【摘要】：江西省新型農村合作醫(yī)療制度從局部試點到全面實施已有10年。作為農村地區(qū)一項基本醫(yī)療保障制度，新型農村合作醫(yī)療制度通過建立疾病風險共擔的保障機制，有效的提高了農民對于衛(wèi)生服務的支付能力和抵抗疾病風險的能力，在一定程度上緩解了“因病致貧，因病返貧”問題。但是，近年來新型農村合作醫(yī)療費用出現快速增長，不僅給國家財政和參合農民帶來了巨大的經濟負擔，而且制約了醫(yī)療保障水平的提高。控制醫(yī)療費用的過快增長，，使有限的資金發(fā)揮最大的社會效益和經濟效益，對于有效解決農民“看病難，看病貴”問題，保持新型農村合作醫(yī)療制度的持續(xù)健康發(fā)展具有重要意義。 基于此，本論文從新型農村合作醫(yī)療費用，尤其是次均住院費用為切入點，重點研究江西省新型農村合作醫(yī)療的費用控制問題，論文共分為六章。 第一章是導論，說明論文的研究背景、文獻綜述、研究框架、研究內容和研究方法等。 第二章論述了與醫(yī)療費用及費用控制相關的概念和基礎理論，對影響新型農村合作醫(yī)療費用上漲的因素作出了理論分析。 第三章是對江西省新型農村合作醫(yī)療費用控制現狀的實證研究。通過對江西省新型農村合作醫(yī)療費用的數據分析，得出以下結論：江西省新型農村合作醫(yī)療制度總體運行良好；實際住院補償比不斷提高，但次均住院費用和次均住院補償費用出現較快增長；在各級醫(yī)療機構中，縣級以上定點醫(yī)療機構（尤其是省級醫(yī)院）的次均住院費用最高，其次是縣級醫(yī)療機構；參合病人和新農合基金越來越多流向縣級醫(yī)療機構。對此，江西省推行了多項費用控制措施，包括推行醫(yī)療費用支付方式改革、加強定點醫(yī)療機構監(jiān)管、強化次均住院費用控制、實施基本藥物制度等。 第四章是對泰和縣新型農村合作醫(yī)療費用控制的案例分析。研究發(fā)現：泰和縣新型農村合作醫(yī)療總體運行平穩(wěn)，但次均住院費用上漲較快；在各級醫(yī)療機構中，縣級醫(yī)療機構的次均住院費用增長最快；住院補償基金主要流向縣級醫(yī)療機構。為控制醫(yī)療費用，泰和縣推行的措施主要有：嚴格控制鄉(xiāng)鎮(zhèn)定點醫(yī)療機構住院人次；控制參合病人住院用藥費用；實行單病種限價管理；實行住院基金總量控制。 第五章是對國內外醫(yī)療保險費用控制的經驗借鑒，包括對德國、美國、英國、新加坡等國的經驗借鑒，以及國內部分地區(qū)新型農村合作醫(yī)療費用控制的實踐經驗借鑒。 第六章對加強新型農村合作醫(yī)療費用控制提出政策建議。一是改革和完善醫(yī)療費用支付方式，改變單一的按服務項目付費方式，實行以預付制為主的混合支付制度；二是制定和完善三級醫(yī)療機構的雙向轉診制度，合理分流病人；三是建立完善的監(jiān)督約束機制，嚴格規(guī)范醫(yī)療服務行為。
[Abstract]:Jiangxi Province new rural cooperative medical system from partial pilot to full implementation of 10 years. As a basic medical security system in rural areas, the new rural cooperative medical care system has effectively improved farmers' ability to pay for health services and resist disease risks by establishing a mechanism to guarantee the sharing of disease risks. To some extent, it alleviates the problem of "poverty caused by illness and returning to poverty because of illness". However, in recent years, the new rural cooperative medical fee has been increasing rapidly, which not only brings a huge economic burden to the national finance and participating farmers, but also restricts the improvement of medical security level. To control the excessive growth of medical expenses, so that limited funds can bring into full play the greatest social and economic benefits, and to effectively solve the problem of "difficult and expensive medical treatment" for farmers, It is of great significance to maintain the sustainable and healthy development of the new rural cooperative medical system. Based on this, this paper focuses on the cost control of the new rural cooperative medical system in Jiangxi Province from the point of view of the new rural cooperative medical expenses, especially the average hospitalization cost. The paper is divided into six chapters. The first chapter is an introduction, explaining the research background, literature review, research framework, research content and research methods. The second chapter discusses the concepts and basic theories related to medical expenses and cost control, and makes a theoretical analysis of the factors that affect the increase of new rural cooperative medical expenses. The third chapter is an empirical study on the cost control of the new rural cooperative medical system in Jiangxi Province. Based on the data analysis of the new rural cooperative medical system in Jiangxi Province, the following conclusions are drawn: the new rural cooperative medical care system in Jiangxi Province is running well on the whole; The actual hospitalization compensation ratio is increasing, but the average hospitalization cost and the average hospitalization compensation cost are increasing rapidly. Among the medical institutions at all levels, the average hospitalization expenses of designated medical institutions at or above the county level (especially provincial hospitals) are the highest, followed by the county-level medical institutions, and more participating patients and new rural cooperative funds flow to county-level medical institutions. In view of this, Jiangxi Province has carried out a number of cost control measures, including the reform of the way of paying medical expenses, the strengthening of supervision of designated medical institutions, the strengthening of the control of sub-average hospitalization expenses, and the implementation of the system of essential drugs, and so on. The fourth chapter is a case study on the cost control of the new rural cooperative medical system in Taihe County. The study found that the overall operation of the new rural cooperative medical system in Taihe County was stable, but the average hospitalization cost increased rapidly, among the medical institutions at all levels, the average hospitalization cost of the county-level medical institutions increased fastest. Hospital compensation funds mainly flow to county-level medical institutions. In order to control the medical expenses, the measures carried out in Taihe County mainly include: strictly controlling the number of in-patients in designated medical institutions in villages and towns; controlling the hospitalization expenses of participating patients; implementing the price limit management of single disease; and carrying out the total amount control of hospital funds. The fifth chapter is the experience of medical insurance cost control at home and abroad, including Germany, the United States, the United Kingdom, Singapore and other countries, as well as some areas of the new rural cooperative medical expenses control practical experience. Chapter six puts forward policy recommendations to strengthen the cost control of new rural cooperative medical system. The first is to reform and perfect the payment method of medical expenses, to change the single payment method according to service items, to implement the mixed payment system based on prepayment system, to formulate and perfect the two-way referral system of three-level medical institutions, and to distribute patients rationally. Third, establish perfect supervision and restraint mechanism, strictly standardize medical service behavior.
【學位授予單位】：江西財經大學
【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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