本文選題：新型農(nóng)村合作醫(yī)療　切入點(diǎn)：逆向選擇　出處：《湖南農(nóng)業(yè)大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：新型農(nóng)村合作醫(yī)療制度作為我國(guó)農(nóng)村基本醫(yī)療保障制度,從2003年開始在全國(guó)推行,通過(guò)各級(jí)政府的積極推進(jìn)、有效領(lǐng)導(dǎo)以及相互配合,經(jīng)過(guò)十余年的發(fā)展,新型農(nóng)村合作醫(yī)療制度的覆蓋面不斷擴(kuò)大。2013年底,我國(guó)新型農(nóng)村合作醫(yī)療制度參合人數(shù)達(dá)到8億多人,補(bǔ)償受益人次13.15億,在該年的全國(guó)衛(wèi)生工作總結(jié)會(huì)議上,衛(wèi)生部部長(zhǎng)陳竺同志提到,我國(guó)的新型農(nóng)村合作醫(yī)療制度的參合率都維持在95%以上,籌資費(fèi)用達(dá)到290元/人。新型農(nóng)村合作醫(yī)療制度(以下簡(jiǎn)稱“新農(nóng)合”)基本實(shí)現(xiàn)全覆蓋。盡管新農(nóng)合制度的覆蓋率與參合率一直不斷攀升,但是新農(nóng)合制度中仍然存在不少的問(wèn)題,與保險(xiǎn)市場(chǎng)中其他險(xiǎn)種一樣,逆向選擇問(wèn)題就是其中一個(gè)。逆向選擇問(wèn)題是指那些健康程度低的高風(fēng)險(xiǎn)者參合比例越來(lái)越高,相反健康程度高的低風(fēng)險(xiǎn)者占比例不斷降低。逆向選擇問(wèn)題會(huì)增加醫(yī)療保險(xiǎn)基金的籌集難度,阻礙了基本醫(yī)療保障制度的建立,這也影響著最終新農(nóng)合在我國(guó)全面覆蓋的真正實(shí)現(xiàn),難以達(dá)到人人共享基本醫(yī)療服務(wù)的目標(biāo)。因此,本文在針對(duì)新農(nóng)合參合率突破95%的背景下,利用2012年中國(guó)勞動(dòng)力動(dòng)態(tài)調(diào)查(CLDS)數(shù)據(jù),在介紹國(guó)內(nèi)外逆向選擇選擇理論的基礎(chǔ)上,對(duì)農(nóng)戶新農(nóng)合的逆向選擇問(wèn)題進(jìn)行實(shí)證研究。利用2012CLDS調(diào)查數(shù)據(jù),首先,利用Logit模型從自感健康方面對(duì)新農(nóng)合的逆向選擇進(jìn)行檢驗(yàn),為讓結(jié)果更加穩(wěn)健,再運(yùn)用Probit模型從醫(yī)療服務(wù)利用方面再進(jìn)行進(jìn)一步論證。分別對(duì)我國(guó)的東部地區(qū)、中部地區(qū)及西部地區(qū)分別新農(nóng)合的逆向選擇問(wèn)題進(jìn)行實(shí)證性的檢驗(yàn)。研究結(jié)果表明：在我國(guó)的東部、中部、西部地區(qū),新農(nóng)合制度中存在逆向選擇問(wèn)題。具體表現(xiàn)為：年齡越大、受教育程度越低、自感健康狀況越差的農(nóng)戶更容易選擇參合,并且參合者對(duì)醫(yī)療服務(wù)需求也比較高。提出應(yīng)制定“檸檬定價(jià)”、加強(qiáng)醫(yī)療服務(wù)機(jī)構(gòu)的管理等對(duì)策,避免逆向選擇現(xiàn)象。
[Abstract]:The new rural cooperative medical care system, as the basic medical security system in rural areas of our country, has been implemented throughout the country since 2003. Through the active promotion, effective leadership and mutual cooperation of all levels of government, the new rural cooperative medical system has developed for more than 10 years. The coverage of the new rural cooperative medical system continues to expand. At the end of 2013, the number of participants in the new rural cooperative medical care system in China reached more than 800 million, and the number of compensation beneficiaries was one billion three hundred and fifteen million. At the National Health work Summary Conference of that year, Minister of Health Chen Zhu mentioned that the participation rate of China's new rural cooperative medical system is maintained at more than 95%. Funding costs reached 290 yuan per person. The new rural cooperative medical system (hereinafter referred to as "new rural cooperative medical system") basically achieved full coverage. Although the coverage and participation rate of the new rural cooperative medical system has been continuously rising, But there are still a lot of problems in the NCMS system. Like other types of insurance in the insurance market, adverse selection is one of them. The reverse selection problem refers to the increasing participation rate of those with low health and high risk. On the contrary, the proportion of people with high health and low risk is decreasing. The problem of adverse selection will make it more difficult to raise medical insurance fund and hinder the establishment of basic medical insurance system. This also affects the real realization of the overall coverage of NCMS in our country, and it is difficult to achieve the goal of sharing basic medical services for all. Therefore, this paper aims at the background of NCMS participation rate breaking through 95%. On the basis of introducing the theory of adverse selection at home and abroad, this paper makes an empirical study on the problem of adverse selection of farmers' new agricultural cooperation (NCMS) using CLDS data from 2012 China Labor Force Survey. Logit model is used to test the adverse selection of NCMS in terms of self-perceived health. In order to make the results more robust, the Probit model is used to further demonstrate the utilization of medical services. The research results show that in the eastern, central and western regions of our country, the reverse selection problem of the new agricultural cooperation is tested in the eastern, central and western regions of China, and the results are as follows: in the eastern, central and western regions of China, The problem of adverse selection exists in the new rural cooperative system. The more age, the lower the education level, the easier it is for the farmers with poor self-perceived health condition to choose to participate in the cooperation. The participants also have a high demand for medical services, and put forward some countermeasures, such as "lemon pricing", strengthening the management of medical service institutions, and avoiding adverse selection.
【學(xué)位授予單位】：湖南農(nóng)業(yè)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：F323.89;F842.684;R197.1

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