吴江区农村合作医疗制度研究

发布时间：2018-04-02 03:40

本文选题：农村合作医疗　切入点：农村医疗保险　出处：《西北农林科技大学》2013年硕士论文

【摘要】：中国农村合作医疗制度自20世纪50年代创建以来已有60多年的历史,经过前期的蓬勃发展,到了80年代开始衰退。2003年国务院选择在部分省的部分市(县)进行新型农村合作医疗制度的试点工作,并于2010年在全国范围内展开。新型农村合作医疗在吴江区运行期间许多问题已经显现出来,文章通过采用历史回顾和现状评价相结合法、社会学田野调查方法、定性和定量分析法对这些问题进行了研究,主要从六个方面阐述了吴江区农村合作医疗存在的问题。首先人才供给不足。其次政策制定缺乏合理性,吴江区合管办对医疗基金的管理缺乏科学的测算。再次筹资水平底,抗风险能力有限,在目前政府财力有限的情况下,只能根据筹资水平来合理确定补偿标准,补偿的总费用不能超出基金的总额。第四点是报销额度低,救助待遇差。主要体现在与城镇职工医疗保险比较后的差距。第五点是医疗机构存在的问题,主要是定点医疗机构选择面临两难,医疗机构本身也注重利益。第六点可持续问题凸显,随着筹资水平的连年提高和将特殊人群免缴个人费用纳入保障范围之内,吴江区地方政府的压力也逐年增大。通过阐述这五个问题,文章提出了完善吴江区农村合作医疗制度的建议。通过引进专项人才,同时对现有在岗人员进行专业技术培训,来加强人才队伍建设；通过将镇级基金并入区级基金,统筹运作,从而建立稳定的筹资机制；通过政务公开、实施岗位责任制考核、加强审计来加大考核监察力度；通过加快新农合与职工医疗保险并轨的速度来缩小两者的差距；通过从各方面加强定点医疗机构建设来完善吴江的定点医疗机构；通过政府、农户、合作医疗管理机构、医疗服务机构四个要素来构建完整的合作医疗支撑体系。旨在为政府决策提供一些可参考的建议。
[Abstract]:China's rural cooperative medical system has a history of more than 60 years since it was established in the 1950s. In the 1980s, the recession began. In 2003, the State Council chose to pilot the new rural cooperative medical system in some cities (counties) of some provinces. During the operation of the new rural cooperative medical system in Wu Jiang District, many problems have been revealed. The article adopts the method of historical review and current situation evaluation, and sociological field investigation method. The qualitative and quantitative analysis method has carried on the research to these questions, mainly elaborated from six aspects the existence question of Wu Jiang area rural cooperative medical system. First, the talented person supply is insufficient, secondly the policy formulation lacks the rationality, Wu Jiang's Regional Cooperative Management Office lacks scientific calculation of the management of medical funds. At the bottom of the level of refinancing, the ability to resist risks is limited. Under the current situation of limited government financial resources, compensation standards can only be reasonably determined according to the level of funding. The total cost of compensation cannot exceed the total amount of the fund. The fourth point is that the amount of reimbursement is low, and the treatment of relief is poor. It is mainly reflected in the gap after comparing with the medical insurance of urban workers. The fifth point is the problem existing in medical institutions. The main problem is that the choice of designated medical institutions is faced with a dilemma, and the medical institutions themselves also pay attention to interests. Sixth, the sustainability issue highlights, as the level of funding increases year after year and the exemption of special people from personal expenses is included in the scope of protection. Wu Jiang area local government pressure also increases year by year. Through expounding these five problems, the paper puts forward some suggestions to perfect the rural cooperative medical system in Wu Jiang district, and strengthens the construction of talent team by introducing special talents and carrying on professional technical training to the existing staff in the post at the same time; By merging the township fund into the district level fund and coordinating the operation, a stable financing mechanism is established, and the examination of post responsibility system is carried out through the opening of government affairs and the strengthening of audit to strengthen the examination and supervision. By speeding up the integration of NCMS and employee medical insurance, to narrow the gap between the two; to perfect Wu Jiang's designated medical institutions by strengthening the construction of designated medical institutions in all aspects; to improve Wu Jiang's designated medical institutions through the government, farmers, and cooperative medical management institutions. The four elements of medical service organization are to construct a complete cooperative medical care support system, which aims to provide some suggestions for government decision making.
【学位授予单位】：西北农林科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684;R197.1

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