【摘要】：新型農(nóng)村合作醫(yī)療制度自2003年實施以來,緩解了“看病難、看病貴”的問題,保障了農(nóng)民的基本權(quán)益,適應(yīng)了農(nóng)村社會經(jīng)濟發(fā)展,同時又有利于提高我國醫(yī)療保障制度的公平性。但由于醫(yī)療市場的特殊性及新農(nóng)合制度實施環(huán)境的復(fù)雜性,新型農(nóng)村合作醫(yī)療在實施過程中遇到諸多問題,如不合理費用的增長、監(jiān)管機制的不完善及新農(nóng)合基金入不敷出等。這些問題既損害了新農(nóng)合運行的效率,又影響了新農(nóng)合制度的可持續(xù)發(fā)展。隨著新農(nóng)合制度的不斷完善,政府補貼增加,道德風(fēng)險隨之而來。道德風(fēng)險最早源于海上保險,近年來才逐漸運用各個領(lǐng)域。道德風(fēng)險即是擁有信息較多的一方利用信息優(yōu)勢做出損害信息較弱一方的行為。在醫(yī)療市場中,由于醫(yī)療需求方、醫(yī)療提供方和醫(yī)療監(jiān)督方之間掌握的信息不對稱,再加上醫(yī)療體制的不合理及個人機會主義傾向等原因,道德風(fēng)險問題愈演愈烈。道德風(fēng)險的存在使醫(yī)療費用不合理增長,同時抑制了農(nóng)民合理的衛(wèi)生需求,損害了新型農(nóng)村合作醫(yī)療的公平發(fā)展。本文以湖南省某縣為例,通過個案訪談、參與觀察法、文獻(xiàn)分析法等途徑,探求湖南省省級貧困縣的新型農(nóng)村合作醫(yī)療制度在運行過程中道德風(fēng)險的表現(xiàn)及產(chǎn)生的內(nèi)在機理。道德風(fēng)險的表現(xiàn)主要從醫(yī)療需求方、醫(yī)療提供方和醫(yī)療監(jiān)管方三個方面來論述,內(nèi)在機理主要從醫(yī)療市場的特殊性、醫(yī)療體制的不合理及個人的機會主義傾向來闡述;其次通過利用2003-2013年中國衛(wèi)生統(tǒng)計年鑒的數(shù)據(jù)進行高級統(tǒng)計分析,深入分析道德風(fēng)險問題是否在全國范圍內(nèi)普遍存在,最后從宏觀和微觀層面論述如何規(guī)避道德風(fēng)險,以期找尋有效解決道德風(fēng)險的舉措。
[Abstract]:Since the implementation of the new rural cooperative medical system in 2003, it has alleviated the problem of "difficult to see a doctor and expensive to see a doctor", guaranteed the basic rights and interests of farmers, and adapted to the social and economic development of rural areas. At the same time, it helps to improve the fairness of our medical security system. However, due to the particularity of the medical market and the complexity of the implementation environment of the new rural cooperative medical system, there are many problems encountered in the implementation of the new rural cooperative medical system, such as the increase of unreasonable expenses, the imperfection of the supervision mechanism and the income of the new rural cooperative fund. These problems not only impair the efficiency of NCMS operation, but also affect the sustainable development of NCMS system. With the continuous improvement of the new rural cooperation system, the government subsidy increases, moral hazard follows. Moral hazard originated from marine insurance and has been gradually used in various fields in recent years. Moral hazard is the behavior that the party with more information makes use of the advantage of information to harm the weaker party. In the medical market, due to the asymmetry of information between the medical demand side, the medical provider and the medical supervisor, coupled with the unreasonable medical system and the tendency of individual opportunism, the moral hazard becomes more and more serious. The existence of moral hazard makes the medical expenses increase unreasonably, at the same time restrains the farmer's reasonable health demand, and damages the fair development of the new rural cooperative medical system. This paper takes a county in Hunan Province as an example to explore the expression of moral hazard and the internal mechanism of moral hazard in the process of operation of the new rural cooperative medical system in the poor counties of Hunan province by means of case interview, participation observation method, literature analysis and so on. The expression of moral hazard is mainly discussed from three aspects: the medical demand side, the medical provider side and the medical supervision party. The internal mechanism is mainly explained from the particularity of the medical market, the unreasonable medical system and the individual opportunism tendency. Secondly, by using the data of China Health Statistics Yearbook from 2003 to 2013 to carry out advanced statistical analysis, this paper makes a deep analysis on whether the moral hazard problem exists in the whole country. Finally, it discusses how to avoid moral hazard from macro and micro levels. In order to find effective measures to solve moral hazard.
【學(xué)位授予單位】：湖南師范大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R197.1;F842.684;F323.89

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