長春市朝陽區(qū)醫(yī)療保障城鄉(xiāng)一體化現(xiàn)狀研究
發(fā)布時間：2018-10-31 07:03
【摘要】：目的： 在我國，不同類型的醫(yī)療保險在待遇和籌資方式等方面差異較大，并且城鄉(xiāng)分割的局面人為地將參�；颊邉澐譃閹讉�不同等級，阻礙了不同等級人群的流動，嚴重破壞了社會公平。因此醫(yī)療保險的城鄉(xiāng)統(tǒng)籌工作對于鞏固完善全民醫(yī)保、實現(xiàn)可持續(xù)發(fā)展，具有更加重要、更加深遠的現(xiàn)實意義。醫(yī)療保障是政府最大的民生工程。本研究旨在以長春市朝陽區(qū)為例，通過調(diào)查分析以及對城鄉(xiāng)統(tǒng)籌試點長春市朝陽區(qū)三年運行的效果進行評價，從而提出科學(xué)完善的城鄉(xiāng)一體化醫(yī)療保障對策建議，為政府進一步加大改革力度、縮小城鄉(xiāng)差距、實施城鄉(xiāng)統(tǒng)籌提供基本數(shù)據(jù)，也為相關(guān)職能部門的決策提供科學(xué)依據(jù)支持。 方法： 抽取長春市朝陽區(qū)某醫(yī)院內(nèi)，長春市城鎮(zhèn)職工醫(yī)保、城鎮(zhèn)居民醫(yī)保、新農(nóng)合的高血壓患者各100名，對比分析不同醫(yī)保類型患者住院費用、住院天數(shù)，報銷比例等情況，對不同醫(yī)保類型患者住院醫(yī)療保險使用比較研究；對2011-2013年長春市朝陽區(qū)新農(nóng)合患者在各級醫(yī)療機構(gòu)就醫(yī)的總?cè)舜�，費用總額，醫(yī)療保險報銷總額，個人現(xiàn)金總額情況，以新農(nóng)合患者各級醫(yī)療機構(gòu)就醫(yī)情況進行比較研究。 結(jié)果： （1）三種醫(yī)保類型的參保者在住院就醫(yī)時的住院總費用、住院天數(shù)、自費費用、自費比例、醫(yī)保報銷金額、報銷比例等均存在顯著差異性。城鎮(zhèn)職工醫(yī)保大部分指標(biāo)高于其他兩種類型。城鎮(zhèn)居民醫(yī)�；颊吆托罗r(nóng)合參保者自費比例、報銷比例情況相近。 （2）自2011年起，長春市朝陽區(qū)的新農(nóng)合患者在市級以上醫(yī)院就診人次、基金使用構(gòu)成比逐年上升，而在區(qū)級及以下醫(yī)院的就診人次、基金使用構(gòu)成比逐年減少；隨著醫(yī)療機構(gòu)級別的提高，新農(nóng)合醫(yī)保的患者在住院次均費用、住院次均自費費用方面升高；同一年份內(nèi)，省級醫(yī)療機構(gòu)的新農(nóng)合醫(yī)�；颊叩淖≡貉a償比明顯低于鄉(xiāng)鎮(zhèn)衛(wèi)生院（社區(qū)衛(wèi)生服務(wù)中心）。 （3）長春市朝陽區(qū)醫(yī)療保險城鄉(xiāng)統(tǒng)籌建設(shè)過程中，尚存在管理體制尚未統(tǒng)一、籌資方式和籌資標(biāo)準分散，不同種類醫(yī)療保險差別較大、不同醫(yī)療保險所使用的目錄不同、不同醫(yī)療保險管理體系的信息化程度存在差異等問題。 結(jié)論： （1）城鎮(zhèn)職工醫(yī)保待遇高于其他兩種類型。城鎮(zhèn)居民醫(yī)保患者和新農(nóng)合參保者待遇相近，為城鎮(zhèn)居民醫(yī)保與新農(nóng)合醫(yī)保進行初步整合提供基礎(chǔ)。 （2）“看病難、看病貴”問題仍然存在，新農(nóng)合患者的“舍近求遠”顯示出基層醫(yī)療機構(gòu)建設(shè)的不完善。 （3）長春市朝陽區(qū)醫(yī)療保險城鄉(xiāng)統(tǒng)籌建設(shè)藍圖已初具規(guī)模，但是目前長春市朝陽區(qū)目前的城鄉(xiāng)統(tǒng)籌情況與既有藍圖設(shè)立的目標(biāo)之間仍有差距，以此為切入點，，提出針對性建議，以縮短差距，完善城鄉(xiāng)統(tǒng)籌建設(shè)，促進長春市醫(yī)療保險一體化目標(biāo)的早日實現(xiàn)。
[Abstract]:Objective: in China, different types of medical insurance have great differences in terms of treatment and financing, and the situation of urban and rural segmentation artificially divides the insured patients into several different grades, which hinders the flow of people of different classes. It seriously undermines social justice. Therefore, the urban and rural overall planning of medical insurance has more important and far-reaching practical significance for consolidating and perfecting universal medical insurance and realizing sustainable development. Health care is the government's largest livelihood project. The purpose of this study is to take Chaoyang District of Changchun City as an example, through investigation and analysis, as well as to evaluate the effect of three years' operation of Chaoyang District of Changchun City as a whole, so as to put forward scientific and perfect countermeasures and suggestions for medical security of urban and rural integration. It provides the basic data for the government to further strengthen the reform, reduce the gap between urban and rural areas, implement urban and rural planning, and also provide scientific support for the decision-making of relevant functional departments. Methods: a total of 100 patients with hypertension were collected from a hospital in Chaoyang District, Changchun City, including urban health insurance, medical insurance for urban residents and NCMS. The hospital expenses and hospitalization days of patients with different types of medical insurance were compared and analyzed. The proportion of reimbursement, the use of different types of medical insurance inpatient medical insurance use comparative study; A comparative study was made on the total number of visits, total expenses, total reimbursement of medical insurance, and total personal cash in the medical institutions of the new rural cooperative patients in Chaoyang District, Changchun City, from 2011 to 2013, according to the medical conditions of the new rural cooperative patients at all levels. Results: (1) there were significant differences in the total cost, the days of hospitalization, the self-expense, the proportion of self-expense, the amount of medical insurance reimbursement and the proportion of reimbursement in the three types of medical insurance. Most of the indexes of medical insurance for urban workers are higher than the other two types. The proportion of urban residents'medical insurance patients and the new rural cooperative insured is similar to the proportion of reimbursement. (2) since 2011, new rural cooperative patients in Chaoyang District, Changchun City, have visited hospitals at and above the municipal level. The proportion of fund use composition has increased year by year, while the ratio of fund use composition has decreased year by year in hospitals at district level and below. With the improvement of the level of medical institutions, the average cost of hospitalization and the cost of hospitalization were increased in the new rural cooperative medical insurance system. In the same year, the inpatient compensation ratio of NCMS patients in provincial medical institutions was significantly lower than that in township health centers (community health service centers). (3) in the process of urban and rural development of medical insurance in Chaoyang District, Changchun City, the management system has not yet been unified, the financing methods and standards are scattered, there are great differences between different kinds of medical insurance, and the catalogue used by different medical insurance is different. The informationization degree of different medical insurance management system is different and so on. Conclusion: (1) the treatment of medical insurance for urban workers is higher than the other two types. The treatment of urban residents' medical insurance patients and the new rural cooperative insurance providers is similar, which provides the basis for the initial integration of the urban residents' medical insurance and the new rural cooperative medical insurance. (2) the problem of "difficult to see a doctor and expensive to see a doctor" still exists. (3) the blueprint of urban and rural overall planning of medical insurance in Chaoyang District of Changchun City has begun to take shape, but there is still a gap between the present situation of urban and rural planning in Chaoyang District of Changchun City and the target set up by the existing blueprint, which is regarded as a breakthrough point. Some suggestions are put forward to shorten the gap, perfect the overall construction of urban and rural areas, and promote the realization of the goal of integration of medical insurance in Changchun as soon as possible.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F842.684
本文編號：2301334
[Abstract]:Objective: in China, different types of medical insurance have great differences in terms of treatment and financing, and the situation of urban and rural segmentation artificially divides the insured patients into several different grades, which hinders the flow of people of different classes. It seriously undermines social justice. Therefore, the urban and rural overall planning of medical insurance has more important and far-reaching practical significance for consolidating and perfecting universal medical insurance and realizing sustainable development. Health care is the government's largest livelihood project. The purpose of this study is to take Chaoyang District of Changchun City as an example, through investigation and analysis, as well as to evaluate the effect of three years' operation of Chaoyang District of Changchun City as a whole, so as to put forward scientific and perfect countermeasures and suggestions for medical security of urban and rural integration. It provides the basic data for the government to further strengthen the reform, reduce the gap between urban and rural areas, implement urban and rural planning, and also provide scientific support for the decision-making of relevant functional departments. Methods: a total of 100 patients with hypertension were collected from a hospital in Chaoyang District, Changchun City, including urban health insurance, medical insurance for urban residents and NCMS. The hospital expenses and hospitalization days of patients with different types of medical insurance were compared and analyzed. The proportion of reimbursement, the use of different types of medical insurance inpatient medical insurance use comparative study; A comparative study was made on the total number of visits, total expenses, total reimbursement of medical insurance, and total personal cash in the medical institutions of the new rural cooperative patients in Chaoyang District, Changchun City, from 2011 to 2013, according to the medical conditions of the new rural cooperative patients at all levels. Results: (1) there were significant differences in the total cost, the days of hospitalization, the self-expense, the proportion of self-expense, the amount of medical insurance reimbursement and the proportion of reimbursement in the three types of medical insurance. Most of the indexes of medical insurance for urban workers are higher than the other two types. The proportion of urban residents'medical insurance patients and the new rural cooperative insured is similar to the proportion of reimbursement. (2) since 2011, new rural cooperative patients in Chaoyang District, Changchun City, have visited hospitals at and above the municipal level. The proportion of fund use composition has increased year by year, while the ratio of fund use composition has decreased year by year in hospitals at district level and below. With the improvement of the level of medical institutions, the average cost of hospitalization and the cost of hospitalization were increased in the new rural cooperative medical insurance system. In the same year, the inpatient compensation ratio of NCMS patients in provincial medical institutions was significantly lower than that in township health centers (community health service centers). (3) in the process of urban and rural development of medical insurance in Chaoyang District, Changchun City, the management system has not yet been unified, the financing methods and standards are scattered, there are great differences between different kinds of medical insurance, and the catalogue used by different medical insurance is different. The informationization degree of different medical insurance management system is different and so on. Conclusion: (1) the treatment of medical insurance for urban workers is higher than the other two types. The treatment of urban residents' medical insurance patients and the new rural cooperative insurance providers is similar, which provides the basis for the initial integration of the urban residents' medical insurance and the new rural cooperative medical insurance. (2) the problem of "difficult to see a doctor and expensive to see a doctor" still exists. (3) the blueprint of urban and rural overall planning of medical insurance in Chaoyang District of Changchun City has begun to take shape, but there is still a gap between the present situation of urban and rural planning in Chaoyang District of Changchun City and the target set up by the existing blueprint, which is regarded as a breakthrough point. Some suggestions are put forward to shorten the gap, perfect the overall construction of urban and rural areas, and promote the realization of the goal of integration of medical insurance in Changchun as soon as possible.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F842.684
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