【摘要】：如何科學(xué)合理地構(gòu)建一套關(guān)于新型農(nóng)村合作醫(yī)療運行效果評價的指標(biāo)體系,從而客觀科學(xué)地評價內(nèi)蒙古自治區(qū)新型農(nóng)村合作醫(yī)療的運行狀況,以提高運行質(zhì)量和效果,促進(jìn)該制度健康穩(wěn)定地發(fā)展,成為這項制度進(jìn)入全面推廣時期后面臨的首要問題。由于不同地區(qū)之間在經(jīng)濟(jì)發(fā)展、農(nóng)民收入、農(nóng)民的衛(wèi)生觀念、政策干預(yù)和導(dǎo)向以及基礎(chǔ)環(huán)境等諸多方面存在著差異,新型農(nóng)村合作醫(yī)療制度在各地推行的模式、實施的方案也不一致,目前還沒有一套統(tǒng)一的評價指標(biāo)。另外,與傳統(tǒng)的合作醫(yī)療制度相比,新型農(nóng)村合作醫(yī)療制度在資金籌集、資金使用、費用補償、監(jiān)督管理、受益程度等方面有很多地方實現(xiàn)了突破與創(chuàng)新。 本文運用理論分析與實證分析相結(jié)合的方法,首先闡述了新型農(nóng)村合作醫(yī)療制度的基本概念,敘述了我國新型農(nóng)村合作醫(yī)療制度的歷史沿革,介紹了新型農(nóng)村合作醫(yī)療制度的相關(guān)理論,分析了新型農(nóng)村合作醫(yī)療制度的運行模式。其后,對內(nèi)蒙古自治區(qū)新型農(nóng)村合作醫(yī)療制度的運行進(jìn)行了總體評價,介紹了所取得的主要成效,并剖析了目前新型農(nóng)村合作醫(yī)療制度存在的主要問題。在此基礎(chǔ)上,根據(jù)運行效果評價的理論研究,運用變異系數(shù)法和聚類分析法,并適當(dāng)結(jié)合專家咨詢法,設(shè)計出一套新型農(nóng)村合作醫(yī)療運行效果評價指標(biāo)體系。最后,運用主成分分析法,對內(nèi)蒙古自治區(qū)12個盟市的新型農(nóng)村合作醫(yī)療的運行效果進(jìn)行了綜合評價,并根據(jù)評價結(jié)果提出了今后進(jìn)一步完善新型農(nóng)村合作醫(yī)療制度的建議。 本文形成的主要結(jié)論如下： 1.構(gòu)建了內(nèi)蒙古新型農(nóng)村合作醫(yī)療運行效果評價指標(biāo)體系。按照新型農(nóng)村合作醫(yī)療的過程和結(jié)果,初步選取了26項指標(biāo),作為構(gòu)成初選評價指標(biāo)體系的評價指標(biāo),并計算了26項指標(biāo)的數(shù)值,然后從基金籌集、基金使用、參合情況、費用負(fù)擔(dān)、衛(wèi)生資源利用以及受益程度6個方面進(jìn)行了分組,形成了初選指標(biāo)構(gòu)成的評價體系。為了降低評價指標(biāo)之間的相關(guān)度,提高評價指標(biāo)的代表性,利用變異系數(shù)法和聚類分析法,并適當(dāng)結(jié)合專家咨詢法,對初步選定的26項指標(biāo)進(jìn)行了篩選,三種方法最終篩選出的指標(biāo)為7項；這7項指標(biāo)構(gòu)成了對新型農(nóng)村合作醫(yī)療運行效果進(jìn)行綜合評價的評價指標(biāo)體系。 2.評價指標(biāo)適合進(jìn)行主成分分析。為了避免由于檢驗方法的單一照成檢驗結(jié)果的偏差,同時選取了KMO和巴特利特兩種方法進(jìn)行檢驗。通過檢驗,KMO=0.635(大于0.6),給出的相伴概率值為0.00,小于顯著性水平0.05(有人認(rèn)為是0.01),兩種檢驗方法都說明適宜進(jìn)行主成分分析。 3.內(nèi)蒙古自治區(qū)新型農(nóng)村合作醫(yī)療的發(fā)展是不均衡的。以往的學(xué)術(shù)研究多數(shù)在分析全國的新型農(nóng)村合作醫(yī)療,或重在分析某省(市)試點縣的新型農(nóng)村合作醫(yī)療,而專門分析自治區(qū)新型農(nóng)村合作醫(yī)療運行效果的研究目前還很少。我在這方面作了嘗試,分析了內(nèi)蒙古自治區(qū)新型農(nóng)村合作醫(yī)療進(jìn)入全面推廣時期以后,12個盟市該制度運行的效果。結(jié)果顯示,內(nèi)蒙古自治區(qū)新型農(nóng)村合作醫(yī)療的發(fā)展是不均衡的。 4.經(jīng)濟(jì)增長是影響新型農(nóng)村合作醫(yī)療運行效果的重要因素。社會醫(yī)療保障的發(fā)展水平歸根結(jié)底是由一個國家或地區(qū)的經(jīng)濟(jì)發(fā)展水平?jīng)Q定的,經(jīng)濟(jì)發(fā)展為醫(yī)療保障提供了前提和基礎(chǔ)。只有經(jīng)濟(jì)發(fā)展了,才能提供醫(yī)療保障所需的物質(zhì)基礎(chǔ),經(jīng)濟(jì)發(fā)展水平還決定了醫(yī)療保障的廣度和深度。比如,鄂爾多斯市運行效果的排名占居首位,排序情況也是與該市近幾年經(jīng)濟(jì)的高速增長相吻合的。 5.在推進(jìn)新型農(nóng)村合作醫(yī)療運行的過程中,政府承擔(dān)著主要責(zé)任,發(fā)揮著主導(dǎo)作用。在新型農(nóng)村合作醫(yī)療的發(fā)展定位、基金籌集與分配使用、正確處理農(nóng)村與城市醫(yī)療衛(wèi)生資源配置的矛盾等方面,都需要政府的組織、參與、協(xié)調(diào)、控制。
[Abstract]:How to scientifically and reasonably construct a set of index system on the evaluation of the operation effect of the new rural cooperative medical system, so as to objectively and scientifically evaluate the operating conditions of the new rural cooperative medical service in the Inner Mongolia Autonomous Region, so as to improve the operation quality and the effect, and to promote the healthy and stable development of the system, It is the first problem that the system faces after the full-scale promotion period. Due to the differences in the economic development, the farmer's income, the farmer's health concept, the policy intervention and the guidance and the basic environment among different regions, the new rural cooperative medical service system is implemented in various places, and the scheme of the implementation is not consistent, There is no uniform set of evaluation indicators at this time. In addition, compared with the traditional cooperative medical system, the new rural cooperative medical care system has many places to realize the breakthrough and innovation in the aspects of fund raising, fund use, cost compensation, supervision and administration, benefit degree and so on. In this paper, the basic concept of the new rural cooperative medical service system is described, the history of the new rural cooperative medical service system is described, and the related principles of the new rural cooperative medical system are introduced. On the Operation Model of the New Rural Cooperative Medical System After that, the overall evaluation of the operation of the new rural cooperative medical system in the Inner Mongolia Autonomous Region has been carried out, the main results have been introduced, and the main question of the existence of the new rural cooperative medical service system is also analyzed. On this basis, according to the theoretical study of the evaluation of the running effect, the coefficient of variation method and the cluster analysis method are used to design a new evaluation index for the operation effect of the new rural cooperative medical service based on the expert consultation method. In the end, the main component analysis method is used to comprehensively evaluate the operation effect of the new rural cooperative medical service in the 12 Union cities of Inner Mongolia Autonomous Region, and the construction of the new rural cooperative medical system will be further improved in the future based on the evaluation results. The main knots formed in this paper The discussion is as follows: 1. The evaluation of the operation effect of the new rural cooperative medical service in Inner Mongolia is constructed. According to the process and result of the new rural cooperative medical system, 26 indexes were selected, which were used as the evaluation index of the index system of primary selection, and the numerical value of 26 indexes was calculated. The primary index composition is formed by grouping the cost burden, the utilization of the health resources and the benefit degree. In order to reduce the degree of correlation between the evaluation indexes, the representativeness of the evaluation index is improved, the coefficient of variation method and the cluster analysis method are used, and the expert consultation method is used to filter the 26 indexes which are preliminarily selected, and the three methods are finally screened out. The index is 7; the seven indicators form a comprehensive evaluation of the operation effect of the new rural cooperative medical system price index system. 2. The evaluation index is suitable The main component analysis is carried out. In order to avoid the deviation of the inspection result due to the single result of the inspection method, the KMO and Bartlett are selected. The test results show that KMO = 0. 635 (more than 0.6), the associated probability value is 0. 00, which is less than the significance level of 0.05 (it is considered to be 0.01), and the two test methods are appropriate. Main component analysis. 3. New rural cooperative medicine in Inner Mongolia Autonomous Region The development of the treatment is not balanced. The past academic research is mostly in the analysis of the new rural cooperative medical system in the whole country, or the new type of new rural cooperative medical service in a province (city) is analyzed, and the operation efficiency of the new rural cooperative medical system in the autonomous region is analyzed. The research of the fruit is very low. I made an attempt in this respect, and analyzed the total extension period of the new rural cooperative medical system in Inner Mongolia Autonomous Region. The results show that the new rural cooperative medicine in Inner Mongolia Autonomous Region The development of therapy is not balanced. 4. Economic growth is the influence of the new rural cooperation The level of the development of social medical security is determined by the level of economic development in a country or region, and the economic development is a medicine The premise and foundation of the medical insurance is provided. Only the development of the economy can provide the material basis for medical security, and the level of economic development is also decided The breadth and depth of medical security are the first place in the city's running effect, and the ranking is the same as the city in recent years. In the process of advancing the operation of the new rural cooperative medical system, the government is responsible for the high-speed growth of the economy. The main responsibility is to play a leading role in the development and positioning of the new rural cooperative medical system, the use of fund raising and distribution, the proper handling of the contradiction between the rural and urban health resources allocation, etc.
【學(xué)位授予單位】：內(nèi)蒙古農(nóng)業(yè)大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F323.89;F842.684

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