县域新农合基金管理组织的治理结构与治理效率研究

发布时间：2018-03-19 09:50

本文选题：新型农村合作医疗　切入点：基金管理　出处：《四川农业大学》2013年硕士论文　论文类型：学位论文

【摘要】：为建立农村医疗保障体系,国家于2003年正式决定开始建立以大病统筹为主的新型农村合作医疗制度。就新农合机构设置而言,在中央设有新型农村合作医疗部际联席会议负责制定宏观政策,省、地级设立农村合作医疗协调小组和专家技术指导组。县级设有农村合作医疗管理委员会,而经办机构负责日常具体事务,并定期向监督委员会报告基金管理情况。目前,作为对中国广大农业人口的医疗保障的制度,新农合已切实保障了农民的日常医疗需求。2012年,全国参加新农合人数为8.05亿人,参合率超过98%。在新农合的制度建立和完善过程中,出现了财务问题、虚报参合信息套取资金和基金使用不合理等问题。从治理的角度而言,财务问题原因是内控机制的失衡。本文旨在基于产权理论和委托代理理论,研究县域新农合基金管理组织的治理结构,并探求内部治理失衡的原因。首先,本文对新农合制度的建立和制度变迁作出系统性分析,重点关注基金管理制度。回溯新农合制度的主要政策演变,分析新农合制度的四大特征,包括自愿参加,大病统筹,县域统筹管理和政府监督管理。从筹资制度和补偿制度入手阐释新农合制度建立的主要基本点。筹资制度主要从个人保费收缴方式、财政补助划拨制度和筹资水平等三个方面进行分析。补偿制度主要从补偿比例和补偿范围进行分析。新农合基金管理制度主要从风险基金制度、二次补偿制度和监督制度进行了分析。目前,国内公司治理较非营利组织治理发展成熟,政府治理较为欠缺。基于此,本文对公司和非营利组织的内部核心机构的职能定位及其治理结构进行了研究分析。通过查阅相关法律和代表性治理原则,对治理结构中的董(理)事会、监事会和管理层(执行委员会)的职能进行了定位。在公司治理中,对单层制董事会和双层制董事会进行了模式演绎和对比分析。相对公司治理结构,非营利组织的结构较为松散,相关法律和行业规章约束偏少。借用红十字基金会的组织框架作为非营利组织代表型的治理结构进行分析。此外,公司和非营利组织在内部结构上的差异己体现为不同的治理效果。随后,对县域新农合基金管理组织的内部主体职能部门的治理结构和治理效率进行分析。政府,不单是政治上的主管主体,也是经济上的最大注资者。类比公司和非营利组织的治理结构,县域新农合基金管理委员会因对新农合工作具有管理和组织的决策权,而在治理结构中承担相应的董事会的职能。监督委员会负责监督新农合基金运行过程中的资金流动和会计账目,扮演监事会的角色。经办机构在组织内负责相应的管理层工作。基于此,县域新农合基金管理组织的内部主体职能部门的治理可借鉴公司治理和非营利治理的成熟之处。类比这三者,非营利组织与新农合基金组织有更相似的市场环境,而公司的治理结构的职能设计更具借鉴意义。另外,本文对其治理效率做了定量分析。借用全国统计数据,对参合情况和基金使用情况等作了简要分析。本文对中西部33个县的新农合运作情况作了详细调查。在筹资稳定的前提下,补偿模式的选择是管理委员会最重要的决策之一。通过聚类分析,在有相当的大额医疗费用的补偿水平下,住院统筹加门诊账户的补偿模式比大病统筹加家庭账户的补偿模式,在小额门诊费用的补偿上有更好的成效,实现了更广泛的受益人群和更高的实际报销比例。再者,通过选择投入要素和产出要素,应用DEA模型对33个县的综合效率和规模报酬作出相对性效率分析。整体而言,投入要素高效的转变为产出,一半以上的县达到了规模经济的状态。对已达到规模经济的县,为了实现更高的补偿比例和更广泛的受益人群,不宜采取增加管理成本和增加人力资本的方案,而应考虑补偿模式的制定和优化具体补偿项目的补偿比例。为完善治理结构,本文提出了相应的政策建议： (1)管理委员会——细化内部分工,设立专项委员会 (2)监督委员会——完善内部监督,侧重外部监督 (3)经办机构——完善信息化建设,实现IT治理
[Abstract]:For the establishment of the rural medical security system, the state in 2003 formally decided to establish a catastrophic consisting mainly of the new rural cooperative medical system. The new rural cooperative medical institution setting, a new rural cooperative medical system in the inter ministerial joint meeting of the central charge policy, province, prefecture level establishment of rural cooperative medical care coordination team and expert technical guidance group. At the county level with Management Committee of rural cooperative medical care, and agencies responsible for specific affairs, and report regularly to the committee report of fund management and supervision. At present, the majority of the agricultural population as of China medical security system, NCMS has been effectively protect the farmers' daily medical needs.2012 years, the NCMS number of 805 million people, the participation rate of more than 98%.
In the new rural cooperative medical system to establish and perfect the process, the financial problems, false information for participating funds and fund use is not reasonable. From the perspective of governance, financial problems is the imbalance of internal control mechanism. This paper based on the theory of property rights and the principal-agent theory, the governance structure of the fund management organization. Causes and explore the internal governance imbalance.
First, make a systematic analysis of the establishment and change of system of the new rural cooperative medical system, fund management system. The main focus of attention to the evolution of policy back of the new rural cooperative medical system, analysis of the four major characteristics of the new rural cooperative medical system, including voluntary participation, serious co-ordination, county planning management and supervision of the government. From the main financing system and the compensation system established to explain the NCMS the system of the basic points. The financing system mainly collected from individual premiums, financial subsidy allocation system and financing level of three aspects were analyzed. The compensation system mainly from the proportion of compensation and compensation. The scope of the new rural cooperative fund management system mainly from the risk fund system, analyzed two times compensation system and supervision system.
At present, the domestic corporate governance is non-profit organization governance development, government governance is lacking. Based on this, function orientation and governance structure of the inner core of companies and non-profit organizations are analyzed. Through consulting the relevant legal representative and governance principles, the governance structure of the Dong (LI). The board of supervisors, and management (Executive Committee) of the function of the position. In corporate governance, the board of directors of single and double system board are analyzed and compared. The relative mode of interpretation of the corporate governance structure, the structure of nonprofit organization is relatively loose, the relevant laws and regulations. The organization is less constrained industry frame borrowing the Red Cross Foundation as a non-profit organization governance representative type were analyzed. In addition, differences between companies and non-profit organizations in the internal structure has reflected the different governance effect.
Then, analyze the governance structure and governance efficiency of the fund management organization's internal departments. The main functions of government is not only the main political director, is also the largest economic capital. The governance structure of analogy companies and non-profit organizations, the new agricultural county and fund management committee with the management and organization of the new rural cooperative medical decision-making authority, and in the governance structure to bear the corresponding functions of the board of directors. The supervisory committee is responsible for the flow of funds and accounting supervision of NCMS fund operation in the process of playing the role. The board of supervisors office within the organization responsible for the management of the corresponding work. Based on this, it governance County fund management the main functions of the organization's internal departments can learn from corporate governance and nonprofit governance. The three analogy, non-profit organizations and the new rural cooperative fund has more similar In the market environment, the function design of the corporate governance structure is more useful for reference.
In addition, the governance efficiency is quantitatively analyzed. By national statistical data on the participation of the situation and funds usage. This paper makes a brief analysis on the operation of the NCMS Midwest in 33 counties were investigated. On the premise of the financing stability, choose the model of compensation is one of the most important management decision the Committee. Through cluster analysis, the compensation level has quite large medical expenses under the hospital outpatient co-ordination plus account compensation mode than compensation mode of pooling with family account, have a better effect on small outpatient expense compensation, realized the benefit the wider population and higher proportion of the actual reimbursement and., by selecting the input elements and output elements, make the relative efficiency analysis of application of DEA model in 33 counties, the comprehensive efficiency and returns to scale. Overall, efficient output input transition elements And more than half of the county reached a scale economy. To achieve economies of scale, in order to achieve a higher proportion of compensation and benefit the wider population, should not be taken to increase management costs and increase human capital plan, and should consider making the proportion of compensation compensation mode and optimize the specific compensation project.
In order to improve the governance structure, this paper puts forward the corresponding policy suggestions:
(1) the Management Committee - refine the internal division of labor and set up a special committee
(2) the Supervision Committee - the improvement of internal supervision and the emphasis on external supervision
(3) run institutions - improve information construction and realize IT governance

【学位授予单位】：四川农业大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;R197.1;F842.684

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