湖南省桑植县新型农村合作医疗补偿模式运行效果评估

发布时间：2018-03-21 04:49

本文选题：新型农村合作医疗　切入点：患者满意度　出处：《中南大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：通过对湖南省桑植县新型农村合作医疗的现状分析、综合评价桑植县新农合补偿模式改革的效果,发现其在运行过程中存在的问题和不足,为下一步桑植县新农合补偿模式的改革和完善提供依据和建议。方法：根据研究目的,从湖南省桑植县“新农合信息数据库”中调取有关数据转换成Excel,然后进行数据的校对和数据的整理分析。桑植县新农合补偿模式改革患者满意度调查采用分层整群随机抽样方法,根据当地经济发展水平和农村居民年人均纯收入将桑植县县的39个乡镇分为经济状况好、中、差3个层次,每层随机抽取1个乡镇作为研究点,得到3个乡镇,每个乡镇随机选取100名患者进行满意度调查,共300人。采用SPSS19.0和excel统计软件对桑植县新农合的数据进行统计分析,并选用李永秋、张英洁的“新型农村合作医疗补偿模式综合评价体系”的指标采用TOPSIS法与秩和比法对2010年-2012年桑植县新农合补偿模式进行综合评价。结果：2012年湖南省桑植县新农合的参合率已经达到98%,覆盖了绝大部分农村人口。2010年-2012年桑植县新农合基金筹资规模不断扩大,结余率不断下降,2012年为10.02%；平均住院天数有所增加,到2012年为10.31天；次均门诊、住院费用有所上升；参合农民受益面不断扩大,补偿率也增涨较快,到2012年门诊补偿率达到58.17%,住院补偿率为61.86%,参合农民自付门诊、住院费用均有所下降；桑植县参合农民住院一般选择乡级医院,约占52%,其次为县级医院,约为35%,在市、省级医院住院的比例分别为5%、6.5%。桑植县新农合改革患者满意度调查结果显示,患者总体满意度较好,选择“很满意”和“较满意”的占78.45%。“医生诊疗水平”和“医院卫生环境水平”2个回答中的患者满意度偏低,分别为65.96%和63.56%。患者对医院总体较为满意,但医生的诊疗水平和卫生状况两方面满意度相对较低。在“您是否希望门诊治疗费用也采取病人支付一定数额费用后其余部分由新农合全额报销”的回答中,选择“是的”和“最好免费”的占90.02%,绝大多数参合农民希望门诊也进行补偿模式的改革。结论：1.桑植县新农合补偿模式的改革,提高了农民在乡镇医院住院的补偿比例,参合农民的次均门诊和住院费用都有下降。2.通过TOPSIS法与秩和比法对补偿模式的综合评价结果显示,补偿模式的改革是有效果的,总体上是成功的。3.农民在县级以上医院的住院费用还比较高,住院的医疗负担还较重。
[Abstract]:Objective: by analyzing the present situation of the new rural cooperative medical system in Sanzhi County, Hunan Province, comprehensively evaluating the effect of the reform of the new rural cooperative medical system in Sangzhi County, and finding out the problems and shortcomings in the process of operation. It provides the basis and suggestion for the reform and perfection of the new rural cooperative compensation model in Sangzhi County. Methods: according to the purpose of the study, the relevant data were transferred from the "New Agricultural Cooperation Information Database" in Sanzhi County, Hunan Province to Excel, and then the data were proofread and analyzed. According to the level of local economic development and the annual per capita net income of rural residents, 39 villages and towns in Sangzhi County were divided into three groups: good economic status and good economic status. Three levels of difference, each level randomly selected a township as a research point, 3 villages and towns, each township randomly selected 100 patients for a survey of satisfaction, a total of 300 people. SPSS19.0 and excel software were used to analyze the data of Xinrong Cooperation in Sangzhi County, and Li Yongqiu was selected. Zhang Yingjie's "Comprehensive Evaluation system of New Rural Cooperative Medical compensation Model" used TOPSIS method and rank sum ratio method to comprehensively evaluate the new rural cooperative compensation model in Sangzhi County from 2010 to 2012. Results: in 2012, the participation rate of NCMS in Sangzhi County, Hunan Province had reached 98, covering the vast majority of the rural population. From 2010 to 2012, the New Rural Cooperation Fund (NRCF) in Sangzhi County, Hunan Province, continued to increase in scale of funding, and the balance rate continued to decline, which was 10.02 in 2012, with an increase in the average number of days of hospitalization. By 2012, the number of days was 10.31 days; the average number of outpatient visits was 10.31 days; the cost of hospitalization increased somewhat; the benefits of participating farmers continued to expand, and the compensation rate also increased rapidly. By 2012, the compensation rate for outpatient clinics had reached 58.17, and the compensation rate for hospitalization was 61.866.Participant farmers paid outpatient clinics on their own. The cost of hospitalization of farmers in Sanzhi County was decreased, and that of farmers in Sangzhi County was 52.The next was county hospital, about 35.The proportion of hospitalization in city and provincial hospital was 56.50.The cost of hospitalization in Sanzhi county was about 52%, and that of county hospital was about 35%, the proportion of hospitalization in city and provincial hospital was 5% and 6.5% respectively. The results of the survey on patients' satisfaction with the new rural cooperative reform in Sangzhi County showed that the overall satisfaction of patients was better. 78.45patients were selected as "very satisfied" and "more satisfied". The patients' satisfaction in "the level of doctor's diagnosis and treatment" and "the level of hygienic environment in the hospital" was 65.96% and 63.56, respectively. The patients were satisfied with the hospital as a whole. However, doctors' satisfaction with both the level of diagnosis and treatment and the state of health is relatively low. In the reply, "do you want outpatient treatment expenses to be reimbursed in full by NCMS after the patient has paid a certain amount of money?" "Yes" and "best free" account for 90.02 percent, and the vast majority of participating farmers hope that the out-patient service will also carry out compensation model reform. Conclusion 1. The reform of the new rural cooperative compensation model in Sangzhi County has increased the compensation ratio of farmers in township hospitals. The average outpatient and inpatient expenses of participating farmers have decreased. 2. The comprehensive evaluation results of compensation model by TOPSIS method and rank sum ratio method show that the reform of compensation mode is effective. Generally speaking, the cost of hospitalization of farmers in hospitals above county level is relatively high, and the burden of hospitalization is heavy.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F323.89;F842.684;R197.1

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