浙江省龙游县城乡合作医疗制度效果分析

发布时间：2018-03-16 17:28

本文选题：新型农村合作医疗　切入点：城乡合作医疗　出处：《浙江大学》2013年硕士论文　论文类型：学位论文

【摘要】：研究目的和背景在社会保障体系中,医疗卫生的保障是极为重要的组成部分,医疗保障状况直接体现一个国家、社会发展进步的程度。第六次人口普查结果显示,在2010年我国有13.39亿人口,其中乡村人口67415万人,占总人口的50.32%。如何提高这6亿多农民的医疗水平,逐步解决农民“看病难、看病贵”的问题,提高对广大农村居民的医疗卫生保障水平具有十分重要的现实意义。在这样的背景下,我国开始探索建立新型农村合作医疗制度,在2003年初步建立起了包括城镇职工基本医疗保险制度、城镇居民基本医疗保险制度和新型农村合作医疗制度的社会医疗保险制度体系,并在此基础上衍生出了城乡合作医疗这一新的概念。随着十年来新型农村合作医疗在全国各地的广泛实施,其对参保者医疗服务利用率及医疗费用负担产生的影响成为了评判新型农村合作医疗制度效果的主要依据。本研究通过分析龙游县某县级公立医院住院患者资料,评价龙游县城乡合作医疗制度的效果,并将其与传统的新型农村合作医疗进行对比,并分析二元制与三元制医保体系的优劣。研究方法本文采用文献收集法调查龙游县历年城乡合作医疗政策及实施情况；将龙游县某县级医院2003至2012年上半年的所有住院病人作为研究样本,统计该医院在城乡合作医疗开展前后住院患者总体情况；采用单纯随机抽样法抽取2003至2012年该医院住院患者数前十病种中的两种,以住院费用、住院天数、住院费用报销比例等指标分析合作医疗患者与城镇职工医疗保险患者及自费患者的差异,并使用多元逐步回归法分析住院患者费用的影响因素。研究结果随着新型农村合作医疗在全国的推广,龙游县城乡合作医疗的参与率及收益覆盖率逐年增长,至2012年已实现了接近98%的参与率。研究发现,龙游县某县级医院住院患者中城乡合作医疗参合用户逐年上升,至2012年已占总住院患者的54.18%；合作医疗患者平均住院费用呈逐年上升趋势,与城镇医保患者差距逐年缩小；平均自负费用逐年下降,住院费用平均报销比例明显上升,至2012年已达51.27%,与城镇职工医保患者仍存在不小的差距,但其差距逐年缩小。从患者住院费用多因素分析中发现,影响患者住院费用的主要因素是住院天数和医保类型。通过龙游县与嵊州县县级医院住院患者费用分析可以发现,城乡合作医疗制度与传统的城镇居民医疗保险制度相比提供了更优惠的参保条件和更强的保障水平。研究结论龙游县城乡合作医疗已完成全面覆盖工作。龙游县城乡农村合作医疗有效降低了参与者的医疗负担。龙游县城乡合作医疗的保障程度不及城镇职工医疗保险。城乡合作医疗同时提高了农村居民和城镇居民的保障程度,其效果优于传统新型农村合作医疗和城镇居民医疗保险。
[Abstract]:Purpose and background of the study. In the social security system, medical and health security is an extremely important part. The medical security situation directly reflects the degree of social development and progress in a country. The 6th census results show that in 2010, there were one billion three hundred and thirty-nine million people in our country. Among them, the rural population is 674.15 million, accounting for 50.32 percent of the total population. How to improve the medical treatment level of these 600 million farmers and gradually solve the problem of "difficult and expensive" for farmers to see a doctor? It is of great practical significance to improve the level of medical and health security for rural residents. Against this background, China has begun to explore the establishment of a new type of rural cooperative medical care system. In 2003, a social medical insurance system consisting of the basic medical insurance system for urban workers, the basic medical insurance system for urban residents and the new rural cooperative medical insurance system was initially established. On this basis, a new concept of urban-rural cooperative medical care has been derived. With the extensive implementation of the new rural cooperative medical system in all parts of the country in the past ten years, Its influence on the medical service utilization rate and the burden of medical expenses of the insured has become the main basis for judging the effect of the new rural cooperative medical system. This study analyzed the data of hospitalized patients in a county public hospital in Longyou County. This paper evaluates the effect of urban-rural cooperative medical system in Longyou County, compares it with the traditional rural cooperative medical system, and analyzes the merits and demerits of the binary system and the ternary medical insurance system. Research method. This paper investigates the policy and implementation of urban and rural cooperative medical system in Longyou County by using literature collection method, and takes all hospitalized patients from a county hospital in Longyou County from 2003 to 2012 as research samples. Statistics on the overall situation of the patients in the hospital before and after the development of the cooperative medical system in urban and rural areas, the use of a simple random sampling method to select two of the first 10 types of patients in the hospital from 2003 to 2012, in order to cost the hospital, to stay in hospital days, The difference of medical insurance patients and self-funded patients between cooperative medical care patients and urban workers was analyzed by using multiple stepwise regression method. The influencing factors of inpatients' expenses were analyzed by using multiple stepwise regression method. Research results. With the popularization of the new rural cooperative medical system in the whole country, the participation rate and income coverage rate of the urban and rural cooperative medical system in Longyou County have increased year by year, and by 2012, the participation rate of nearly 98% has been realized. In a county-level hospital in Longyou County, the number of urban and rural cooperative medical users has increased year by year, and by 2012, the average cost of cooperative medical care patients has increased year by year, and the gap between them has narrowed year by year. The average conceited expenses decreased year by year, and the proportion of average reimbursement of hospital expenses increased obviously. By 2012, there was still a large gap with the medical insurance patients of urban staff and workers, but the gap was narrowed year by year. It was found from the multivariate analysis of patients' hospitalization expenses, The main factors influencing patients' hospitalization expenses are the days of hospitalization and the type of medical insurance, which can be found through the cost analysis of county-level hospitals in Longyou County and Shengzhou County. Compared with the traditional urban residents medical insurance system, the urban and rural cooperative medical insurance system provides more favorable conditions and a stronger level of insurance. Research conclusion. Longyou County urban and rural cooperative medical care has completed comprehensive coverage. Longyou County urban and rural cooperative medical care effectively reduced the participants' medical burden. Longyou County urban and rural cooperative medical insurance less than the level of urban staff medical insurance. The rural and urban cooperative medical system has improved the security degree of both rural residents and urban residents, and its effect is better than the traditional new rural cooperative medical care system and the urban residents' medical insurance.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.1;F842.684

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