本文選題：新型農(nóng)村合作醫(yī)療 + 高費用住院病人��； 參考：《華中科技大學》2013年碩士論文

【摘要】：研究目的 在對新農(nóng)合高費用住院病人保障水平現(xiàn)狀進行初步總結(jié)的基礎上，分析新農(nóng)合高費用住院病人保障水平的影響因素和保障水平偏低的根本影響原因，并對其中部分重要影響因素進行重點探討，為新農(nóng)合提高高費用住院病人保障水平，切實降低農(nóng)民就醫(yī)自付費用提供政策依據(jù)。 研究方法 通過機構(gòu)調(diào)查法獲取廣西H、L兩縣2009-2011年新農(nóng)合基本運行情況資料及H縣2011年、L縣2009-2011年新農(nóng)合住院病人費用數(shù)據(jù)，在此基礎上運用統(tǒng)計學分析、反事實分析、敏感度分析和衛(wèi)生系統(tǒng)診斷樹研究法對相關數(shù)據(jù)和資料進行分析。 研究結(jié)果 1.H縣2011年、L縣2009-2011年高費用住院病人平均實際補償比分別為41.62%、36.09%、33.68%和38.05%(均低于全縣平均水平，且差異均具有統(tǒng)計學意義)；平均個人自付費用分別為各縣當年農(nóng)民人均純收入的4.14、2.63、2.76和3.09倍；平均補償范圍內(nèi)費用所占比分別為73.97%、90.48%、90.14%和89.47%(均低于全縣平均水平，且差異均具有統(tǒng)計學意義)。不同病種的高費用住院病人實際補償水平比較中尿毒癥的平均實際補償比最高（51.25%），高出其余四個病種10個百分點左右（差異均有統(tǒng)計學意義）。（不包含二次補償） 2.2011年兩縣實施的二次補償政策明顯提高了高費用住院病人平均實際補償比，，H、L兩縣平均實際補償比分別提高了8.00%和14.21%，平均個人自付費用分別降低了13.71%和22.93%（差異均具有統(tǒng)計學意義）。 3.名義補償比、補償范圍內(nèi)費用所占比、就診醫(yī)療機構(gòu)層級、病種、住院總費用、住院天數(shù)和新農(nóng)合補償封頂線是新農(nóng)合高費用住院病人保障水平的影響因素，其中名義補償比、補償范圍內(nèi)費用所占比和就診醫(yī)療機構(gòu)層級是關鍵因素。 4.模擬兩縣新農(nóng)合高費用住院病人在本課題所界定的高費用標準以上的部分費用的平均名義補償比提高到70%（模擬一），平均實際補償比提高到70%（模擬二），高費用住院病人中個人自付費用高于上年農(nóng)民人均純收入的病人補償范圍內(nèi)的個人自付費用降低50%（模擬三）以及高費用住院病人平均個人自付費用降低到上年農(nóng)民人均純收入的一倍四種情況（模擬四）時所需新增資金量，H縣所需新增基金量占2011年基金籌資總額的比例分別為2.17%、8.00%、7.80%、29.91%,L縣分別為5.32%、8.06%、12.39%和26.94%。綜合來看，模擬一和模擬三可行性較大，模擬二和模擬四可行性較小。 5.從新農(nóng)合籌資、支付、組織、規(guī)制和行為等五方面看，兩縣新農(nóng)合高費用住院病人保障水平偏低的根本影響原因可歸納為政府投入不足、個人籌資有限，新農(nóng)合管理者能力不足，監(jiān)管能力有限、措施不足，支付方式改革滯后等。 研究結(jié)論 1.高費用住院病人整體保障水平偏低，疾病經(jīng)濟風險大，保障水平亟待提高。 2.新農(nóng)合二次補償能有效提高高費用住院病人保障水平，但政策實施的公平性較差，應推進建立城鄉(xiāng)居民大病保險，將現(xiàn)有二次補償過渡到規(guī)范的大病保險。 3.兩縣應適當提高縣級以上醫(yī)療機構(gòu)名義補償比，同時考慮優(yōu)先對部分成本效益較高的重大疾病病種給予較高名義補償比，并對超過一定費用標準的住院病人實施特殊補償政策；完善雙向轉(zhuǎn)診制度，住院轉(zhuǎn)診制度在規(guī)范上轉(zhuǎn)的同時應特別注重向下轉(zhuǎn)診的設計；重點加強縣級醫(yī)療機構(gòu)在費用較高，但技術較為成熟的治療項目的發(fā)展；增強對醫(yī)療機構(gòu)服務的監(jiān)管，優(yōu)先將重大疾病治療中成本效益較高，臨床應用相對成熟且尚未在報銷目錄中的治療項目和藥品納入補償范圍。 4.為保證高費用住院病人保障水平的穩(wěn)步提升，經(jīng)濟層面上應繼續(xù)大力提高新農(nóng)合的籌資額度，同時，應積極推進按病種付費等支付方式改革，如對部分費用高，但費用分布較穩(wěn)定的重大疾病病種實行定額付費方式。 5.不同地區(qū)高費用住院病人保障水平存在一定差異，具體地區(qū)應具體分析。
[Abstract]:research objective
On the basis of a preliminary summary of the current situation of the high cost inpatient guarantee level of NCMS, this paper analyzes the factors affecting the level of inpatient guarantee and the underlying causes of the low level of inpatient guarantee, and focuses on some important influencing factors to improve the level of the high cost inpatient guarantee for the NCMS. To reduce the farmers seeking self to provide policy basis for payment.
research method
The basic operation data of Guangxi H, L two county new rural cooperation (nncms) and the data of hospitalized patients in H County for 2009-2011 years in 2011 and L county were obtained by the method of institutional investigation. On this basis, statistical analysis, anti fact analysis, sensitivity analysis and health system diagnosis tree research method were used to analyze the related data and data.
The results of the study
In 1.H County, in 2011, the average actual compensation ratio of high cost hospitalized patients in L County for 2009-2011 years was 41.62%, 36.09%, 33.68% and 38.05% respectively (all were lower than the county average, and the difference was statistically significant); the average personal self payment was 4.14,2.63,2.76 and 3.09 times of the per capita net income of the peasants in the year of each county, and the cost within the average compensation range was within the range of average compensation. The percentages were 73.97%, 90.48%, 90.14% and 89.47% respectively (all were lower than the average level of the whole county, and the differences were all statistically significant). The average compensation ratio of uremia in the high cost hospitalized patients with different diseases was the highest (51.25%), and the other four diseases were 10 percentage points higher (the difference was statistically significant). Does not contain two times compensation)
The two compensation policies implemented in two counties in 2.2011 years obviously improved the average real compensation ratio of high cost hospitalized patients. The average real compensation ratio of H and L two counties increased by 8% and 14.21% respectively. The average personal self payment cost was reduced by 13.71% and 22.93% respectively (the difference was statistically significant).
3. nominal compensation ratio, the ratio of cost within the range of compensation, medical institution level, disease species, total hospitalization expenses, hospital days and CCF compensation capping line are the factors affecting the level of inpatient guarantee in the new CCMS high cost, of which the ratio of nominal compensation, the ratio of expenses within the scope of compensation and the level of medical institutions are the key factors.
4. the average nominal compensation ratio of the high cost standards above the high cost standard defined by the two county new NCMS patients is increased to 70% (simulation one), the average real compensation ratio is increased to 70% (simulation two), and the personal self payment of high cost inpatients is higher than the compensation range of the per capita net income of the farmers in the previous year. The cost of personal self payment was reduced by 50% (simulation three) and the average personal self payment of hospitalized patients was reduced to one of the four cases (simulation four) of the per capita net income of farmers in the previous year (simulation four). The proportion of new funds required for H County in 2011 was 2.17%, 8%, 7.80%, 29.91%, and 5.32%, 8., respectively, L County, respectively. 06%, 12.39% and 26.94%., a simulation and Simulation of three large and two feasibility simulation, simulation four feasibility of small.
5. from the five aspects of the NCMS financing, payment, organization, regulation and behavior, the basic factors affecting the low level of the high cost inpatient guarantee in two counties can be summarized as lack of government input, limited personal financing, lack of ability of the new rural cooperative management, limited supervision ability, insufficient measures and lagging reform of payment methods.
research conclusion
1. the high cost of hospital patients overall security level is low, the disease economic risk, security level needs to be improved.
The two compensation of 2. NCMS can effectively improve the level of high cost inpatient guarantee, but the fairness of the policy implementation is poor. It is necessary to promote the establishment of urban and rural residents' big disease insurance, and transfer the existing two compensation to the standard disease insurance.
3. the two counties should appropriately improve the nominal compensation ratio of the medical institutions at the county level and above, and consider giving priority to the higher nominal compensation ratio for some major diseases with higher cost and benefit, and implementing special compensation policies for inpatients with more than a certain cost standard; perfect two-way referral system, and the transfer of hospitalized referral system at the same time Special attention should be paid to the design of downward referral; the development of county-level medical institutions with higher costs but more mature treatment projects; the enhancement of the supervision of medical services; priority will be given to higher cost benefits in the treatment of major diseases, and the clinical application is relatively mature and has not yet been included in the reimbursement list of treatment projects and drugs. The scope of compensation.
4. in order to ensure the steady improvement of the security level of high cost hospitalized patients, we should continue to improve the financing amount of the NCMS at the economic level. At the same time, we should actively promote the reform of payment according to the payment of disease types, such as the payment method for the major diseases and diseases with higher cost but more stable distribution of cost.
5. different areas of the high cost of hospital patient security level has certain differences, specific analysis should be specific areas.
【學位授予單位】：華中科技大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R197.1

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