCMS, and so on. The existence of these problems makes it difficult to meet the demand for medical treatment of the participating farmers, and contradicts the original intention of the new rural cooperative system.
Third, the cause analysis of the problems in the new rural cooperative medical system. Based on information asymmetry theory, interest group theory, Pareto efficiency theory and Nash equilibrium theory, this paper analyzes the problems of the new rural cooperative system through the game analysis on the design of the new rural cooperative system, the responsibility of operation and management, supervision and management and so on. The reasons. There are many problems in the implementation of the new rural cooperative system, which are directly related to the deficiency of the system design. The arrangement of the new NCMS low level protection system is not only not satisfied with the interest demands of the farmers with large diseases and small diseases, but also contradicts the choice of the rural designated medical institutions. This contradiction also derives the restrictive referral system, As a result, the operation management of the new rural cooperative system and the funds needed are all responsible for the local government, but the performance assessment is still GDP oriented, which makes the local government do not match the financial power and power of the operation and management of the new rural cooperative system, and the responsibility is not unified, thus leading to the ununification of the power and the power. The local government has not only the inherent motive force for the operation and management of the new rural cooperative system, but also has no sufficient financial power to supervise and manage the new rural cooperative system effectively. Under the condition of the government supervision is not in place, the excessive medical treatment of the designated medical institutions and the conspiracy to conspire with the farmers and the fixed-point medical institutions have occurred when the new rural cooperative funds are conspire. The cooperative medical system, the choice of rural fixed-point medical institutions and the system arrangement of the operation management responsibility and capital contribution of the NCMS system are not only related to the situation of the low level of China's economic development at the present stage, but also on the game strength comparison between the two parties involved in the system game.
Fourth, to improve the Countermeasures of the new rural cooperative medical system. "Philosophers only explain the world in different ways, but the problem is to change the world." (1) the paper aims at the problems and causes of the new rural cooperative system, and draws lessons from the rural medical insurance system in Japan, Britain and Germany for the fund raising, medical treatment, and rural medical water. On the other hand, some suggestions were put forward to improve the new rural cooperative system, including the legislation of the new rural cooperative system, the increase of the government's investment in the operation of the new rural cooperative system, the improvement of the service level of the designated medical institutions, the improvement of the medical referral system, and the supervision and management of the operation of the new rural cooperative system.
【學(xué)位授予單位】：遼寧大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：F323.89;F842.684;R197.1

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