本文選題：新型農(nóng)村合作醫(yī)療基金 + 監(jiān)管有效性�。� 參考：《山東農(nóng)業(yè)大學》2013年碩士論文

【摘要】：新型農(nóng)村合作醫(yī)療制度實施以來，在保障農(nóng)民獲得基本衛(wèi)生服務、緩解農(nóng)民因病致貧和因病返貧方面發(fā)揮了重要的作用。但在新型農(nóng)村合作醫(yī)療制度運行過程中，違規(guī)征繳參合費用和套取基金的情況不斷出現(xiàn)，凸顯出對新型農(nóng)村合作醫(yī)療基金進行有效監(jiān)管的必要性和緊迫性。本文以此為背景，圍繞新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價指標體系構建、方法選定及其應用等問題展開具體研究，對提高新型農(nóng)村合作醫(yī)療基金監(jiān)管的有效性將會起到重要的推動作用。 論文共分為七章，第一章為導論，第二章為基礎研究，主要包括相關概念界定和理論基礎；第三至六章為本文的主要部分，涉及了新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性指標體系的構建、評價方法的選定、實證分析及相應建議；第七章對全文的研究進行了總結(jié)并提出了尚待研究之處。 本文的主要研究結(jié)論有： （1）在明確新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性基本內(nèi)涵與理論基礎的基礎上，闡明了新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價的功能，即描述功能、分析和評價功能、監(jiān)督功能、引導功能；并且設計了新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價的步驟。 （2）在闡明構建新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價指標體系的目標與基本原則的基礎上，，運用德爾菲專家咨詢法篩選指標、運用帶有專家可信度的層次分析法確定指標權重，最終形成了完整的新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價指標體系，包括3個一級指標、6個二級指標、26個三級指標，通過分析認為指標覆蓋內(nèi)容全面、建立指標方法合理、權重計算準確。 （3）在闡明新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價方法的選擇原則之后，對現(xiàn)代幾種典型的綜合評價方法如數(shù)據(jù)包絡分析法、人工神經(jīng)網(wǎng)絡法、灰色綜合評價法、模糊綜合評價法的優(yōu)缺點及適用場合進行了比較，認為新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價過程將涉及到大量復雜情況和許多不易進行定量的因素，對它們的評價分級沒有絕對明確的界限，具有模糊性，使用其他三種評價方法存在著不合理性，而模糊綜合評價法能夠?qū)⒉灰锥康囊蛩赝ㄟ^模糊數(shù)學的隸屬度理論予以定量化，可以較為系統(tǒng)全面的解決這一問題，故選定模糊綜合評價法作為適宜方法，進而根據(jù)新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價指標體系的設計，闡述了模糊綜合評價法的計算過程。 （4）利用新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價指標體系和模糊綜合評價法，對濰坊市青州市、濟寧市汶上縣和棗莊市市中區(qū)進行了評價，計算出三個縣市新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性綜合評價值分別為17.544，16.024，17.504，即三個縣市中，濰坊市青州市新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性最強，棗莊市市中區(qū)次之，濟寧市汶上縣新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性最弱。同時也對三個地區(qū)的監(jiān)管能力、監(jiān)管效率、滿意度綜合評價得分進行了橫向比對，找出造成新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性強弱的關鍵因素包括信息化管理率、執(zhí)法取證設備配備率、監(jiān)管工作執(zhí)行等。 （5）針對新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性評價指標體系的設計和實例分析中暴露的問題，結(jié)合新型農(nóng)村合作醫(yī)療基金監(jiān)管的實際情況提出了具體建議。提升新型農(nóng)村合作醫(yī)療基金監(jiān)管有效性的建議主要有：完善新型農(nóng)村合作醫(yī)療基金監(jiān)管制度和體系、加強新型農(nóng)村合作醫(yī)療基金監(jiān)管隊伍建設、加強新型農(nóng)村合作醫(yī)療基金監(jiān)管信息化建設以提升監(jiān)管部門的監(jiān)管能力；強化風險意識，克服冒險行為、積極開展現(xiàn)場檢查、加大對定點醫(yī)療機構處罰力度以提升監(jiān)管部門的監(jiān)管效率；建立信息披露制度、建立多層次的信息發(fā)布渠道、建立投訴舉報制度和監(jiān)管激勵機制以提升監(jiān)管的滿意度。另外，還應采取建立健全基層經(jīng)辦機構建設、推行鄉(xiāng)級新型農(nóng)村合作醫(yī)療經(jīng)辦機構人員縣級垂直管理、開展“新型農(nóng)村合作醫(yī)療誠信醫(yī)院”創(chuàng)建活動等措施作以輔助。
[Abstract]:Since the implementation of the new rural cooperative medical system, it has played an important role in guaranteeing farmers' basic health services, alleviating farmers from getting poor and returning to poverty because of the disease. However, during the operation of the new rural cooperative medical system, illegal collection and collection of fees and funds are constantly emerging, which highlights a new rural cooperative medical service. It is necessary and urgent for the effective supervision of the treatment fund. This paper takes this as the background, and focuses on the construction of the evaluation index system of the new rural cooperative medical fund supervision effectiveness evaluation system, the selection of methods and its application and so on, which will play an important role in promoting the effectiveness of the new rural cooperative medical fund supervision.
The thesis is divided into seven chapters. The first chapter is the introduction, the second chapter is the basic research, which mainly includes the definition and the theoretical basis of the related concepts; the third to the six chapter is the main part of this article, which involves the construction of the new rural cooperative medical fund supervision effectiveness index system, the selection of evaluation methods, the empirical analysis and the corresponding suggestions; the seventh chapter is the whole system. This paper summarizes the research and puts forward some points for further study.
The main conclusions of this paper are as follows:
(1) on the basis of clarifying the basic connotation and theoretical basis of the effectiveness of the new rural cooperative medical fund supervision, this paper expounds the function of the evaluation of the effectiveness of the new rural cooperative medical fund supervision, that is to describe the function, the function of analysis and evaluation, the function of supervision and the function of guidance, and the effectiveness evaluation of the new rural cooperative medical fund supervision is also designed. The steps.
(2) on the basis of clarifying the objectives and basic principles of establishing the evaluation index system for the effectiveness of the new rural cooperative medical fund supervision, using the Delphy expert consultation method, the index is selected and the index weight is determined by the analytic hierarchy process with the credibility of the expert. Finally, the evaluation of the effectiveness of the new rural cooperative medical fund is formed. Price index system, including 3 first grade index, 6 two grade index and 26 three grade index. Through the analysis, the index covers the overall content, the establishment of the index method is reasonable, the weight calculation is accurate.
(3) after clarifying the selection principle of the effectiveness evaluation method of the new rural cooperative medical fund supervision, this paper compares the advantages and disadvantages of several modern typical comprehensive evaluation methods, such as data envelopment analysis, artificial neural network, grey comprehensive evaluation and fuzzy comprehensive evaluation, and thinks that the new rural cooperative medical foundation is the basis of the new rural cooperative medical system. The evaluation process of the effectiveness of gold supervision will involve a large number of complex situations and many factors which are not easy to quantify. There is no absolute definite boundary for their evaluation and classification. It is fuzzy, and the other three kinds of evaluation methods are unreasonable, and the fuzzy comprehensive evaluation method can make the factors which are not easy to be quantified through fuzzy mathematics. The degree theory is quantified and can solve the problem systematically and comprehensively. Therefore, the fuzzy comprehensive evaluation method is selected as the suitable method, and then the calculation process of the fuzzy comprehensive evaluation method is expounded according to the design of the evaluation index system of the new rural cooperative medical fund supervision effectiveness.
(4) using the evaluation index system of the new rural cooperative medical fund supervision effectiveness and the fuzzy comprehensive evaluation method, the evaluation is carried out on Qingzhou city of Weifang, Wenshang County and Zaozhuang city in Jining City, and the comprehensive evaluation value of the supervision effectiveness of the new rural cooperative medical funds in three counties and cities is 17.544,16.024,17.504, that is, three counties. In the city, the new rural cooperative medical fund in Qingzhou city of Weifang is the most effective, the Central District of Zaozhuang city is the second. The effectiveness of the new rural cooperative medical fund in Wenshang County of Jining is the weakest. At the same time, the supervision ability, the supervision efficiency and the comprehensive evaluation score of the three regions are compared, and the new rural areas are found out. The key factors of the effectiveness of the supervision of the cooperative medical fund include the information management rate, the rate of law enforcement evidence collection equipment, and the implementation of supervision work.
(5) in view of the problems exposed in the design and case analysis of the effectiveness evaluation index system of the new rural cooperative medical fund supervision and management, the concrete suggestions are put forward in combination with the actual situation of the new rural cooperative medical fund supervision. The suggestions for improving the effectiveness of the new rural cooperative medical fund supervision are as follows: the improvement of the new rural cooperative medical foundation Gold supervision system and system, strengthen the construction of the new rural cooperative medical fund supervision team, strengthen the construction of the new rural cooperative medical fund supervision information construction to improve the supervision ability of the supervision department, strengthen the risk awareness, overcome the risk behavior, actively carry out the field inspection, and increase the punishment to the designated medical institutions in order to improve the supervision department The system of information disclosure, the establishment of multi-level information distribution channels, the establishment of the complaint reporting system and the supervision and incentive mechanism to improve the satisfaction of the supervision. In addition, the construction of the grass-roots agencies should be established, and the new rural cooperative medical institutions personnel at the county level should be carried out at the county level and the "new type" should be carried out. Measures such as the establishment of a good faith hospital in rural cooperative medical care and so on.
【學位授予單位】：山東農(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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