我国农村居民疾病风险管理模式探索

发布时间：2018-02-21 08:21

本文关键词： 疾病风险管理健康管理商业健康保险新型农村合作医疗　出处：《山东大学》2013年硕士论文　论文类型：学位论文

【摘要】：本文首先对我国农村居民的疾病风险进行了评价,评价对象为我国农村居民面临的16类主要疾病风险,评价维度包含疾病风险损失概率和疾病风险损失程度。损失概率的衡量采用了疾病别两周患病率和疾病别慢性病患病率指标；损失程度的衡量采用了疾病经济负担指标,其中,本文采用了二步模型法和人力资本发分别测算了16类疾病风险的直接经济负担和间接经济负担。根据疾病风险损失概率和损失程度的衡量结果,本文绘制了疾病风险分类图,将16类疾病风险划分为五类,分析了针对每一类疾病风险的风险管理需求。基于我国农村居民的疾病风险评价结果和疾病风险管理现状,本文从三个方面阐明了探索农村居民疾病风险管理新模式的必要性。第一,疾病风险管理供给不足,在政府层面,疾病风险预防和控制不能提供针对居民个人的风险管理措施,新型农村合作医疗和医疗救助只能满足农村居民最基本的医疗保障需求,在减轻农村居民疾病经济负担方面效果不甚理想；在社会层面,商业健康保险在农村发展缓慢,不能在农村医疗保障体系中充分发挥作用,健康管理产业处于起步阶段,不能提供全面、专业的健康管理服务；在居民个人和家庭层面,疾病风险管理整体缺失。第二,现行疾病风险管理模式存在诸多缺陷,比如疾病风险预防机制缺失,慢性病风险控制机制缺失,道德风险引起医疗费用增加和卫生资源浪费等。第三,疾病风险日益复杂多样,社会老龄化问题凸显,都对疾病风险管理提出了更高的要求。针对现行疾病风险管理模式的缺陷和疾病风险管理现状的不足,本文探索设计了农村居民疾病风险管理新模式的框架。在该框架下,疾病风险管理体系涵盖了疾病风险发生之前的疾病风险预防和疾病风险发生之后的疾病风险控制和补偿。其中,在疾病风险预防和控制方面,引入“健康管理”,通过对人群的健康教育、行为干预以及慢性病的干预等措施,预防疾病发生,降低疾病风险损失概率和损失程度；在疾病风险补偿方面,探讨商业健康保险和新型农村合作医疗有效契合,提出了因病而异的疾病风险补偿策略。最后,本文就新模式的推行提出了建议。
[Abstract]:This paper first evaluates the disease risk of rural residents in China, and evaluates the 16 kinds of major disease risks faced by rural residents in our country. The evaluation dimension includes the probability of loss of disease risk and the degree of loss of disease risk. The probability of loss is measured by disease specific two-week prevalence rate and disease specific chronic disease prevalence index, and the degree of loss is measured by disease economic burden index, in which, In this paper, the direct economic burden and indirect economic burden of 16 kinds of disease risk are calculated by using two-step model method and human capital issue, respectively. According to the results of the loss probability and degree of disease risk, the classification map of disease risk is drawn in this paper. The risk management requirements for each disease risk are analyzed by dividing 16 disease risks into five categories. Based on the results of disease risk assessment and the present situation of disease risk management, this paper expounds the necessity of exploring a new model of disease risk management for rural residents from three aspects. First, the supply of disease risk management is insufficient. At the government level, disease risk prevention and control can not provide individual risk management measures for residents, the new rural cooperative medical care and medical assistance can only meet the most basic medical security needs of rural residents. At the social level, the development of commercial health insurance in rural areas is slow, it can not play a full role in the rural medical security system, and the health management industry is in its infancy. Failure to provide comprehensive, professional health management services; overall absence of disease risk management at the individual and family levels. Second, there are many shortcomings in the current disease risk management model, such as the absence of disease risk prevention mechanisms. The lack of chronic disease risk control mechanism, the increase of medical expenses caused by moral hazard and the waste of health resources, etc. Third, disease risk is increasingly complex and diverse, and the problem of aging society is prominent, all of which put forward higher requirements for disease risk management. In view of the defects of the current disease risk management model and the deficiency of the present disease risk management, this paper explores and designs the framework of the new disease risk management model for rural residents. The disease risk management system covers disease risk prevention prior to disease risk and disease risk control and compensation after disease risk. Introducing "health management" to prevent the occurrence of disease and reduce the loss probability and degree of disease risk through the measures of health education, behavioral intervention and chronic disease intervention. This paper discusses the effective agreement between commercial health insurance and new rural cooperative medical system, and puts forward the disease risk compensation strategy which is different from illness. Finally, this paper puts forward some suggestions on the implementation of the new model.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684;F323.89;R193

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