太原市2006-2012年新型农村合作医疗运行情况分析

发布时间：2018-02-09 06:18

本文关键词： 新型农村合作医疗运行分析建议　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景与意义新型农村合作医疗制度(以下简称“新农合”)自2003年实施以来,在缓解农民“因病致贫、因病返贫”方面发挥了积极作用,对于贯彻落实党的十八大精神,促进城乡协调发展,全面建设小康社会,具有十分重要的意义。但实际运行中也存在着一些不容忽视的深层次问题,如筹资渠道单一、补偿制度不完善、医疗费用增长较快等问题日渐显现。目的本研究通过系统地分析太原市2006-2012年新农合运行数据,了解太原市新农合运行情况,指出运行中存在的问题,提出建议和措施,为完善和促进太原市新农合持续健康发展提供依据。方法数据主要来源于太原市及各县(市、区)新农合管理中心的新农合报表,获取太原市各县(市、区)的人口、经济、健康和卫生资源状况及总体运行数据。本研究主要采用描述性和分析性研究方法阐明太原市新农合运行情况,分析太原市新农合运行中存在的问题。结果 1.参合情况：2006-2012年,太原市新农合参合人数从84.02万人增加到104.52万人；平均参合率从84.30%上升到99.38%,新农合参合人数、平均参合率实现了稳中有升,基本实现了制度全覆盖,农民也开始逐渐接受和认同这项制度。 2.筹资情况：2006-2012年,太原市新农合筹资标准从50元/人提高到294元/人,其中,财政补助标准由40元/人提高到244元/人,所占比例从80%上升到83%；筹资额从3879.01万元增加到30912.36万元,年平均增长率41.33%。无论是筹资标准还是筹资额的增长都说明了各级政府对新农合的支持与投资力度越来越大,且财政投入比例在上升。 3.基金使用情况：2006-2012年,太原市新农合基金支出从2400.92万元增加到29243.07万元,年平均增长率51.68%,且住院支出构成比在80%以上,新农合实际用于参合农民的基金越来越多,也说明了新农合以大病统筹为主,适当兼顾小病的政策目标,与此同时,基金使用率提高,累计结余率下降。 4.参合农民受益情况：2006-2012年,太原市新农合总受益人次从34.50万增加到110.57万,次均住院补偿额从1281元增加到3527元,住院实际补偿比从26.51%提高到45.50%,参合农民受益面和受益水平提高,对医疗卫生服务的利用率也同步上升。结论实现太原市新农合可持续发展,切实减轻农民医疗负担,需要加强以下几个方面的工作。参合与筹资方面：加大新农合宣传力度,扩大筹资渠道,创新和规范筹资方式。基金补偿与管理方面：加强新农合信息系统管理,严格医疗费用审核；完善新农合基金结算,加强基金运行的动态监测,推进支付方式改革。参合农民受益等方面：加大对定点医疗机构的监管力度,控制医疗费用不合理增长；提升基层医疗机构服务水平,严格转诊管理,引导参合农民基层就医；完善门诊统筹补偿方案和管理。
[Abstract]:Background and significance. Since the implementation of the new rural cooperative medical system (hereinafter referred to as "New Rural Cooperative Medical system") in 2003, it has played an active role in alleviating the peasants'"poverty caused by illness and returning to poverty because of illness", and has played an active role in implementing the 18 spirit of the Party. It is of great significance to promote the coordinated development of urban and rural areas and to build a well-off society in an all-round way. However, there are some deep-seated problems that cannot be ignored in the actual operation, such as the singleness of financing channels, the imperfection of the compensation system, Medical costs are growing faster and so on. Purpose. Based on the systematic analysis of the operation data of the new rural cooperative cooperation in Taiyuan from 2006 to 2012, this study finds out the operation situation of the new agricultural cooperation in Taiyuan, points out the problems existing in the operation, and puts forward some suggestions and measures. To improve and promote the sustainable and healthy development of new agricultural cooperation in Taiyuan. Method. The data mainly come from the new rural cooperative report form of the new rural cooperative management center of Taiyuan city and each county (city, district), get the population and economy of each county (city, district) of Taiyuan city. In this study, descriptive and analytical methods were used to elucidate the operation of New Rural Cooperation (NCMS) in Taiyuan, and the existing problems in the operation of NCMS in Taiyuan were analyzed. Results. 1. Participation: from 2006 to 2012, the number of new rural cooperative partners in Taiyuan increased from 840,200 to one million forty-five thousand and two hundred ; the average participation rate rose from 84.30% to 99.38; the number of new rural cooperative participants and the average participation rate rose steadily and steadily, and the overall coverage of the system was basically achieved. Farmers also began to gradually accept and identify with this system. 2. Financing situation: from 2006 to 2012, the standard for raising funds for new agricultural cooperation in Taiyuan increased from 50 yuan per person to 294 yuan per person, of which the financial subsidy standard was raised from 40 yuan per person to 244 yuan per person, the proportion of which rose from 80% to 833 yuan; the amount of funds raised increased from thirty-eight million seven hundred and ninety thousand and one hundred yuan to three hundred and nine million one hundred and twenty-three thousand and six hundred yuan. The average annual growth rate of 41.33% indicates that governments at all levels are increasing their support and investment in NCMS, and the proportion of financial investment is increasing. 3. Fund utilization: from 2006 to 2012, the expenditure of the New Agricultural Cooperation Fund in Taiyuan increased from twenty-four million nine thousand and two hundred yuan to two hundred and ninety-two million four hundred and thirty thousand and seven hundred yuan, with an average annual growth rate of 51.68 yuan, and the proportion of hospital expenses was more than 80%. More and more funds were actually used by the new rural cooperative fund for participating farmers. It also shows that the new rural cooperation should focus on the coordination of serious illness and give due consideration to the policy goal of minor illness. At the same time, the utilization rate of the fund has increased and the cumulative balance rate has decreased. 4. From 2006 to 2012, the total beneficiaries of the new rural cooperative in Taiyuan increased from 345,000 to one million one hundred and five thousand and seven hundred , the average hospitalization compensation increased from 1,281.81 yuan to 3,527 yuan, the actual compensation ratio of hospitalization increased from 26.51% to 45.50 yuan, and the benefit area and benefit level of the participating farmers increased. The utilization rate of medical and health services has also risen simultaneously. Conclusion. It is necessary to strengthen the following work to realize the sustainable development of new agricultural cooperation in Taiyuan and to lighten the medical burden of farmers. Participation and financing: increase the publicity of NCMS, expand funding channels, innovate and standardize the ways of raising funds. Fund compensation and management: strengthen the management of NCMS information system, strictly audit medical expenses; improve the settlement of NCMS funds; Strengthen the dynamic monitoring of fund operation, promote the reform of payment methods, participate in the benefits of farmers and other aspects: strengthen the supervision of designated medical institutions, control the unreasonable growth of medical expenses, improve the service level of primary medical institutions, Strict referral management, guide farmers to seek medical treatment at the grass-roots level, improve the out-patient compensation scheme and management.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F323.89;F842.684

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